Look, there’s definitely some correlation between the frequency and severity of manic episodes related to environmental stimuli. In this posy I postulate some of the things I feel contribute to triggering (hypo)manic episodes and, in some instances, suggest ways to avoid them.
Sleep
Obviaas, right? This is a tricky one considering that the presentation of a BP patient’s perceived need for sleep at all is a symptom of the illness in itself. As is frequent with most (hypo)manic symptoms a BP patient usually only realizes several hours later that they’ve been playing the “Wikipedia Game” (a race to find the least number of clicks to an article about Hitler) against themselves.
The game might start with common search terms like, say, “Mandela’s Legacy” but quickly escalates to the obscure, like say, “Aerosmith’s genealogy” and after a whopping 414 clicks you land on Hitler’s entry accompanied by a the obnoxious Hadeadah squawk and it dawns on you (excuse the pun) that you’ve been awake for 16 hours.
Regardless, sleep is one of those things that us mortals need to function. This takes discipline – discipline that should be so rigid that you decline an invitation to grill Ramaphosa about bullet trains over dinner so you stick to your sleep regimen.
I know what you’re thinking: easier said than done. And I totally agree with that sentiment, but simply trying to commit to regular sleep patterns is a good start. If it means taking something to help induce sleep then so be it. Popping a Seroquel XR at 18:00 does the job for me – by 22:00 I’m ready to consider getting into bed and with a half-life (or whatever they call it these days) by 06:00 the next morning I feel fresh and ready to tackle the day.
Unless of course I forget entirely because Goebells is fascinating and I must know everything there is to know. And by forget I mean “miss just this one dose” because Goebbels.
Stress
Avoid. Avoid. Avoid. At any and all costs. Again not easily achieved for a plethora of reasons: BP folk have a penchant for excessive spending on unnecessary things that in turn leave us financially crippled and considering selling a microwave for a criminally low trade-in at Cash Converters so we can keep the lights on.
Then there’s the stress of work – we take on so many projects, some of which are totally unachievable, our commitments become overwhelming and ultimately reflect badly on our performance.
The anxiety of impending reprimands and poor performance evaluations leaves one paralyzed with anxiety (aka stress with stomach cramps and you left your Imodium in your other pants). In this economy a lack of job opportunities and high levels of unemployment must surely be a source of profound stress for many out there, many of whom have yet to be diagnosed.
The loss or poor health of a loved one is also a biggie. Not just that of a relative but also the loss of friendships and companionship after you’ve alienated everyone you hold dear and you’re left with zero support systems, muddling your way through life alone and confused.
I’ll be the first to admit that stress avoidance is a real bitch to get right, but some optimistic authors reckon it’s possible by setting boundaries, compartmentalizing and dealing with what’s important to you and the things you alone can control.
I’m not convinced but ‘that’s what they say’.
Routine
Never heard of it, don’t know what it’s about.
Apparently it’s all about having a set of activities that you perform at the same time every day or at consistent intervals. I’m sure some clever at Herbalife invented this fad. Life happens and routines are near impossible to keep in a modern society where every notification demands changing course to satisfy an immediate requirement.
Balance is important here though. We cannot be everything for all people all of the time, in fact we need to be everything for ourselves all the time – no one else has the inclination to look after you except yourself.
So, turn off e-mail synchronization on your phone, disable blue ticks so people don’t expect immediate action, stop firing up that presentation you have due for next week outside of work hours. Prioritize time for yourself.
Circadian rhythm disturbances
In my experience this is a biggie too.
International travel inevitably involves a shift in one’s dependence on a consistent time for the sun to set and rise regulating our internal ‘body clock’. Screw with that, even a little, and your body’s ability to regulate sleep-wake cycles, hormone release, eating habits and digestion, body temperature, and other important bodily functions is impaired. We don’t want that.
It’s not just travel that’ll screw this up, it’s also those borderline see through curtains you bought that exaggerate just how light it is outside.
There’s various ways to overcome circadian rhythm disturbances ranging from the sublime to the ridiculous. Probably best if you ask your travel doctor about options here, I’m far to cynical to make any assessments of the tools some people reckon work, like blue light blocking glasses and AR headsets (I mean, WTF?).
Conflict
You don’t need to fight every battle, and not every battle is your to fight.
Conflict is a definite trigger to induce manic outbursts of irrational anger, inappropriate insults that are counter productive and usually result in a BP isolation where your opinions are considered ill conceived and downright useless.
Rinse and repeat – firing off that e-mail dripping with malice and vitriol elevating our levels of stress and causing excessive, even obsessive, quests to be proven right even if it means staying up to hear the Hadeda’s sing the song of the people.
Alcohol & Substance Abuse (including Caffeine and Sugar)
I’m quite sure every reader if this blog is well aware that these are the ingredients for catastrophe. Over 60% of of people with BP suffer a comorbidity with substance abuse disorders.
In case you’re not up to speed (again, excuse the pun) street drugs and the world’s most abused substance, alcohol, interfere with the intended action of BP medication rendering them useless in some cases and in others having unintended side-effects that trigger manic episodes. Also, alcohol is a depressant and post-mania depression aggravated by alcohol is a surefire way to open the doors for self-harm.
It would be hypocritical of me to claim straight up that I’ve got a grip on my demons in this regard, I certainly don’t always have the self-control to say no to the odd beer (oh look minimizing!), but I’m working on it, and for now that’s the best I can do.
Too much of a good time
Again, I have my doubts about this one.
The literature suggests that “bright lights” can trigger manic episodes (that explains why I lose touch with reality in Dischem), and that loud music, traffic and crowds will thrust us into mania. Not sure how these can be avoided:
- I get my meds at Dischem (maybe I should consider those blockout glasses…)
- I still enjoy meeting new people I’ll never speak to again in a club,
- Traffic is what it is and,
- Dischem is always crowded.
So, whoever researched this twaddle would rather everyone with BP stay home for ever. Well, it’s a no from me.
Can you think of other triggers that induce (hypo)mania that I may have missed? I’d love to hear them so share yours in the comments so we can all look out for them.
