And here comes yet another method of coping with bipolar disorder. Sometimes it feels like there’s no end in of it. No end in terms of how we can help ourselves, and no end to our personal growth. I’d put it this way: it’s a steep, massive mountain with no visible summit, but the view just keeps getting better while we climb.
In this post, I’ll focus on introducing routines into daily life and their beneficial impact on people living with bipolar disorder (BD).
Interpersonal and Social Rhythm Therapy
IPSRT (Interpersonal and Social Rhythm Therapy) is a therapeutic method dedicated to individuals with bipolar disorder. It focuses on increasing awareness, understanding the illness, supporting pharmacological treatment adherence, and—most importantly—introducing daily routines aimed at improving quality of life and achieving remission. The therapy is based on the assumption that vulnerability to manic/depressive episodes is genetically linked to sensitivity to disruptions in circadian rhythms and a heightened susceptibility to neurotransmitter system imbalances. Hence, introducing routine helps stabilize the system, as studies have shown [1].
Additionally, maintaining a daily routine and observing its effects gives patients a sense of control over the illness, motivating them further, as they feel it’s not just about taking medications. Routine also clearly improves the quality of life for those with BD—and the benefits extend to other groups as well, like the elderly.
The Power of Routine
At first, I thought routine would help me catch subtle changes in mood—if I do the same thing at the same time every day, it’s easier to spot a shift. And that’s true. But it turned out that routine is even more powerful than that. Since we perform the same activities regardless of our mood, they bring us back to balance. In other words, they anchor us, form a base, and restore equilibrium.
It’s not entirely clear how this happens. Take my own example. I dedicate up to an hour a day to physical activity. On off days or after a sleepless night, I’ll at least go for a walk. Walking makes me feel better physically – I feel the blood flow. Especially in the forest, it calms me down. Recently, I was feeling really low and couldn’t find anything to boost my mood. But I kept my routine and went for that walk. It brought me back to default settings. I returned home feeling slightly better and satisfied that I fulfilled the routine. This applies to every habitual task—even brushing your teeth. My morning routine, ending with a five-minute meditation, really wakes me up, no matter if I’m anxious, sad, or agitated.
Routine in Treating Depression
The book The Mindful Way Workbook [2], which I mentioned in another post, also emphasizes the importance of daily routines. It offers a system for recognizing mood decline and managing it through routine tasks. It distinguishes between two types of daily activities: those we enjoy and those we are skilled at (which give us satisfaction). It sounds simple, but without a structured set of routine tasks, motivation can be hard to maintain.
Pleasure that requires little effort could mean a bath (it is a part of the daily routine) or yoga—not buying something, eating chocolate, or drinking beer. An activity we’re skilled at might be cleaning or cooking. We know how to do it, it’s not hard, maybe not fun, but completing it gives us a sense of satisfaction and brings us closer to balance. This mainly applies to depressive states, but these same tasks can help calm us or ground us when we’re overstimulated (in hypomania).
Well-Being
Research on improving the lives of people with bipolar disorder highlights four key factors [3]: a regular daily rhythm and meaningful activities, overcoming stigma through social connection, reclaiming a positive identity—especially through work and better understanding of the illness to support self-management.
Here, we focus mainly on the first aspect. The research emphasizes the importance of a fixed daily schedule—especially concerning meals, taking medication, and sleep. It also suggests that having a job is a good motivator for patients.
From a mindfulness perspective, I don’t fully agree with that last part. If someone replaces a job with another routine, it can work just as well. Thinking that job is the only path to meaning or purpose in life may feel like a trap for some people. The article, based on interviews, suggests that constantly staying busy to avoid thoughts is a good thing. I disagree again. Mindfulness teaches us something else entirely: how much we can discover by simply doing nothing, and how comfortable we can become with ourselves through awareness practice (like meditation or mindful everyday tasks).
Routine also creates a sense of safety, stability, and certainty—something people with BD frequently emphasize. They say they can manage and ease their symptoms better through regular practices like meditation, yoga, walking, or cycling.
An examplary Daily Routine
As with everything, building a routine should happen gradually. Too many expectations at once (a rigid, packed schedule) can quickly kill motivation. Your routine must suit your unique needs and our body—and that’s something you learn over time. It’s important to match expectations to what’s realistically doable, not what we imagine is ideal. Every day is a new beginning. Falling out of routine due to travel, a bad mood, or illness should not mean we abandon our routine but that we keep working on it.
People on medication often struggle with getting up. A morning routine—a sequence of actions—can help. An example could be: meds → coffee and relax → refresh → tidy up → meditate. It’s helpful if your routine includes something you look forward to, even the night before—it makes waking up easier. Once the sequence is complete, you feel awake and ready for the day. Similarly, an evening routine helps wind us down, for example: bath → yoga → meditation → reading.
I’ve noticed I’m more easily thrown off balance without my morning and evening routines. Sometimes, news or emotional events would disrupt the peace I’d built. But starting over with the routine helps bring me back to abalanced state.
You can begin by building a short morning and evening routine, and then add things like regular meals and daily physical activity. Weekly recurring tasks like shopping or cleaning can follow.
A clean, simple app called “Structured” can help. You can enter specific tasks, set their durations, and arrange them throughout your day, with colorful icons and a timeline. A nice touch is being able to check off completed tasks. And it’s free.
Is Routine Boring?
You could say that doing the same things over and over makes life dull. People with BD often crave change. In hypomanic and manic states, our neurotransmitters thrive on novelty. But is that really good for us? That’s something to consider while euthymic. Changes can overstimulate us and make things worse.
Over time, you can learn to maintain a routine while occasionally mixing in events like travel or late nights out, without disrupting the whole routine. You can adopt a minimalist version of your routine—for example, while traveling: take your meds, brush your teeth, wash your face, and get dressed—in the same order. Before a night out, you could do part of your evening routine (e.g., bath, yoga, meditation). Big life changes like pregnancy, changing a job, or hospitalization can be supported with smaller, adjustable routines that don’t overwhelm you.
Personally, I don’t feel bored with my routines anymore, because the activities I choose are interesting, slightly stimulating, and enjoyable. Like trail running—you can change the route, intensity, or type of workout. While playing the piano, each time I can learn something new or improve a piece. And meditation often considered passive—is actually one of the most intense experiences – thoughts race, emotions rise, tears or profound joy and peace.
Sleep Inertia
A scientific article on sleep inertia in people with bipolar disorder [4] identifies it as a comorbidity. Sleep inertia means lingering grogginess and disorientation for hours after waking. One strategy for managing it is the “RISE-UP” routine, which involves: resisting the snooze button, increasing physical activity (light stretching/exercise), splashing cold water on the body or face, exposure to sunlight, listening to upbeat music and performing a simple task.
It’s a bit demanding. Personally, I don’t think I could follow such a strict routine daily—it feels like military training. But it’s generally known that skipping snoozing and getting some light movement in the morning does help.
For people with BD, this routine might be too intense. Easy to suggest, hard to do. So I encourage more compassion to ourselves and customization to own needs. If giving up snoozing feels like having the covers ripped off you and is deeply uncomfortable, allow yourself to keep it. Try shortening it, or limit to three snoozes instead of ten. If cold water feels like punishment, skip it. Take a warm shower and do light stretching instead.
I once tried placing my alarm in the shower to force myself to get up and take a shower right away —it didn’t work, I just went back to bed. Eventually, I found a blog where someone described how having a detailed morning routine helped them wake up. Once you start the first task, you’re already with the current and it’s easier to keep going.
RISE-UP has shown effectiveness in bipolar disorder (though long-term studies are lacking), so if you like it—go for it.
Summary
Routine can truly work wonders. It’s another tool—among many I’ve discussed on the blog. Most of them support one another. For example, routine can make taking medications, automatic, reducing the stigma of being sick. And in the spirit of mindfulness, routine can even become a meditative act that restores a neutral or even pleasant emotional state.
There is a time for everything, and there’s no need to try everything at once. I started with medication, then moved on to behavioral therapy, followed by mindfulness practice. I gained additional skills through various books (some of which I mention on the blog), and eventually, I began implementing routine. The results have been incredible—especially according to my loved ones. I don’t have the distance to see all the changes myself, but I’m glad they notice and appreciate it, as it makes their relationship with me easier.
– Agnieszka
*The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.
[1] Frank E., Halastala, S., Ritenour, A., Houck, P, Ming Tu, X., Monk, T.H., Mallinger, A.G., Kupfer, D.J. Inducing Lifestyle Regularity in Recovering Bipolar Disorder Patients: Results from the Maintenance Therapies in Bipolar Disorder Protocol. 1997.
[2] Teasdale, J., Williams, M., Segal, Z. The Mindful Way Workbook: An 8-week Program to free yourself from depression. 2014.
[3] Jupille, J., Harscoet, J.A., Duval, M., Grall-Bronnec, M. Moret, L., Chirio-Espitalier, M. “What makes you well?” Supports of well-being in bipolar disorder. A qualitative study. 2023.
[4] Kaplan, A.K.,Talavera, D.C., Harvey, A.G. Rise and shine: A treatment experiment testing a morning routine to decrease subjective sleep inertia in insomnia and bipolar disorder. 2018.