My dr's rule is 2 days with no sleep, 3 days with minimal sleep I am to call in and need some type of treatment. This seems to help prevent things from getting too far out of control as long as I manage to have the insight to follow the rule. The last year or so I've had a PRN specifically for insomnia so I haven't had to call in and it's worked out fairly well; I still didn't sleep when manic and still have been through a really ugly time but I was at least sedated into some rest and a few hours of sleep during the worst of that symptom.

I wouldn't go much longer without getting rest without getting help. It's reason enough to go to an ER.