How Daily Routine Can Help Bipolar Symptoms

A regular schedule keeps your body clock in tune, promoting mood stability. Discover how to maintain a consistent routine.

Toting my workout bag, I pass a coworker in the hallway, who remarks, “You are so good about exercising.”

I struggle to keep from voicing my instant reaction: “Fear of psychosis is a pretty good motivator!” Instead, I smile and say, “Too much sitting.”

I’m faithful to my exercise routine — 30 minutes of intense activity, six days a week — because it helps me sleep through the night and combats the tentacles of depression. For years, two other simple routines have also kept me from flirting with mania: Taking my medication by 10 p.m. and getting to bed by 10:30.

It turns out there’s a lot of science to back up the importance of regular daily habits — like adhering to a sleep schedule — when you live with bipolar disorder.

How Do Circadian Rhythms Affect Bipolar Disorder?

Speaking of sleep, you’ve probably heard the term “circadian rhythms,” which are
biological cycles that occur roughly every 24 hours. They are governed by a countless
array of individual “clock genes” throughout the body, as well as a “master clock” in the
brain called the suprachiasmatic nucleus (SCN), according to the National Institute of
General Medical Sciences.

One function of the SCN is controlling production of the hormone melatonin, which is
based on the amount of light your eyes receive. At night, your master clock alerts your
brain to make more melatonin, which is what makes you sleepy, while morning light
shuts down melatonin production so you’ll feel more alert.

Exposure to bright light early in the day contributes to better sleep by syncing the melatonin “clock.” Keeping the house dim as you approach bedtime — and avoiding use of electronic devices with “blue light” screens — allows the melatonin cycle to follow its natural pattern.

The SCN also has a direct connection to the eye’s retina and responds to light signals. People with bipolar appear especially vulnerable to such cues. For example, seasonal changes in length of day, as well as crossing time zones, count among common triggers for mood shifts.

Overall, light and dark have the biggest influence on someone’s circadian rhythm.

However, other factors can also affect it, including food intake, stress, physical activity,
one’s social environment, and temperature.

If your circadian rhythms fall out of sync on a short-term basis, you may experience drowsiness, poor coordination, and difficulty with focus and learning. But if your circadian rhythms fall out of sync longer-term, you may have an increased risk of issues like diabetes, heart and blood pressure problems, and mood disorders — which is where bipolar disorder comes into play.

In a review published in Current Opinion in Psychiatry, author Isabella Soreca, MD, of the University of Pittsburgh, Department of Medicine, stated that bipolar is a “disorder of circadian rhythms.” Those with bipolar disorder show varied body temperatures and melatonin rhythms, much day-to-day variability in activity and sleep timing, and ongoing sleep or wake cycle disturbances, including with sleep continuity.

In other words, having bipolar goes along with a tendency toward day-to-day shifts in when you get hungry, when you feel most alert, what time you go to bed, and how long you stay asleep.

The Importance of Following a Daily Routine for Mood Stability

Greg Murray, PhD, a professor at Swinburne University in Melbourne, Australia, is renowned for his research into mood disorders, circadian rhythms, and personality. “The circadian system is like the drummer in a band,” he explains. Everyone on the front line can play their solos and melodies, but if the drummer is unreliable, the front line can’t engage with the audience and be present.”

Dr. Murray uses phrases like “arrhythmic” and “prone to dysregulation” to describe the circadian system in people with bipolar.

In another colorful metaphor, he urges the need for scaffolding — in the form of daily routines — to shore up the shaky mechanism and achieve a good quality of life.

“The regularity of activity, separate of the types of activity … keeps the body clock in tune,” he says.

The power of regularity was demonstrated in a randomized control trial published in Psychology and Health. Since timed food had been shown to reset the circadian rhythm in rodents, researchers wanted to see if similar results could be found among long-haul flight cabin crew. The trial found that when long-haul cabin crew kept to regular mealtime schedules on days off, it was shown to reduce jet lag.

Brad of Los Angeles has structured his life around regular mealtimes and adheres to a strict schedule for his freelance writing.

For a long time, on Sundays, he’d write most of the posts for his blog. On weekdays, he walks five miles to the public library getting in exercise and exposure to natural light, which are both important in regulating mood — and works on his novel from noon to 5 p.m. He also sets aside time to keep up with other writers and current events.

“During the week, I try to read two hours’ worth of blogs, one hour before breakfast and one hour after dinner,” he says.

Also, through his participation in Weight Watchers, Brad has learned to plan meals in advance. He preps breakfast and lunch the night before, which makes it easier to eat at the same time every day.

Regular Habits Can Help Regulate Your Biological Clock

David J. Kupfer, MD, professor emeritus of psychiatry from the University of Pittsburgh Medical Center, agrees that following a routine, made up of regular habits, helps regulate the running of your biological clock.

“Everything we do sends messages to the brain, and every activity affects body temperature, cortisol levels, and more,” explains Dr. Kupfer.

He says that the first meal of the day, as well as the last meal of the day, are very important. “When you exercise, in terms of regularity, is vital,” he says. “You should take naps at the same time.”

In some ways, Kupfer adds, “Doing everything at the same time every day … can be just as powerful as taking medication.”

What Is Interpersonal and Social Rhythm Therapy (IPSRT) for Bipolar Disorder?

Interpersonal and Social Rhythm Therapy (IPSRT) is considered to be an adjunctive therapy for people with mood disorders and meant to boost their moods. In a controlled trial published in Annals of General Psychiatry, researchers aimed to assess the efficacy of IPSRT for bipolar disorder.

IPSRT focuses on techniques to improve medication adherence, manage stressful life events, and improve the disruptions of social and circadian rhythms. It also teaches people skills to help them better protect themselves against the development of future episodes.

Researchers found that people from the experimental group reported a large improvement in anxious depressive and manic symptoms, global functioning, and reaction to mood stabilizers. However, researchers also said that more studies are needed, with a longer follow-up period.

How to Form Habits That Stick

So, what if sticking to a routine doesn’t come naturally? That’s when realistic goal-setting comes into play.

Articulate the change you’re aiming for — such as eating a healthy dinner every evening at 6 p.m. — and then break it down into manageable steps that will move you in that direction.

Setting goals that are too hard to meet is setting yourself up for failure, explains Louisa Sylvia, PhD, a staff psychologist and associate director at Dauten Family Center for Bipolar Treatment Innovation at Massachusetts General Hospital, and author of The Wellness Workbook for Bipolar Disorder. Her major research interests are developing resiliency and wellness programs for people with mood disorders.

“A big chunk of the work we do is understanding what realistic goals to achieve are and how to reward yourself appropriately,” says Dr. Sylvia. “Learning how to reward yourself takes practice, like any other new skill.”

She recommends basing your desired changes on what you are already doing and building up routines slowly, extending bit-by-bit as each new behavior becomes more established.

“I always want people to realize they are probably doing more activity than they realize, such as changing their clothes or walking up the stairs,” Sylvia says.

Take Brad as a case in point. His structured life of today looks far different from the period following his initial bipolar diagnosis more than a decade ago.

“I kept my list really short,” he says. “I’d wake up, go to the mailbox so I got outside, took a shower, and got dressed. At the time, doing those four things would be a full day for me.”

He adds that he’s lucky he married someone who’s been a huge cheerleader for him the entire time. “He helped me establish a good schedule, especially in the beginning, and would double-check to make sure I was doing those things,” says Brad.

It’s also essential to not get discouraged by slow progress or setbacks. “Any chronic condition requires you to buy in and take ownership,” Kupfer says. “You have to be able to control your own changes in establishing routines and learn what goes well — and what doesn’t go well.”

End-of-Day Routines for Better Sleep Preparation

When it comes to regular routines, getting your “sleep-wake cycle” in order plays a huge role in wellness.

To keep your circadian rhythms in sync, the Centers for Disease Control and Prevention (CDC) suggests following certain “sleep hygiene” practices, such as getting up at the same time each day (even on weekends), making sure your bedroom is a comfortable temperature, as well as quiet, dark, and relaxing, and going outdoors in the day to get some exercise.

In addition, evening rituals for winding down train the brain to prepare for sleep. Popular methods include having a cup of non-caffeinated tea (chamomile is documented to have a sedative effect), taking a hot bath (the rise and subsequent drop in your body’s baseline temperature appear to promote sleep), and listening to calming music.

Mauricio, a tennis teacher and coach in Southern California, has a hectic schedule between his various tennis jobs. He says his daily workout, as well as end-of-day routines, keep him on track, along with a daily meditation practice.

Other strategies help him relax, too. He might stretch for 10 minutes using a foam roller or do breathing exercises to release physical tension. He might also make a to-do list for the next day on a whiteboard or piece of paper so he won’t continue to fret about everything he has to get done the next day.

“If I lie down with a tense body, if something is bothering me, I will be restless,” he explains.

Mauricio started learning about healthy behaviors and stress reduction while participating in a research program at the University of California–Los Angeles. Weekly visits with a psychologist help him maintain and build on what he learned.

“In group treatment, we talk a lot about the importance of structure and routine — it’s foundational,” Sara Lapsley says of her counseling work at the Royal’s Institute for Mental Health Research in Ottawa, Ontario. She also works with CREST.BD, a multidisciplinary collaborative network of researchers, people living with bipolar disorder, healthcare providers, and family members and supporters.

Before her own bipolar diagnosis, “routine” was not in Lapsley’s vocabulary. A former punk rocker and veteran of the Vancouver music scene, she was no stranger to chaos.

She shares her personal wellness journey with the people she counsels to emphasize how regular habits can help control mood shifts.

“Most people have had devastating episodes,” she says. “If stability can offer some protection against the reoccurrence of an episode, it’s a small price to pay. It’s more fun to live an unfettered life, but ultimately, structure and routine pay off.”

How to Overcome Obstacles to Maintaining Routines

Establishing consistent daily routines is especially challenging when your work schedule doesn’t cooperate.

“People with bipolar disorder tend to be creative and not like routines, so they can be attracted to jobs with tight deadlines, like being a musician, cook, or journalist, jobs that don’t have routines built in,” Murray says.

When Murray counsels musicians who are having trouble with their moods, he asks them, “What is it about being a musician that you value, and how do you protect that while you make some changes?”

He suggests they brainstorm ways to break down the day, such as scheduling music students and personal practice into a regular time block every morning, and setting a time in the afternoon to answer emails and arrange gigs. Additional planning can address how to handle disruptions, like late nights and time on the road.

Coping With Mood Shifts Disrupting Routines

Mood shifts present another obstacle to sticking with your routines. If motivation lags during depression, Murray recommends a two-pronged approach: cognitive and behavioral.

Cognitive strategies involve training yourself to notice critical self-talk, and other negative thoughts, and defeat them. On the behavioral side, Murray recommends sitting down with someone in your support system — a friend, therapist, or partner — to plan out, in a journal of some sort, what you will do every hour over the next week.

“The next day, you’re by yourself, you look at your schedule, and the decision has been made — there is nothing to decide,” he says. “When we’re depressed, one of the things that keeps us stuck is indecisiveness.”

The challenge with mania or hypomania is taking on too many activities. A good question to ask yourself is: “How many new plans have you got at the moment?”

Murray recommends giving permission to someone you trust to let you know when your behavior hints at an elevated mood.

Mauricio credits the awareness that comes from regular meditation with letting him know when it’s time to cut back on commitments so that he doesn’t head toward mania or depression.

“All it takes is 10 to 15 minutes to be able to sit still in a place where there is not a lot of stimuli, mind my breath, settle into where I am sitting, and let my mind go away from the rush of thoughts and into breathing,” he says.

Editorial Sources and Fact-Checking

• Circadian Rhythms. National Institute of General Medical Sciences. September 2023.
• Soreca I. Circadian Rhythms and Sleep in Bipolar Disorder: Implications for Pathophysiology and Treatment. Current Opinion in Psychiatry. November 2014.
• Ruscitto C et al. The Impact of an Implementation Intention to Improve Mealtimes and Reduce Jet Lag in Long-Haul Cabin Crew. Psychology and Health. October 14, 2016.
• Steardo L et al. Efficacy of the Interpersonal and Social Rhythm Therapy (IPSRT) in Patients With Bipolar Disorder: Results From a Real-World, Controlled Trial. Annals of General Psychiatry. March 9, 2020.
• Tips for Better Sleep. Centers for Disease Control and Prevention. September 13, 2022.

UPDATED: Printed as ‘Routine Maintenance,’ Winter 2017.