Can hypomania be OK?
October 19, 2011 7:51 PM   Subscribe

Whenever I miss a lot of sleep I get hypomania. It's, um, kinda awesome. Still, hypomania is supposed to be bad. Should I be worrying about this?

I don't have bipolar. I mean, sometimes I'll have several days in a row where I feel great or horrible, but no serious shifts in personality, or long-term cycling, or anything like that. I do have issues, though: general anxiety, occasional mild depression, and ADHD.

I'm a late sleeper. When my school schedule is only two or three days a week, I can never get adjusted, so I'm getting up at eight or nine on school days when I normally get up at eleven or twelve. Plus, with my ADHD, I'm usually working into the night to finish my homework anyway. So I always only get 2-5 hours sleep on school nights.

I get hypomania every time. The effect waxes and wanes, but it hits a peak from about about the nine hour point and on. I get most of the standard symptoms: I think really fast, I talk too much, I get a little cocky, and I feel much less tired than I should--and actually a bit wound up evening. If I drink coffee or take my Adderall to wake up in the morning, it amplifies the effect, but it happens either way. By the end of the day I feel like a huge badass and get a ton of work done, and I get really sharp and funny in conversation. Yesterday I set up a jam session with a new friend. I decided to schedule it for Thursday night, when I'll be underslept from school, so I'd be more sociable and play better. That's when I realized I should make this post.

I think it slops over to the next day a bit, because I can often wake up easily and feel pretty good the next day even if I only get 6-7 hours sleep. If I sleep off the sleep debt in one big ten or twelve hour session, I get a crushing hangover, but if I just sleep in a little bit for the next couple of days, I feel normal.

I take mood stabilizes for epilepsy (lamotrigine and later oxcarbazepine) but I don't really remember if this happened before I went on them. I guess it could be a paradoxical reaction somehow, but it happened on both drugs.

So, what do you guys think? It's great for me, but is there a downside that isn't occurring to me? I'm going to bring this up with my GP, but I might get a knee jerk "hypomania is bad" answer, so I thought I'd throw it open to you guys.

Thanks in advance.
posted by anonymous to Health & Fitness (22 answers total) 6 users marked this as a favorite
 
I work in the mental health field, and this sounds like Bipolar II to me. If you google it you may recognize your symptoms. People who have bipolar II enjoy it because they have lots of energy and feel great. Also, not sleeping is a symptom of Bipolar II. I would go to a psychiatrist and get an assessment.
posted by la petite marie at 8:03 PM on October 19, 2011 [7 favorites]


Lack of sleep is kind of a hallmark symptom of manic/hypomanic episodes. I'm curious why you're calling this hypomania--have you actually talked to your psychiatrist about it before? Your brain needs sleep in order to function well. That's why it isn't good for a person to have manic episodes where they regularly lose that much sleep. No one who has manic episodes or bipolar disorder wants the mania to go away, because it's "fun," but it often comes with a lot of anxiety or a lot of unpleasantness after the fact. Having to sleep off the sleep debts, as you said, isn't really a great way to function on a regular basis, and could have some more significant consequences in the long term (lethargy, more intense dips into depression, difficulty bouncing back as quickly, etc.). There might also be some interpersonal effects you may not be super aware of right now, but could easily intensify over time. You should talk to your psychiatrist or GP, absolutely.
posted by so_gracefully at 8:10 PM on October 19, 2011 [1 favorite]


No matter what this is that you're experiencing, it's not something sustainable. You mention classes, so I'm assuming you're around college-age. At that age, it's easy to sacrifice sleep, nutrition, and other good health habits and it feels pretty good when you do some of it. Eventually, it catches up with you, but with a freer schedule than most, you can take the time to sleep in, veg out, and recharge your batteries.

If you keep up with it, no matter the psychiatric diagnosis, it's going to wear you down. If it is a manic/hypomanic episode, you may do so without noticing, but even if your mind seems to keep up with you, your body doesn't function as well without a decent amount of sleep. It can leak into other areas, where you'll be more prone to illness, bad decision-making, and overall crankiness/feeling crappyness.

I'd say to learn to find other ways of replicating that feeling. Maybe intense exercise will do the trick. Maybe meditation, or thrill-seeking sports or a night in a comedy club.

Sleep when you can. It's one of the few free gifts we get.
posted by xingcat at 8:44 PM on October 19, 2011 [1 favorite]


Yes, you should be concerned. These things seem great, and maybe they seem great to everyone else too because hey! you're exciting! You're thinking really! fast! about! cool! things!

...and then one day you go a bit too far and things go really really really wrong all of the sudden. Not your fault. Just happened.

Not that I've seen that happen, no. Certainly, I've never spent the next few days dealing with hospital authorities trying to explain what went wrong, no. Not drugs. Just too much living in too short a time, honestly sir. Trying to cover the psych ward bill because your finances are completely shot to hell but somebody has to try to cover things before your credit is utterly destroyed and you're homeless, no. Setting my phone so the ward floor phone number rings at maximum volume in the most irritating way to make sure I always pick up the phone because god knows what will happen if I disappoint and miss the call now that you've finally crashed out.

Anyway, um, chat with your GP if for no other reason than frankly it really sucks to be the person trying to straighten things out afterwards -- after you've gone completely and totally insane for a few days.

...if you've got any close family or friends you probably want to spare them the misery. If you don't, then, you probably want to make extra sure this doesn't happen to you because without someone to clean up afterwards it gets really really bad. Really fast.
posted by aramaic at 8:45 PM on October 19, 2011 [5 favorites]


Not to be all dramatic, but I used to have similar experiences with hypomania. Then in my mid-twenties my enjoyment of sleep deprivation and stimulants lead to an episode of psychotic mania that took years to recover from. My genetic predisposition and reckless teenage use of psychedelics aside, I would be cautious when it comes to substances that increase this manic effect. The combination of stimulants, mood stabilizers (especially if not taken regularly) and erratic sleep seem to me a dangerous combination, and while it may feel like there is no real downside to hypomania, the same can't be said for a full blown manic episode. Remember, the average onset age for bipolar is 21--and definitely see a doctor. Even though psychiatrists can be an incredible pain in the ass when it comes to stuff like this, they do know things.
posted by Lorin at 8:46 PM on October 19, 2011


I used to do this in college instead of drugs. But honestly it's probably bad, and while its pretty cool to have some weekend where you're partying so much everything is awesome you shouldn't force it.
posted by Lovecraft In Brooklyn at 8:47 PM on October 19, 2011


This totally happens to me, too, and it is kind of awesome. Last year I switched to a regular sleep schedule (and later mornings) to deal with my anxiety, and it helps, but I now have no creativity. I look at my B.A. thesis like it's a piece of cold toast, and I'm rarely passionate about anything. So, it might not be good for you... but it brings you that much closer to genius.

I've tried exercise, &c. but the only thing that really brings me back to that place is caffeine or nicotine, and I don't smoke anymore, so coffee it is. Sleep deprivation is not good for you, but people in high-pressure careers (including doctors) routinely deal with it, and speaking as a student at a top-tier college, 5 hours of sleep per night is pretty average. From experience, you sound more like you're benefitting from avoiding oversleep more than anything, unless I'm bipolar too. So here's my bad advice for the day, and I've earned my place in petty Hell.
posted by stoneandstar at 8:54 PM on October 19, 2011 [1 favorite]


Occasional lack of sleep itself won't kill you, but I'd be worried about the stupid and potentially dangerous things you might do when manic.
posted by blargerz at 9:02 PM on October 19, 2011 [1 favorite]


Of course hypomania can be OK, if all you mean by 'hypomania' is 'having a lot of energy and being in a great mood'. The problem with mania/hypomania is grandiosity & poor judgment, and those're obviously problems in themselves. Think back on your actions during those times - are you buying things you can't really afford, doing sexual things you wouldn't do normally, skipping class & homework to go do Awesome and Dramatic things? It's good to remember that mental illness diagnoses are about fixing problems that are hurting your life - if it's not a problem, then it's not a problem.

You might want to talk to a therapist if you're concerned about telling the difference b/w hypo- and mania, and whether your hypomania / sleep deprivation is likely to lead to manic episodes (as per two anecdotal comments above but not per the advice I personally received from my therapist, who told me that I shouldn't be concerned about having hypomanic episodes since they weren't causing problems in my life).

Honestly it sounds like you might be getting too MUCH sleep most nights and just be in a (normal) good & energetic mood when you don't. Have you tried sleeping 6-7 hours every night? That's well within normal range for amount of sleep for someone to need. Try setting an alarm and getting up at the same time every day (this is also standard advice for stabilizing circadian rhythms / dealing with sleep issues).
posted by Lady Li at 9:25 PM on October 19, 2011 [2 favorites]


My only experience with mania is living with my bipolar roommate/friend in college for several years, and you're right--hypomania can be awesome. She was an art major and had some amazingly creative works come to her in a manic state, and she was always really fun and social and made so many friends when manic. It was great...until it went too far and she basically stopped sleeping and ran up all her credit cards shopping online and got thousands of dollars in debt, and dropped classes class because she was really focused on her own personal projects, and when she finally came down her life was a wreck around her. I guess what I'm saying is, hypomania as you describe it can be awesome and useful, but it's a fine line between hypomania and full-on mania, and will you be able to tell when you've crossed it? Or stop yourself from crossing it? Or WANT to stop? It's scary. I'd be careful and talk to a doc if I were you.
posted by Bella Sebastian at 9:25 PM on October 19, 2011


Hypomania got more severe for me as I got older too. But a more immediate concern is that mania tends to start out as a merely hypomanic episode, so deliberately inducing hypomania is not the greatest idea. Especially given that you're at the typical age of onset for it and not, like, 40. But don't talk to your GP about this. You're on prescription amphetamines. That's risky for somebody who's hypomanic, if they don't have a specialist who's on top of what they're taking to compensate and making sure it stays balanced over time. (Who diagnosed you with hypomania but not bipolar II, and did they know you were taking stimulants?) You need a psychiatrist to manage your mood stablilizers vs. your ADD medication. I really can't emphasize this enough.
posted by Adventurer at 10:44 PM on October 19, 2011


You might read up on bipolar II, rapid cycling, and the frequent co-occurence of ADD/ADHD. If, by the way, you've just been buying the Adderall from somebody for the sake of convenience instead of getting a prescription, your psychiatrist is not going to give a shit, but the fact that you're taking it is extremely important.
posted by Adventurer at 10:51 PM on October 19, 2011


I get most of the standard symptoms: I think really fast, I talk too much, I get a little cocky, and I feel much less tired than I should--and actually a bit wound up evening.

Dude, you just figured out the secret, and now askme snowflake questions are going to decrease by 4000fold.

What I would suggest is to get off the adderall with the help of your doctor.

Good luck.
posted by hal_c_on at 2:00 AM on October 20, 2011


Are we missing something here - perhaps OP is one of the lucky few who needs less sleep? I need around 7.5 hours like most folk, and if I sleep for longer, I get a "sleep hangover" like this person after their catching-up sleep.

OP - don't get too OMG SOMETHING IS VERY WRONG just yet. Maybe you just need less sleep. There are plenty of people whose optimum sleeping amount is less than 4 hours. The only problem is if you can't sustain yourself on that amount.
posted by greenish at 2:50 AM on October 20, 2011


That sounds like a post my partner could have written six or seven years ago, when he was having these mild, awesome hypomanic episodes. Which slowly got more pronounced until last year when he had a serious full-blown manic episode, involving quiitting his job, making grandiose decisions that affected both our lives negatively, and winding up with a bipolar I diagnosis. Per his specialist, most people take about 10 years from onset of bipolar symptoms to diagnosis, messing around with depression and/or ADD diagnoses along the way, because early bipolar can be basically just mild awesome hypomania and easy to miss.

Which isn't to say you're on that path, but just that it may be worth doing a sanity check once in a while with a trusted friend or your GP to make sure your behavior from an outside perspective is still awesome and not edging toward scary.
posted by Stacey at 3:03 AM on October 20, 2011 [1 favorite]


Hey, it could be more mild, and less of an issue. Sleep deprivation can work as an anti-depressant on even quite depressed people (unfortunately it goes away once they sleep), so it could just be part of the normal variation of human experience, a bit of a primitive "Woo! It's summer! I'm gonna run around because I don't need to hibernate! Yeah!".

On the other hand, with bi-polar, I've seen it not just be a symptom, but a cause of a manic swing - a dangerous feedback loop (kind of like zinc deficiency causing symptoms of lack-of-hunger, and mild euphoria, which is very counterproductive in an anorexic).


And in that vein though, lack of sleep is a serious, serious danger sign for an episode of mental illness.
SERIOUS.

Just as a, don't-get-eaten-by-bears piece of advice, and I am not kidding here, never go more than one night without sleep. Just don't.
Be aware of it in yourself, and watch out for it in others.

I'm going so far as to say, if that's a concern, if you ever get any spare sleep tranquilizers, ambien etc, or benzodiazepenes, keep an 'in case of emergency, break glass' supply, for if someone is past the point they can get to sleep by themselves easily. For you, or who knows, even someone else.
And, this is maybe not for you, but a little bit for if anyone else is reading this, and can identify with this - arrange it with friends that they will tell you if they think you need sleep, or are acting weird, and have the plan that you will sleep, or see a Dr, or whatever. Have it sorted in advance.

I have, more than once (*dammit!*), seen a situation where the saying, "A benzo in time, saves 9 (weeks in a psychiatric ward)" would be appropriate.

So yeah, while I might a bit paranoid* about the issue - sleep?
It's there for a reason.


* Haha! Paranoid! That's very funny, brain. Not. :P
posted by Elysum at 3:28 AM on October 20, 2011 [3 favorites]


Whenever I miss a lot of sleep I get hypomania. It's, um, kinda awesome.

Are you sure your perception of your own awesomeness is accurate? That's the tricky thing about mania. Your self-perception is likely all sorts of out of whack. I'd talk to a trusted friend and/or mental health professional about these mood changes. It's possible that, for others, you're less awesome to be around and more of a stressful handful. And with the cocktail of drugs that you're on, I don't think this is something to mess with.
posted by PhoBWanKenobi at 7:19 AM on October 20, 2011 [2 favorites]


From the OP:
As is inevitable with these things, I've left out some details that turned out to be important.

This has been happening the whole time I've been in college, and I'm a senior. So if I'm in a downward spiral that will end in me waking up in Vegas with two girls I don't recognise and an empty bank account, it's taking an awfully long time! Also, to be clear, I've never stayed up on purpose for to get this effect, and don't plan to. It's mainly the ADHD thing: I can never finish a paper before late on the night before it's due, and I don't expect I can fully fix that any time soon.

I know about sleep debt and how awful it is. It accrues indefinitely, and if you let build up it will mess you up worse and worse over time. That's why every time I have to stay up, I make sure to make up the sleep debt over the next couple of days. If it weren't unhealthy, I'd want to short myself on sleep often, of course. But I'm never even tempted, which is probably a good sign.

I've never done anything when I'm in a hypomania that I regret later. Well, sometimes I'll get hyper-focused on a certain thing when I should be doing something productive. But we're talking about practicing guitar tabs or watching old episodes of 30 Rock on Netflix, not buying things or sleeping with people. I've never looked back and thought I had any irrational thoughts. It's not like some crazy headrush; I just do the same stuff, but with a lot more energy and a bit of an intense attitude.

At this point some of you are thinking "he's just making a big deal out of a minor thing," and you're probably right. Still, it meets the standard definition of hypomania. Others of you will still think I have bipolar II, which I guess is possible, but if so, it's an awfully mild case! It truly only happens in the day after I stay up; on winter and summer breaks, when I don't have to stay up late, it's never happened even once.

I've had this for many years, so it's hard to imagine that I do have bipolar and it's just sneaking up on me over slowly. I guess it could have gotten time worse over time without my noticing over, but I don't think so.

For those asking about my psychiatric care and diagnoses: I have a psychiatrist, but he's the kind of guy who pretty much just writes scripts for you, unless you ask him for special attention. He prescribes my Adderall. I self diagnosed with hypomania a few weeks ago when I realized how well it matches with what I get. I looked it up to find that the symptoms lined up almost perfectly. I have a good understanding of the basics of mental health, because half of my family works in the field. Since you guys have made a mildly convincing case that I might have Bipolar II, in my next psychiatrist's appointment I'll talk about my symptoms with him to rule it out.

One interesting idea occurred to me in writing this. I've been on the mood stabilizers for epilepsy since I was 15, on doses well above the normal range for treating bipolar (1600mg/day oxcarbazepine, later switched to 800mg/day lamotrigine). Is it possible that I've developed Bipolar II over the years, but it's almost unnoticeable because the drugs have treated it so well? That idea seems a bit clever, but this is almost exactly what you'd expect in that case, no? Definitely something to talk about with the psychiatrist.

I'll post another follow up if there's a lot more questions or things that need clarification. Thanks for all of your thoughtful answers so far!
posted by jessamyn (staff) at 9:49 AM on October 20, 2011


I take 600mg of oxcarbazepine and was on lamotrgine in the past, both to prevent hypomania. I've got bipolar II (and a ton of other stuff.) They took me off of my ADHD meds this month to try and get a handle on my anxiety.

You should also look into cyclothymia, and read this article, since you say you're experiencing only "mild" depression.

And for what it's worth, in college my hypomania mostly presented in the form of staying up all night to write a brilliant paper, signing up to take too many credit hours, joining a club on a whim for the sixteenth time, etc. There was a lengthy period where they said I was just depressed, until I finally mentioned enough of those hypomanic moments, none of which bothered me at all (except when I crashed afterwards, which astonishingly enough happened every single time.)

Things got worse very, very slowly for me, and the hypomania has never ever been as disruptive as the depression. I'm 30 and have yet to have anything even close to a full manic episode. Doesn't mean it won't happen someday, though.

And the trouble with hypomania for me mostly comes in a complete lack of awareness. I really think it's a neat, practical, sensible, clever idea to do X thing which every single person I know immediately sees is a bizarre and totally hypomanic idea. It's like my brain lives in the Happy Anything Is Possible universe while my body and the rest of humanity are in the less interesting, far more limited, actual universe. It's really a shame about credit scores and transcripts and traffic laws and so forth being the standards by which we are measured, because otherwise hypomania would rock.
posted by Fee Phi Faux Phumb I Smell t'Socks o' a Puppetman! at 12:28 PM on October 20, 2011 [3 favorites]


My mother was diagnosed w/ Bipolar II at age 52. Now, after putting all the pieces together, we realize that she's probably had it all her life. When she was younger, she was much more able to quickly bounce back from the lack of sleep and days full of frenzied activity... When you're 50+, not such a spring chicken anymore. She only thought to seek treatment (or honestly consider it a problem) when she couldn't handle the sleep debts and "fun hangovers" anymore.

I've never looked back and thought I had any irrational thoughts.

I'll make no judgement on your condition as IANAD - but reread this. Would a less than rational person _really_ look back on their actions and see them as irrational?

Again, while you may be able to handle all of these issues now, why not seek the council of a dr or therapist now BEFORE things get out of control? You can always listen to their advice/recommendations/medication suggestions and then disregard.
posted by Mrs_Eep at 1:15 PM on October 20, 2011


I'm relieved you're going to take it to your shrink. If it's gotten noticeable or frequent enough for you to have started thinking about this in the last few weeks, though, that might be a sign that you should see about getting an earlier appointment, because if you do escalate you're going to want treatment for it even less than you do already. And again, and perhaps most importantly, one of your drugs might be terrible for that.

I've had this for many years, so it's hard to imagine that I do have bipolar and it's just sneaking up on me over slowly.

Not the case at all. Especially since you're not even out of college yet. There are plenty of people who start out with symptoms of cyclothymia, for example, and progress to bipolar II. And you are, as you note, inadvertently being medicated for it already, although perhaps not the way your shrink would do it if he were doing it on purpose. There seems to be some thinking now that while lamotrigine can be excellent for bipolar depression (regular antidepressants can provoke cycling and mixed states), it might not, by itself, be the strongest anti-mania agent available. (Of course a strong anti-mania agent may not be remotely necessary or appropriate. My point is just that nothing you've said rules anything out.)

In college I had occasional bouts of hyperactivity and some anxious irritability and a tendency to stay up forever by myself for no good reason (OK, except for papers), but none of that seemed very significant compared to my depression, even though all the SSRIs I was prescribed stopped working or made me agitated. Then when I was 28 or so and self-medicating with energizing (to me) weed instead of depressing alcohol, I went through a months-long phase wherein I felt and often explained that I had suddenly cured myself forever through the power of positive thinking. Then I crashed and found out I hadn't. Since that first breakthrough I have had much crazier states of mind available to me when I'm not medicated (or even eating or sleeping) properly. I can still get a little hypomanic even when I am on top of everything, but since the dude who prescribes my drugs sees me every week, and because I also know by now to notice what I'm spending and how much I'm sleeping and whether I'm suddenly being struck by the unsual clarity of my own insights, I don't worry about it too much. The sooner your psychiatrist knows there's something to be aware of, the better.
posted by Adventurer at 3:37 PM on October 20, 2011 [1 favorite]


Would a less than rational person _really_ look back on their actions and see them as irrational?

Just to quell that fear, actually - yes, in cyclical conditions people do look back on prior actions, and see them as irrational. Of course, that is mediated by context dependent memory - depressive thoughts are more recallable during depression, and vice versa, so you can genuinely 'forget' having been in a different state.

(Ie depression 'my life has always sucked' - not hyperbole, often genuinely can't remember feeling happier).

I wasn't actually thinking you sounded very far on the bipolar spectrum, but hey, being on the lamotrigine, does add an interesting complication to the mix. Run it by your Doctor, and run it by your friends. People around you might notice more, if your emotions are really that variable.

And, to reiterate - most mental illnesses don't come out of nowhere, they are often collections of behaviours found in the normal population, and some people are way off down the scale on it. But there is a scale, and the bit that puts you over to identifying with the label, and getting treatment, is if it is leading to suffering in your, or others lives.
And of course, checking out if there is anything that would prevent a slide to suffering, if that is a concern.

If you, and those you deal with, are functionally ok - then it's ok.
posted by Elysum at 3:43 PM on October 20, 2011


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