Who am I and why am I talking about bipolar disorder?
Hey, my name is Katie. I have bipolar disorder, and I like to talk about it sometimes because I think it’s kind of interesting. I also think it’s helpful for people to understand what mental illness (such as bipolar disorder) is like, so that there are fewer misunderstandings and fewer stigmas. Fewer misunderstandings and stigmas mean less fear of the unknown and more people able to get treatment in order to manage illnesses and live happy, productive lives. (Totally possible with mental illness, by the way.)
I give this statistic out a lot, mainly because it’s a good one: 1 in 4 adults experience, will experience, or have experienced mental illness in their lifetime. That’s 25% of all people that you know or will meet, and that is a lot of people! Many more than a lot of us may realize. Most of those 1 in 4 experience depression or anxiety. I’m not just talking about “depression” or “anxiety” as we all experience them. I’m talking about major depressive disorder (MDD) and generalized anxiety disorder (GAD), both serious mental health conditions that can be very difficult and debilitating. These two are the most common mental health conditions. After those main two, there are a whole variety of others, including bipolar disorder.
Statistically speaking, there are only 2-3 out of every 100 people who live with bipolar disorder (2.6% of adults in the U.S.). So bipolar disorder is much less common. Because it is not a super common experience, and because not a lot of people like to talk about it (or about mental illness in general), there are a lot of misconceptions and misunderstandings about what bipolar is and what it looks like.
Being one of that lucky 2.6% (haha), I have spent a lot of years observing my own thought and behavior patterns and learning how the illness works in my own life. And now to satisfy the curious, I have written up this post of insights into bipolar disorder. So whether you are here out of curiosity, or you want to learn more about mental illness so you can help yourself or another thrive while living a mental health condition, welcome! I hope this is informative, maybe helpful, or at least slightly (very slightly) entertaining.
She’s so bipolar.
This is a fun phrase we like to use sometimes, referring to ourselves or others. “I feel so bipolar today,” is something we might say when we are experiencing a lot of emotions or mood swings. Maybe you know someone who has been described as “bipolar” even when he or she probably wasn’t actually “diagnosably” bipolar. We call someone bipolar if they change their mind a lot based on their emotions, or if they seem to have a lot of mood swings all the time. But of course, these things don’t mean a person actually has the mental illness bipolar disorder, they are just things we describe using the colloquial term “bipolar.” Katy Perry’s song, “Hot N Cold,” is a good example of the colloquial use of the word “bipolar.” I personally don’t see anything wrong with people using the term “bipolar” this way. It’s just one of the many ways we use and mold and shape language in order to describe shared experience.
But bipolar disorder in reality is quite different than the colloquial understanding of someone being “bipolar.”
Hopefully some of what I say here will explain the specific ins and outs and provide a more nuanced understanding.
What is bipolar disorder?
So if bipolar disorder doesn’t just mean “I have a lot of mood swings,” then what is it, really?
The common conception has got one thing right:
In bipolar disorder, there are emotional ups and downs. These are called “mood episodes,” and are characterized as being either a (1) “depressive episode” (low mood), (2) a “manic or hypomanic episode” (elevated mood / high energy), or (3) a “mixed episode,” which can mean (you guessed it) a mixture of both low and high moods at one time. There are many, many variations on these three themes, but mood episodes in bipolar can be generally characterized this way.
How do bipolar mood episodes happen?
Mood episodes are different than regular emotions.
I experience regular emotions just like everyone else: happiness, sadness, anger, frustration, etc. But experiencing day to day highs and lows is not what makes me “diagnosable” with bipolar disorder. A bipolar mood episode is very different from an experience of the regular ups and downs and emotions that we humans typically experience.
I used to think that bipolar mood episodes just “came out of nowhere,” and could hit me at any moment, derailing whatever I had planned that week. While that may be true on some occasions (but is rare), after years of paying close attention to my experience, I have actually narrowed in on the biggest predictor of bipolar mood episodes. I speak just from personal experience, but this is a common for many other people who live with bipolar, from what I have learned / understand.
This main predictor holds true for me in a sweeping majority of cases.
Sleep is actually the biggest predictor of whether I will experience a mood episode.
It sounds simple, but it actually took me a lot of years and considerable grief to come to the full realization of just how intensely sleep matters for my mood.
If I don’t sleep, I enter a mood episode. (Usually hypomania, which is later followed by depression, or a “crash.”)
How much sleep do I need?
Everyone needs sleep. But for me, sleep is super-ultra-very-extremely important.
If I get 8-10 hours of sleep per night (10 being the happiest ideal – I know, I need a lot), this pretty much ensures I will be level in my moods. “Maintaining baseline” is what I call it.
If I get only 6 hours of sleep, I need to play catch up. At 6 hours, especially if that 6 hours has been interrupted at all (by a restless child, for example), I am pretty likely to develop a hypomanic episode.
What is hypomania?
I differentiate hypomania and mania according to severity. Hypomania, to me, means manageable. I can function. I can fulfill responsibilities (a little too well, sometimes – when I’m in hypomanic “superpower” mode – which can kick on and which, these days, I attempt to kick out of as quickly as possible, in order to maintain baseline). Hypomania is elevated (and usually positive) mood, confidence, energy, and restlessness.
When do I get hypomanic?
After one night of 6 hours of (especially interrupted) sleep, I get pretty much instantly hypomanic.
This is even if I’ve been consistently getting my 10 hours a night for even weeks or months previous.
Then, if after one night of 6 hours I allow myself to continue to not get a full 10 hours of sleep, the hypomania can continue and then develop into mania. As a well-educated (based on much personal experience) estimate, it takes about 2-6 days for hypomania to develop into mania. That range fluctuates based on the amount of sleep per night I get during those 2-6 days, and based on what I spend my time during those days doing.
What is mania?
To define mania over what I’ve already described as hypomania, and speaking just from my experience (and from discussions with my psychologist and psychiatrists), mania equates to = not able to function. Day to day responsibilities are not a go. I can’t function on a normal level, can’t take care of time-sensitive tasks (since I don’t have much of a concept of schedule, particularly due to distractibility), and therefore I can’t really care for my family. Mania is to be avoided at all costs. This is grounds for hospitalization. Thankfully I’ve only reached the non-functioning point a couple times in my life.
Side note: the difference between hypomania and mania
I used to think that the difference between hypomania and mania was delusion (believing things that aren’t true) and/or paranoia, and the potential for psychosis. The difference being that these things (delusion, paranoia, psychosis) occurred in mania but not hypomania. However, I have since learned from my own experience that delusion and paranoia due to a mood episode are possible in hypomania, not just mania. At one point I experienced some delusion and paranoia during a hypomanic episode in which I was totally functional and on top of life, at which point I debriefed with my psychologist (in talk therapy), and clarified that the difference between hypomania and mania is not capacity for delusion or psychosis but ability to function in day to day tasks, as I’ve described above.
Back to sleep.
As in, back to talking about it. Although if all this “sleep talk” is making you tired, feel free to go take a nap. I’ll be here when you get back.
As I was saying. If on day 1, say, I get 6 hours of sleep, I get hypomanic. Then if on days 2, 3, and 4 I let my sleep go to 2-4 hours per night (for whatever reason), I will be very likely to get manic after those 2-4 days, especially if, during the day, I spend my time getting obsessive (and spending lots of time) over any sorts of projects or ideas.
In another hypothetical scenario on day 1, say I get 6 hours of sleep, and I get hypomanic. Then if on days 2, 3 and 4 I let my sleep hover at 5-6 hours per night, I will likely be in a continuing hypomanic episode after those 2-4 days. If I’ve consistently gotten 5-6 hours over those 4 days but *have not* gotten any 8-10 hour days, the hypomania won’t get to baseline, I’ll be hypomanic. And the longer I go without a 10 hour night of sleep, the more at risk I become for developing into mania. If, in these types of cases, I don’t attempt to get more sleep through deliberate efforts, I’m more likely to get *less* sleep each progressing night as a natural result. And for me, mania is a natural consequence of a progression over the course of days (or weeks) of less and less sleep.
What happens during a hypomanic episode? Or during a manic episode? What do I do? What does it feel like?
Read on to part 2 to learn about hypomania and mania:
You are reading part 1 of this 3-part series:
I recommend reading the three posts in order (it will make the most sense), but you are, of course, free to skim and read what you like from any of the posts. I literally cannot stop you.