These changes in activity levels usually begins slowly and builds over time. As such, activity levels can be used as a measure for tracking the progression of the elevation in mood. When you recognise that your mood begins to be elevated, it is important to begin monitoring your activity levels. If your activity levels begin to consistently and progressively increase, your early intervention strategies should be activated to
prevent a full-blown episode of mania. Here are two strategies you can incorporate into your early intervention plan.

PREVENTING SLEEP DISRUPTION
Research has shown that sleep deprivation can be both a trigger to, and a consequence (symptom) of, mania. Some patients find that with little or no sleep, they become exhausted, but cannot slow down enough to fall asleep. These symptoms may escalate into a full blown episode of mania and possibly psychosis. Other bipolar patients may enjoy the increased energy and vigour, but find that this level of
energy and activity cannot be sustained without negative consequences, such as irritability and paranoia. The best strategy for coping with sleep disruption is to prevent it. If it is possible, try to forecast or identify times when your normal sleeping habits are likely to be disrupted (eg, when having to rush for a deadline, traveling, going on holidays, etc.)

Here are some good sleeping habits to maintain, so that you can prevent a hypomanic or manic episode:
  • going to bed and waking up at the same times each day
  • avoid napping if it causes night-time insomnia (or don’t take too long a nap)
  • try to minimize sleep disruptions (eg, share night-time responsibilities, bring
  • favorite pillow on holiday, use ear plugs or eye shields, or medications)
  • avoid over-stimulation (eg, too much physical activity before bedtime, caffeine)
  • avoid thinking too much at night (do some relaxation exercises or calming activities)
LIMITING YOUR ACTIVITIES
Besides pharmacological intervention, there are some strategies you can implement to prevent mild or moderate mood elevation from becoming a full-blown manic episode. The key principle for any behavioral intervention for preventing mania is to limit activity and to keep activity levels to a “normal” level. It is recommended that while you are well, use a Weekly Activity Schedule (provided on the next
page) to plan and organize your regular week, and ensure that there is a balance of responsibilities, pleasant activities, and time for sleep and/or rest. Then, when you begin to suspect that you may be hypo-manic, use a separate activity schedule to monitor your activity level and compare it to your “normal” and balanced schedule. If you find that your activity levels have increased significantly, try to get yourself to slow down and return to your normal weekly schedule. You could also ask a friend or family member to help you do this.

So remember:
Preventing mania is all about slowing yourself down, relaxing, and having enough rest. These are things you could easily do once you recognize some of your early warning signs. For example, if you realize that you’re beginning to feel a little keyed up and restless or more energetic, you could take a slow and relaxing walk somewhere nice or take a nice long bath. These strategies are recommended not to stop you from feeling happy but to prevent your good mood from escalating toward mania. Many bipolar patients have said they love it when their mood is slightly elevated but
do not enjoy the experience of full-blown mania. This is where you can learn to better manage your moods so that you can prevent them from escalating to full-blown episodes.

Organizing & Prioritizing Ideas/Projects
During mania and hypo-mania, there is often a flood of new ideas and interests. People with hypo-manic symptoms frequently overestimate how much can be accomplished in a given day. They underestimate the time it takes to complete tasks and underestimate the costs involved in implementing certain ideas.
Coupled with the optimism and increase in self-confidence, patients in an elevated mood may take on too many (and perhaps, risky) projects, thus making it more likely that projects are not completed or are not successful. In addition, they run the risk of becoming exhausted from doing too many things.
When you begin to realize that your mood is becoming elevated and you begin to have many creative ideas, it is important that you begin organizing and evaluating these ideas. The purpose of this exercise is to help you take a step back and to slow down a little. It also helps you keep a record of your creative ideas and to set yourself up to succeed in doing some of these projects (be they small or large) because you will have thought through some of the important details before you start doing anything.
First, write down all the ideas for activities or projects that you have. Then, evaluate ALL your ideas, projects, or actions by asking yourself:

  • What are the costs and benefits of trying out this idea, or embarking on this project, taking on this new responsibility, or carrying out this action?
  • What resources do I need?
  • What are the steps I must take to carry out this idea/project successfully?

It is important that you do this for every idea, project, new responsibility or action that you have in mind.
After you have evaluated your ideas, list them in order of priority. Also, for each idea or project, you might want to set a deadline for yourself as to when the project should be completed. Then, carry out the idea or project that you placed as the TOP priority. Remember, before you begin carrying out a new idea or project, you must have completed the previous one. In this way, you can ensure that you limit your activity levels, while focusing your energy and resources on one important project at a time, thereby increasing your chances of success. This will also help you prevent a full blown episode of mania, likely hospitalization, and total exhaustion.
By doing this exercise, you will not only slow yourself down, you will also have a record of all your creative and interesting ideas, and ensure that some, if not all, of these ideas will be carried out successfully.

When bipolar patients begin to experience hypo-mania and mania, activity levels and libido increase, and hours spent sleeping decrease
This cycle of increased activity and decreased sleep/rest can perpetuate and escalate the manic episode Sleep deprivation can be both a trigger to, and a result of, mania The best strategy for coping with sleep deprivation is to prevent it Good sleeping habits include: sleeping and waking at the same times each day, avoiding naps, minimizing sleep disruptions, avoiding over stimulation, avoiding thinking too much at night The key principle for any behavioral intervention for preventing mania is to limit activity or to slow down and to keep activity levels to a “normal” level With the flood of new ideas and interests that often come with hypo-mania or mania, bipolar patients may underestimate the time it takes to complete tasks and the costs involved in implementing certain ideas With the dual purpose of slowing yourself down and ensuring the success of any project, try to evaluate all your ideas for projects, taking into account costs and benefits of the idea, resources needed, and steps for implementation.