Bipolar and Your Body Clock: Tips for a Healthy Sleep Schedule

Night owl or early bird? Learn how syncing your natural rhythm with a steady sleep routine can help with mood stability.

Cass M. has always been in love with sleep. 

“I can easily snooze until 11 a.m. or noon,” says the Virginia woman. “I’m always ready for a nap.”

Unfortunately, waking up for school or work has always been a “huge task,” she says. A proverbial night owl, Cass is most alert in the late afternoon and early evening. When left to her own devices, she tends to fall asleep around 2 a.m.

So how does she meet the demands of the real world? With difficulty.

“I have held 9-to-5 jobs and I would be beyond exhausted in the mornings,” says Cass, whose bipolar 1 was diagnosed when she was 19. “I would often take 5-hour Energy drinks to stay awake, but they made me jittery, and my anxiety beyond agitated.”

What Cass experiences has a biological name. Each of us runs on a roughly 24-hour internal “body clock,” known as the circadian rhythm, which influences when we feel alert or sleepy, when we get hungry, and even how our hormones fluctuate, according to Cleveland Clinic. 

Within this system, every person also has a natural sleep–wake tendency called a chronotype — often described as a night owl, an early bird (or lark), or somewhere in between, sometimes nicknamed a hummingbird. These preferences are largely genetic and shift somewhat with age.

Finding a Sleep Strategy That Fits Real Life

When Cass got a new job as an administrative assistant, she made a plan to adapt to business hours. She created some sleep rules:

• Go to bed no later than 10 p.m. — and keep screens out of the bedroom. “I used to think they helped me fall asleep, but now I know the light can keep you more stimulated,” she says.

• Have her partner wake her up every morning, so she arrives at work on time. “It’s feet off the bed, getting up, and moving around,” Cass says. “I definitely need a cup of coffee, but I now avoid energy drinks.”

Understanding Circadian Rhythms and Chronotypes

Experts explain that circadian rhythms are maintained by a “master timekeeper,” the suprachiasmatic nucleus, located just above the optic nerves and exquisitely sensitive to light cues. These rhythms affect sleep, hunger, hormone release, and daily energy levels.

Night owls like Cass make up one of three broad categories of natural sleep patterns.  According to chronobiologist Michael Smolensky, PhD, coauthor of The Body Clock Guide to Better Health: 

• About 20 percent of adults can be classed as owls.
• A far smaller percentage are larks — up before the sun and perky early in the day, but apt to lose steam by evening. 
• Everyone else falls into a more flexible group labeled hummingbirds.

How Sleep-Wake Cycles Affect Bipolar Symptoms

A growing body of research shows that disruptions in circadian processes are not just a consequence of bipolar disorder but a driver of mood changes.

Findings from McGill University highlight that people with bipolar tend to show lower daytime activity and delayed sleep–wake cycles. Mood switches appear influenced by both the standard 24-hour biological clock and a second, dopamine-driven rhythm that controls alertness.

Because these two internal clocks run at different speeds, their alignment — or misalignment — may help trigger episodes of mania or depression. In people without bipolar disorder, the dopamine-based clock likely stays dormant. According to lead author Kai-Florian Storch, pinpointing how these dual clocks interact is considered the “holy grail” of bipolar research and may eventually guide new treatments.

Genes, Sleep, and Bipolar Disorder

Genetics may play a role when it comes to sleep, too. In an older study, an international research team found that sleep and daily-rhythm problems aren’t just side effects of bipolar disorder — they’re a core part of it, and they can linger even when mood symptoms are under control. 

Over three years, the team tracked the sleep-wake patterns and daytime energy of more than 500 people from 26 families with a history of bipolar. They discovered that, on average, relatives with bipolar 1 tended to:

• wake up later and sleep longer
• have bigger day-to-day swings in their sleep schedule
• show lower activity levels while awake

These differences showed up regardless of whether someone was depressed, manic, or feeling stable. When the researchers examined related genes, they pinpointed 13 specific traits tied closely to bipolar 1 — strengthening the link between our biological clock, genetics, and this mood condition.

“We know bipolar 1 is strongly heritable in these families,” says co-author Joseph Takahashi, PhD, who runs a lab at the University of Texas Southwestern Medical Center focused on the molecular and genetic bases of circadian rhythms. “If we can find a biological understanding of why this may be happening, we can treat it.”

Becoming Aware of What May Trigger Bipolar Mood Symptoms

Circadian rhythms are directed by a “master timekeeper” called the suprachiasmatic nucleus. It is located just above the optic nerves in the brain and is extremely responsive to light cues.

Anything that messes with the timekeeper can trigger mood symptoms — staying up too late, crossing time zones, Daylight Saving Time (whether “falling back” or “springing ahead”), and/or changes in day length as the seasons turn.

Research also points to metabolic disturbances and environmental stressors as added complications. This suggests a need for personalized chronobiology-informed interventions. In other words, chronotherapies — treatments tailored to the body’s natural circadian rhythm — to support mood stability.

Finding a Steady Rhythm That Works for You 

Of course, your daily routine is an integral piece of the sleep puzzle.

Interpersonal and social rhythm therapy, which was developed as a psychotherapy for bipolar, aims to regularize circadian rhythms by emphasizing structure in daily routines. This includes when you go to bed and when you get up, when you have meals, when you work, and even what time you exercise each day.

Your underlying chronotype may complicate the issue, however, especially if your body clock is out of sync with social norms.

A study published in April 2025 found that people with an evening chronotype — those who naturally stay up late — face higher risks of rapid cycling, depressive symptoms, early disorder onset, and suicidality. Even in remission, they often experience disruptions in sleep and eating.

Being Awake at Atypical Hours

People who naturally wake very early — sometimes called “advanced sleep” types — may fit the standard workday more easily.

Phil S. of Iowa City, Iowa, regularly greets the day at 5 a.m. but has learned not to send emails too early. “People get suspicious — they wonder where I’m at in my bipolar cycle, whether I slept at all,” he says.

“Going back to sleep has never been an option. I’ve tried deep breathing and progressive body relaxation, and they don’t calm my heart rate.”

Those methods also fail at bedtime, which for him varies from 9 p.m. to midnight. “The more wired I am, the harder it is to go to sleep,” he explains.

If necessary, Phil takes a sleep aid, though it can leave him groggy in the morning.

Monitoring How Your Medications Affect Your Sleep

According to psychiatrist and sleep expert Atul Khullar, MD, “delayed sleep disorder is fairly common in people with bipolar disorder.” However, he points out that certain medications have a sedating effect that may contribute to oversleeping in the morning.

Lithium, for example, can shift circadian rest-activity patterns. A randomized controlled trial published in April 2025 found that within one week of treatment, people on lithium showed reduced daytime activity and earlier wake times — changes that occurred independently of mood symptoms and may serve as early markers of treatment response.

Dr. Khullar, an associate clinical professor of psychiatry at the University of Alberta, advises discussing timing or type of medication with your prescriber if mornings are difficult. “There are more less-sedating options for bipolar treatment now than there were years ago,” he notes.

It’s also wise to rule out medical conditions like sleep apnea, which can mimic depression and fatigue and worsen tiredness.

Adjusting Your Daily Habits to Improve Your Sleep

For Wendy M., of San Diego, a stretch of bipolar depression in her thirties led to sleeping 12 to 14 hours a day.

“Typically, I’d go to bed at 8 p.m. and wake up at 8 or 10 a.m.,” recalls Wendy, who, until then, was more familiar with the hyped-up energy of mania. “It was difficult because I had a job as a writing tutor at a community college, and I had to be there at 10 a.m.” There were days she simply couldn’t get out of bed and often called in sick.

So Wendy turned to a sleep specialist for help. One of the first things the doctor asked her was whether she exercised.

“She was aghast I did no exercise,” Wendy says. “I like to dance, so I started doing aerobics to fast-paced music that I love. And I stopped having so much fatigue.”

RELATED: Ask the Doctor: Why Sleep Is Essential For Bipolar Stability

She attributes her exercise program to helping her establish a more conventional sleep pattern. Wendy also:

• stopped smoking and drinking alcohol
• began seeing a new psychiatrist, who adjusted her medications
• set a consistent bedtime of 9 p.m. and wake-up of 6 a.m. 
• dimmed the lights and read a calming book at bedtime 
• met a friend for a 7 a.m. walk to stay accountable

“Routine is so important for me,” Wendy says. “It’s all about keeping a steady rhythm in my day. “I’m like the most boring person alive now,” she jokes. “I try not to mess with my body clock, because it will mess up my whole life.”

Editorial Sources and Fact-Checking

• Circadian Rhythm Sleep Disorders. Cleveland Clinic. January 23, 2024.
• Markam PS et al. Mesolimbic Dopamine Neurons Drive Infradian Rhythms in Sleep-Wake and Heightened Activity State. ScienceAdvances. January 1, 2025.
• Pagani L et al. Genetic Contributions to Circadian Activity Rhythm and Sleep Pattern Phenotypes in Pedigrees Segregating for Severe Bipolar Disorder. PNAS (Proceedings of the National Academy of Sciences). December 2015.
• Campbell IH et al. Metabolic Plasticity: An Evolutionary Perspective on Metabolic and Circadian Dysregulation in Bipolar Disorder. Molecular Psychiatry. July 2025. 
• Singh R et al. Factors Associated With Chronotype in Individuals With Bipolar Disorder in Remission. Indian Journal of Psychiatry. April 2025.
• Xu N et al. Effect of Lithium on Circadian Activity Level and Flexibility in Patients With Bipolar Disorder: Results From the Oxford Lithium Trial. EBioMedicine. April 2025.

UPDATED: Originally printed as “A Field Guide to 40 Winks,” Fall 2016