Potential bi-polar/hypomanic disorder

[cacophonaut]

I'd like to get the opinion of bluelighters on something. First, let me explain my situation. I'm a 22 year old guy, and for as long as I can remember, I've had trouble sleeping. It has never risen to the level of serious, consistent insomnia, but I seem to experience intermittent bouts of insane sleeplessness. I sit up at night incessantly reading, writing, making music, watching films and thinking...but mainly thinking. Its like my mind refuses to shut up: thoughts race, I cant sit still, I hold two hour long inner monologues that drift from topic to topic, and ideas die and are born like fireworks in my head. The experience is quite exhilarating and enjoyable, but it means I find it almost impossible to keep regular hours, which is a major issue for me. As a child, I used to believe my sleeplessness was due to this constant mental chatter, but later I decided it must be something more bio-rhythmic; something amiss with my circadian cycle or the regulation of a crucial neurotransmitter. Now I'm not so sure.

I had a conversation about these things with a postgraduate psychology student friend of mine, and she suggested my state sounds a lot like a form of bi-polar disorder called hypomania. So I looked it up in the DSM (diagnostic and statistical manual for mental disorders), and according to its diagnostic guide I possess all the seven listed symptoms to some degree: increased self-esteem or grandiosity, decreased need to sleep, more talkative than usual or pressure to keep talking, flight of ideas or subjective experience that thoughts are racing, distractability, increase in goal-motivated activity or psychomotor agitation, and excessive involvement in activities that have a high potential for painful consequences (I'm pretty sure my drug use qualifies for that one).


I'm planning to see my doctor as soon as I can. I'm well aware of the shaky nature of amateur self-diagnosis, and the potential for the mind, when it sees a list of symptoms, to actively seek instances of them in its memory and then jump to the conclusion that it has an illness. The thing is, I wouldn't be all that bothered by a positive diagnosis. What I'm interested in is possible courses of therapy which might successfully treat my main problem, which is sleep. So far everything I have tried has failed to help with this, and a new understanding of the root of my problem might shed some light on its possible remedies that may have been ignored before.

I'm also concerned for the implications of a diagnosis on my use of substances. I could live without the more pleasure-orientated drugs, but never being able to do psychedelics again would be devastating. I don't want to lose out on all the insights I have yet to gleam from their altered-states

So I would like to know if anyone has experienced this disorder themselves or know someone who has, and what advice they might have for me.

 

[blahman8000]

Hypomania isn't a disorder, it's a state of mind that can be secondary to a disorder on the bipolar spectrum. You might be suffering from cyclothymia, or cyclic mood disorder, which is kind of like a mild version of bipolar. The episodes aren't as long or extreme. There are periods of deep depression and at other times hypomania, but not as extreme as with bipolar I. I've actually been diagnosed with cyclic mood disorder, and can relate to a lot of the symptoms you've listed (the excessive talking and pressure to keep talking definitely stood out for me last night in a conversation, for instance), although I sometimes question my diagnosis. I don't take any medication or see any professional for it.

If you're concerned about this, there is certainly help out there for these symptoms. Do you have periods of depression too, that alternate with the hypomania? Any mood swings? Have you been diagnosed with ADHD or suspect that you might have it?

 

[cacophonaut]

I don't have any periods of depression that are noticeably outside the spectrum of the normal human emotional rollercoaster; as with anyone, I have days when I feel a little glum, but nothing you could realistically call depression. I do however have mood swings. I can switch from lighthearted and laughing to irrationally irritated at the slightest thing, leaving me feeling pissy and uncommunicative toward others, in a pretty extreme way. I get to a point when I almost relish the righteous indignation of an row.

I don't know if I have ADHD, but I was one of those children deemed "hyperactive" by parents and teachers. To be totally honest, most of the symptoms I listed are facets of my life that I enjoy, and even rely on. As a musician, most of my best ideas arrive after a few days of little sleep and intense mental activity, and I cant say I don't enjoy the quasi-high I experience during one of my insomniac bouts. My only problem is the sleep I lack: it catches up with you big time and you end up feeling vacant and lethargic for a while. My problem is I have no control over these episodes. They arrive according to some internal schematic that I am not privy to, and I would like to develop some ways for dealing with them when they kick in at inopportune moments. I would be more interested in the value of psychotherapy than psychopharmacology in this sense.

 

[blahman8000]

Again, I can definitely relate. I'm also a musician and a lot of my best music was written when my mind was kind of in overdrive, and often when I lacked sleep. I feel more capable of diving into it and letting ideas come and go rapidly. And there are options to treat the lack of sleep, because that definitely is something you need to address. I've had a LOT of sleepless nights in my life, not necessarily because of full-blown insomnia but because my mind is wide awake even when my body wants to shut down. Many nights I've simply WANTED to stay up regardless of how tired I was, because I was in a more inspired and/or high strung state of mind. But after starting to sleep regularly, 8 hours a night, I've begun to really appreciate how important it is. You should definitely organize a healthy sleeping pattern around your goals or else eventually you won't be able to accomplish very much and you won't even feel like yourself sometimes.

The mood swings can definitely be a problem. I have the same experiences very often and it can get pretty intense. The outcome isn't always good. Again, there are medications out there that can address these kinds of things (if a doctor deems it necessary), but if you're adverse to that option, then I guess it's a matter of increasing self-awareness and self-control. Keeping things regulated. Learning to relax when you know you have to. That can definitely be accomplished with the help of therapy. You should definitely consider finding a therapist who can help you organize this energy in a healthy way. A doctor might suggest pharmaceutical solutions, though, such as medication for ADHD or even mood stabilizers. Hypomania is often tied in with ADHD, as are disorders on the bipolar spectrum.

 

[34-dihydroxyphen]

Wait, so is sleep your number one problem and are you guessing that it is due to hypomania?

Describe your sleep patterns a little bit. Do you just happen to stay up late at night too often, at the expense of sleep you need to carry out responsibilities the next day? If so, how frequently do you stay up at night? And if you were free from morning obligations, would your sleep still trouble you, or is it only problematic in relation to daytime obligations? When you do sleep, do you sleep well?

Or do you have a problem keeping any sleep schedule at all? Are you just as likely to wake up at 6:00 AM as you are to wake up at 6:00 PM, depending on where your schedule is on a certain day?

There isn't really enough information about your sleep for me to comment, but hypomania is relatively common, and being a night-owl is perfectly normal for a 22 year old. In fact, if you are a night-owl who is forced to live most of their life in the daytime, what most people would consider a normal amount of wakefulness may feel like hypomania to you, as you are not used to feeling awake in the daytime, due to your circadian rhythm telling you that you should be asleep or winding down at "normal" hours of the day and telling you that you should be awake and in your peak at the wee-hours of the night. Of course, if it truly effects your ability to function you may be developing a circadian rhythm disorder (I suffer from a non-24 hour sleep wake cycle disorder, it's completely debilitating), but also keep in mind that most young adults have a Delayed Sleep Phase for a time.

And even if you maintain a Delayed Sleep Phase past your early adult-hood, it is fairly easy to cope with. Melatonin and light therapy can be very effective, but do not touch them without first consulting a sleep specialist (and by specialist I mean specialist, not your average doctor claiming he knows how to help you out, as misusing these powerful techniques can do more harm than good, and most doctors who do not specialize in sleep issues will at the very least give you a bad time to take your melatonin, which can cause problems for those with fragile sleep).

 

[cacophonaut]

I have made many unsuccessful attempts at establishing some kind of regular sleeping pattern, but it seems my body has a mind of it's own, as it were. If I were to lie down in the dark and try to make it sleep before it was ready to, all that generally results is a heap of sleep-related anxiety. I end up stressing because I have to get up soon and the stress only heightens the insomniac state. On top of that, as a teenager I was often called lazy because I would try to catch up on the sleep I missed during the week by sleeping all weekend, instead of going out and getting a job, as I was exhorted to do by my parents. I still have a weird guilt-complex related to this, and any failing attempts at sleep seem to switch it on, which intensifies the anxiety. So I end up in a bit of a vicious circle: I cant sleep, so I worry about not sleeping, which in turn keeps me up even more, which worries me even more, etc. As of this moment I haven't slept more than three hours since thursday night, and by my clock it is currently 6am sunday morning. That's over fifty hours.

I'm not a big fan of pharmaceuticals unless absolutely necessary (i.e. for pain) or short-term. I think the mood swings could definitely be handled with more down-to-earth practices. I have taken up zazen, the Zen meditation style, as a regular activity, and though I haven't been doing it long it seems to have a calming and clarifying effect that continues even after I have finished sitting. I also think it might be an idea to vent some of the negative drive into a productive activity like a martial art, but alas, that is something I have been considering for a long time and never gotten round to.


One thing that frustrates me is the nature of work: there is little room for someone who, by no fault of their own, finds a normal routine difficult. I often wonder if my state, be it hypomanic or not, is not an abnormal mode of existence but a perfectly valid one, and it is the world which is abnormal and warped. Psychiatry is a good example of this. We call a person abnormal if they cannot follow the accepted norms of human behavior, and medicate them accordingly, but in truth what is considered "abnormal behavior" changes from epoch to epoch depending on the values of the society, so surely it is the world which is not accommodating enough to allow these people a place in it, rather than the people that are too odd to find a place?

See, this is the kind of mad, rambling shit I end up talking about when I'm in this mood. I could fill pages.

 

[cacophonaut]

Wait, so is sleep your number one problem and are you guessing that it is due to hypomania?

Describe your sleep patterns a little bit. Do you just happen to stay up late at night too often, at the expense of sleep you need to carry out responsibilities the next day? If so, how frequently do you stay up at night? And if you were free from morning obligations, would your sleep still trouble you, or is it only problematic in relation to daytime obligations? When you do sleep, do you sleep well?

Or do you have a problem keeping any sleep schedule at all? Are you just as likely to wake up at 6:00 AM as you are to wake up at 6:00 PM, depending on where your schedule is on a certain day?

There isn't really enough information about your sleep for me to comment, but hypomania is relatively common, and being a night-owl is perfectly normal for a 22 year old. In fact, if you are a night-owl who is forced to live most of their life in the daytime, what most people would consider a normal amount of wakefulness may feel like hypomania to you, as you are not used to feeling awake in the daytime, due to your circadian rhythm telling you that you should be asleep or winding down at "normal" hours of the day and telling you that you should be awake and in your peak at the wee-hours of the night. Of course, if it truly effects your ability to function you may be developing a circadian rhythm disorder (I suffer from a non-24 hour sleep wake cycle disorder, it's completely debilitating), but also keep in mind that most young adults have a Delayed Sleep Phase for a time.

And even if you maintain a Delayed Sleep Phase past your early adult-hood, it is fairly easy to cope with. Melatonin and light therapy can be very effective, but do not touch them without first consulting a sleep specialist (and by specialist I mean specialist, not your average doctor claiming he knows how to help you out, as misusing these powerful techniques can do more harm than good, and most doctors who do not specialize in sleep issues will at the very least give you a bad time to take your melatonin, which can cause problems for those with fragile sleep).

Sleep has been the problem since as far back as I can remember, which is what leads me to suspect it is not some passing young-adult thing, but something more underlying. Remember, though sleep is my main problem, it is only so because people expect me to have a normal sleeping pattern. The other symptoms are still present, they simply don't cause me any issues in my day to day life.

If I were to draw up a calendar with each hour of each day in segments, and highlight the hours in which I slept, there would be no discernible pattern, neither in time of day nor duration. As an example, I could maybe sleep two hours one night, then stay up for two full days, then sleep right through a day, wake up at night, go back to sleep for a few hours, then wake up at first light, be up all day, sleep at night, etc. On a really bad week, I can go days without sleeping at all, and these tend to appear sporadically, punctuated by periods of almost-but-not-quite normal sleeping patterns like going to bed at 2am and waking up at 6 for work. Its so bad sometimes I would consider it a normal sleep if it only happened at night, regardless of how long it was or when.

 

[34-dihydroxyphen]

Sleep has been the problem since as far back as I can remember, which is what leads me to suspect it is not some passing young-adult thing, but something more underlying. Remember, though sleep is my main problem, it is only so because people expect me to have a normal sleeping pattern. The other symptoms are still present, they simply don't cause me any issues in my day to day life.

If I were to draw up a calendar with each hour of each day in segments, and highlight the hours in which I slept, there would be no discernible pattern, neither in time of day nor duration. As an example, I could maybe sleep two hours one night, then stay up for two full days, then sleep right through a day, wake up at night, go back to sleep for a few hours, then wake up at first light, be up all day, sleep at night, etc. On a really bad week, I can go days without sleeping at all, and these tend to appear sporadically, punctuated by periods of almost-but-not-quite normal sleeping patterns like going to bed at 2am and waking up at 6 for work. Its so bad sometimes I would consider it a normal sleep if it only happened at night, regardless of how long it was or when.

Ok, I hear you there. Likely it is some type of circadian disorder. If you are insured, I would recommend visiting sleep clinics. It's hard to find the right one because most sleep specialists are prepared to deal with sleep apnea(what most people go to sleep clinics for) and don't really give a shit about the patients with rare sleeping disorders. Sleep apnea is where the money is for them, and many cannot be bothered being passionate about their work and caring to look a little bit deeper with patients like me and you who have disorders that require a more individual approach, as opposed to the one size basically fits all disorders. You will know when you find the right doctor. A sleep specialist either takes an interest in the rarer disorders or he doesn't, so in my case I either run into dismissal or a genuine interest in understanding how these very rare disorders work. There is very little in the way of research for circadian disorders other than Delayed Sleep Phase, so a doctor has a lot of room to experiment if the standard melatonin + light box therapy is ineffective.

But yeah, I've been out of commission from the world for four years now, except for an optional part-time job I go to when my schedule finds itself in the day-time shift, but I really want to finish college and have a life. These disorders effect every aspect of functioning, and the worst part was getting friends and family to accept that it is a disorder, and I didn't choose this crazy shit, as to a casual observer people who suffer from circadian rhythm disorders appear lazy. It's hard to get people to understand that waking up at 9:00 AM on a consistent basis for me would be equivalent to them attempting to wake up at 3:00 AM on a semi-consistent basis, and as soon as they adjust to a 3:00 AM schedule they have to start waking up at Midnight, then 9:00 PM, etc... (if anybody can understand what I'm talking about, it means that no matter what, in order to wake up and go to work/school every day I have to be tired to the point of narcolepsy). My clock basically wants to wake up two hours later each day, and even if I force myself to wake up in order to stick to my responsibilities, there will one day come a night where I stay up a full 24+ hours as though my internal clock is moving independent of any external actions I take. Eventually, no matter how hard I try or how committed I am, my schedule has to shift.

I have to say though, your schedule appears even more chaotic than mine if I understand it correctly. I would venture a strong guess that a lot of this hypomania is due to the fact that you are tired, but your internal clock is telling you it isn't time to sleep, so your system compensates by releasing heavy amounts of stimulating neurotransmitters at inappropriate times and possibly in unique combinations because something is preventing you from absorbing the natural stimuli Earth provides (sunlight and darkness) to keep us on a 24 hour sleep-wake cycle. You should begin producing melatonin roughly 5 hours before bedtime (basically as it gets dark outside) and sunlight should tell your system that it is time to wake up.

If for some reason you are not receiving these natural cues, your entire system is going to go out of whack and you will experience strange periods of low energy when you should be high on energy and extremely high energy when you should be low on energy and sleeping. Alternatively, extreme stress will cause you to release high levels of cortisone which will prevent you from sleeping normally, and it is always possible that an extended episode of high stress combined with a fragile internal clock (some people are more stable than others in this regard) can lead to long-term issues, as once the pattern has been disrupted to the point where your internal mechanisms lose all sense of what it was like to be normal, there is no going back again without some type of treatment. This is basically theory B but if you can think of any particularly stressful events that correlate to your schedule becoming unmanageable it would be a plus.

If an extended period of free-time is possible, it would be good to spend a month or two with no responsibility in order to see how your sleeping patterns behave when you do not have to force yourself to wake up. It will give you a better idea of how your internal clock wants to behave (how long your sleep-wake cycle is, how long you sleep when you don't have to play catch-up, is there a particular time that you happen to wake and sleep at, etc..), and how much of your circadian chaos is a direct result of physiological/internal factors versus external/environmental factors. Waking up everyday before your body is ready is sort of like going through perpetual jet-lag, which makes your schedule more chaotic than it would otherwise be, and obfuscates the true nature of your disruptions.

 

[BeachDude82]

One thing i have found that tends to help if you have 'racing thoughts' that won't stop especially when trying to go to sleep is GABA. It promotes mental relaxation and reduces racing thoughts substantially. Just don't take more than the recommended dosage. Too much can cause you to have shortness of breath for about 20 min after it kicks in which can scare you a bit. Happened to me twice when i took a powdered form and must not have leveled off the scoop.

Cyclothymia is also something to look into. Also, see if you're mood swings correspond to the full moon. I know that sounds odd, but my wife tracked my behavior for 3 years without telling me and most every time i would have an irritable mood swing it would correspond to the full moon. However, it started around the time we started a business together and that has been a major rollercoaster ride if i have ever seen one. Hope this helps!

 

[SmokingAces]

I'm diagnosed bipolar but without the depression it would just be hypomania or something. Bipolar is cycles of manic thinking your some sort of superior being and precision thinking coupled with periods of crippling depression and anxiety.