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Elisa Goldstein, Ph.D.Elisha Goldstein, Ph.D.
A blog about mindfulness, stress-reduction, psychotherapy and mental health.

Bipolar Disorder: 5 Steps to Sleep

Elisha Goldstein, Ph.D. Updated: Jul 20th 2009

counting sheepI'm not going to sugarcoat it, having Bipolar Disorder can be a frustrating experience as relapse into depression and/or manic is common and getting the right combination with meds isn't yet a perfect science. However, don't despair; one of the most important things to keep in mind is that you are not alone, this is treatable, and that you are an active participant in your health and well-being.

Many consider getting proper sleep the foundation of recovering from a depressed, mixed, or manic episode.

Proper sleep hygiene can give someone the clarity of mind to not buy into the negative self judgments that often spiral someone into a state of depression. It can also interrupt the beginning of a manic cycle which is often followed with little or no sleep.

 There are many theories on how to get to sleep (e.g., prayer, not eating too late, lavender oil). However, one thing that you may want to consider is that the very act of struggling with the lack of sleep or "trying" to fall asleep is increasing the aggravation and making it more difficult to sleep.  It would be better if we could take a step back in our minds and become witness to the various thoughts, feelings, and sensations that were coming and going. At the very least, we wouldn't be adding to the tension and give the body and mind a greater opportunity to fall asleep.

One way of doing this is just by bringing attention to the breath when going to bed. Here are the instructions:

  1. Bring attention to breath - Place your attention on wherever the breath is most predominant. This may be at the tip of the nose, the chest or the abdomen region. Just choose one and stick with it.

  2. Wandering mind - Your mind may be very active and that is perfectly fine, it will absolutely wander off the breath and it may do this often. As soon as you noticed the mind wander you are now present and have the choice not to engage in activity that is increasing tension in the mind and body.

  3. No expectations - Having the expectation that this will put you to sleep is a mind trap. Try and release yourself from any expectation and simply practice being with the breath and bringing the mind back when it wanders. Even if you do this all night long it is said that your body is still getting good rest.

  4. Nonjudgment - The mind is bound to come in with judgments such as "this isn't going to work," "this is stupid," or "this is the wrong thing to do." As best you can, wrap these types of thoughts up in your mind as judgments and re-label them as "thoughts," let them be, and gently redirect attention back to the breath.

  5. Dealing with Frustration - This is bound to come up as this is a new practice and the automatic judgments can be strong. When you notice frustration, see if you can label it as that, let it be and allow the breath to flow in and out of where you feel that frustration in the body. There is no need to judge, analyze or figure anything out. Just breathing into the feeling like you might with stretching, and breathing out. Letting it be.

Ofcourse, if you are currently in a manic or mixed episode and have not slept much, many Psychiatrists and medical doctors will also explore sleep medications to support you as well in order to get you back on track.

 Try this practice out and see how it works for you. Please share your thoughts and stories below. Your interactions provide a living wisdom for us all to benefit from.



Elisha Goldstein, Ph.D.

Elisha Goldstein, Ph.D. is a clinical psychologist in private practice in West Los Angeles and is author of the upcoming book The Now Effect, co-author of A Mindfulness-Based Stress Reduction Workbook, Foreword by Jon Kabat-Zinn, author of the Mindful Solutions audio series, and the Mindfulness at Work™ program currently being adopted in multiple multinational corporations.

Check out Dr. Goldstein's acclaimed CD's on Mindful Solutions for Stress, Anxiety, and Depression, Mindful Solutions for Addiction and RelapsePrevention, and Mindful Solutions for Success and Stress Reduction at Work. -- "They are so relevant, I have marked them as one of my favorites on a handout I give to all new clients" ~ Psychiatrist.

If you're wanting to integrate more mindfulness into your daily life, sign up for his Mindful Living Twitter Feed. Dr. Goldstein is also available for private psychotherapy.

Reader Comments
Discuss this issue below or in our forums.

Overactive mind - Janis - Mar 13th 2011

I am a 60yo who was diagnosed as a manic-depressive and later with Bipolar and have been on Lamotrogine 150mg for the last 10yrs & Imovane 12mg as a sedative. Sleep has always been difficult & dreaming exhausting. I have used the technique of mentaly focusing on each word of The Serenity Prayer. G-d (what ever you perceive to be, Higher Power, Mother Earth, Supreme Being) grant me (endow, give, bless, present, make me aware) the serenity (peace, comfort, warmth, love,) to accept (understand, be grateful for, receive, open to opportunities) the things I cannot change (who I am, where I come from, where I am at, what I have done, the past!)..etc

This meditation may take me through the whole of the prayer.."the wisdom to know the difference" .. but more often than not.. I am able to fall asleep - It does not happen each night, but most yes.. I will try your 5 steps to sleep on nights that it does not... 

Sleepimng and Bio polar - Jason - Sep 11th 2009

Thank you for the article. My girlfriend is bio polar so is my mother, and I've studied this disorder so that I can better understand them and try to know what they are experiencing. Both are on lithuim and anti depressants, and are doing very well, but Ive realised that when there is a bit of stress involved either work, or sport, they tend to struggle to sleep, and they get quickly aggetiated. I've accepted it and try to neutral it out by not getting to involved with arguments and so forth, but cant find away to help her to fall a sleep. Its happen before and as soon as she gets her sleep, she is the most wonderfull person ever. She struggles to switch of her mind at night, what can I do to focus her attention away from all the ideas and rather to something more relaxing. Please help

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