I have to have sleep. I wrote about my 4 days of non-sleep last week and it was making everything worse! I now know it can be a trigger for a manic episode but mine was self induced by the pdoc since she wanted me off all the Benadryl. I had to go back to it this weekend. It was worse for me not to sleep than to take it. If it's not something you have personally changed, then definitely keep an eye on it.