Bipolar kid with major sleep issues

Hi guys,
My daughter (who is 14) was finally properly and fully diagnosed and is on the path to recovery! Yay!
That said, we are still dealing with MAJOR sleep issues, as we always have. Today is a great example. It's noon right now. I just woke her up. I let her sleep a little while because I know she didn't fall asleep until about 8am. Should I try to keep her up? That always seems to fail (as in I CANNOT keep her awake - even outside), or just backfire (she ends up STILL not sleeping that night, like last night). I will be gone for a couple of hours today, and I'm sure she will end up sleeping then. I've been trying to help her get her sleep schedule sorted out for her entire life... everything we do is on a schedule, really. There is structure, even though she is in online school. I'm tempted to try to keep her up long enough to get a couple of things done with her and then just let her sleep... I will be leaving in about an hour, and I know that's what she'll do while I'm gone anyway. We do her schoolwork between 9am-2pm. I leave for work at 1:30pm. She has a strong tendency to sleep while I'm at work, and then I come home and she is alert and often manic (many times, she's only sleeping half of my shift). She has become easier to wake since going in depakote, which is major progress for her. She still sleeps through alarms, though.
Any tips on flipping her schedule? Or obtaining one? She's got a WISE team I'm about to give keys to because she doesn't wake up to the doorbell, even with our gigantic dog barking at it (I have this same tendency - we do both wake up to imminent danger, just not normal things).

Hmm... is it possible that your teen is in denial about having bipolar?

I know I have teens (I'm a step parent), and they will have varied sleep schedules. They don't have bipolar but we expect them to say lights out at about 10-10:30pm.

Maybe your teen is in denial and hasn't been educated about the importance of regular sleep schedule? Just an idea. I don't mean to offend.

Oh, no. She is well aware. WISE team, me, her and PCP all agreed this was incredibly likely before I found her psych doc. When I took her in, I had her explain the symptoms she had, filled in the blanks she couldn't remember, have family history, and psych said yep. Bipolar 1, psychotic features. She knows what time she's SUPPOSED to sleep. Like I said, we have always had a schedule. Last night (and MANY nights before), she tossed and turned all night long. No lights, no sounds, no screens. Eventually, I told her to get up and do something for a few minutes because she'd reached the point where she was frustrated and it was not productive or conducive to sleep. This is not at all uncommon for her. She has no control over when she sleeps, and never has. Really, I don't either without medication. That was 90% of the determining factor in my own dx as I did not know family history ran so deep yet (at least every woman - 3 generations before her, possibly one man). She knows all about this... we've been battling it since she was born. She was 7 when SI & psychosis appeared.

I'm sorry to hear that. That's awful.

Thankfully, she is slowly getting better... finally. I called her therapist today and was surprised to find her on duty. She told me to keep her awake & somewhat productive until at least 8pm (her normal bedtime is supposed to be around midnight and one am, yes, I know, a bit weird, but I'm a swing shift worker and she's in online school with classes starting at 9am at the earliest and has always been nocturnal. She really has a hard time with that one 9am class (which is only one day a week) no matter what we do, really. The rest are later in the day). Anyway, it's now 9pm and she's sleeping so far. I hope she gets some rest. She often wakes up between midnight and 2am when she falls asleep this early and is unable to go back to sleep, just like me.
She plans to be a programmer or game designer and will be going for a BS in computer science. Fortunately, her field has the flexibility of swing & graveyard shifts and online classes available for college if necessary.

Well, so far it is 2:45am and *she* is still asleep, which I think is good news (obviously I am not asleep... this is why I won't work days ever - I fall asleep early and my body decides it must've been a nap, that lasts for several days or weeks, I go manic, then crash and oversleep... I had 5 day shifts scheduled at work once at made it to 4. Then a work training that was 5 days. Made it to 4. Mind you, I told them all about this in my interview and they said they'd work around it).
Anyway, this thread isn't about me...
She's sleeping, but it doesn't seem she's sleeping too well. There are no lights on, no sounds (other than house settling and a fan that's always on), even the animals are quiet. Yet she's still all wiggly in her sleep.
I spoke too soon. There goes a cat doing something... yesterday, her therapist and I were trying to come up with a theory about the best time to try to wake her from a nap (for "normal" people, there are specific times, for example, at the time, she was at 90 minutes), but based in the way she sleeps, we had no idea. There is no sleep research center here that looks for anything besides apnea (she has very mild apnea, below levels even necessary to treat it).

She just woke up. She said, "it's too early". I said yes, honey, it is. She asked if she could go back to sleep, and I said of course. Then she kept talking about random stuff. We'll see...

And... no surprise, she's still awake. Like mother, like daughter. The whole house has been quiet and dark, no screens (for her) and she's struggling to go back to sleep and can't. That makes what? 6hrs sleep? Pretty good for her, really...

Sleep is so vital for the brain. I understand waking up in the middle of the night. I do that 2-3 times a night. I'm trying to get better at not doing it. Getting on a regular healthy sleep schedule is important. Here's hoping for ya.

I can ONLY sleep with medication. Is she not on anything? And you said you are, correct?

I'm rather concerned about your use of the word 'recovery'. One doesn't recover from bipolar - they manage it.

I'm sorry you are frustrated but this is frankly a reality of the illness. Some medications can contribute to this as well. The first thing is to monitor this; even documenting it is a good idea. And of course communicate this with the primary mental healthcare provider.

Remember too that medications take on average 6-10 weeks to take effect with some well longer than that. Does your daughter take PRNs (that means 'take as needed' medications). I have some for anxiety which I take only if I really need to as they tend to be sedating.

The reality of the situation is that stable medicated bipolar individuals will sleep a lot. I myself sleep about 10hrs at night with at least one 2hr nap during the day. During the height of winter it is worse than that.

I know of several of my bipolar acquaintances that have circadian rythym problems too. One thing they say that helps is the use of a light therapy lamp. This requires 10-15 minutes per day. You don't actually look into them rather set them up alongside your regular activity (ie. computer, reading). Again, talk to the psychiatrist and they might agree this is worth a try.

Good luck.

justafriend, I've got to say - what a thorough, thoughtful post. I learned from that too. Excellent advice.

No, she isn't. Her psych doc is considering it in the future, but working on just the mood stabilizer for now (next will be AP). Yes, I take one most nights.

I work in mental health actually, in a trauma informed recovery center. That is where that language is coming from - it's drilled into me. I'm well aware that it's a lifelong illness. She did get it from me, after all.

I'm actually very happy about her progress. Suddenly, I'm able to wake her up in a reasonable amount of time. It used to take 3+ hours. It was terrible, and she suffered horribly. I'm happy to see her not suffer so much - FINALLY.

We actually have used sun lamps in our entire house for years... it's part of our sleep hygiene process (including a light box alarm clock and weighted blanket). We live in the north. Every bulb in our house is a sun bulb. My mother put them in to combat depression, we kept them to help regulate our sleep cycles (it doesn't work on its own).

Another thing to add about my use of the word "recovery"... she has been struggling with psychosis daily through all of this. That is the biggest symptom we want to see end. We know it starts with sleep. Due to family and health history, she's not a good candidate for seroquel, and risperidone has adverse effects on her. Both of those would of course be first line treatment otherwise. I asked about ziprasidone (works well in me), but her psych doc thinks it is probably not strong enough for how bad her symptoms are, and is considering more like zyprexa (I don't remember all the generic names).

Update on her journey:
She recently told me she's been lying about taking her morning dose because it gives her the dreaded brain fog, so I immediately notified her pdoc. Hopefully, shell have a good solution. I had a pt & friend with similar symptoms to hers who is on zyprexa only and is doing great. Maybe that could work for her? Whatever works... as long as she's safe, happy, and able, I'm fine.

I'm very glad you found out. It's great that she trusts you. Hopefully now you can find a solution.

It took a lot of work on the part of me and her therapist to get it out of her... I just knew there was a 14 pill discrepancy, so obviously something was wrong. I wish she'd open up a little more. I hope this therapist sticks around longer. Every time she loses one, it's like starting all over again. Plus, I've learned a lot of techniques I use both with my daughter and pts. from her.

So happy you have been able to zero in on the medication issue.

Your point of view, as a mental healthcare worker, was very insightful. I valued your point of view and look forward to seeing your continued participation. You taught me something. Thank you.

I agree with justafriend306. I think it's so cool to hear your perspective as a psych worker along with your own experience! If I knew you in person, I'd love to hear more.