How to Start a Routine — and Stick With It — When You Have Bipolar Disorder

"Establishing a daily and weekly routine helps create stability amid these fluctuations," says Matt Glowiak, PhD, a licensed clinical professional counselor with the mental health treatment provider Recovered in New York City. "However, starting a routine can be difficult, especially when motivation is low. For those with bipolar disorder, symptoms themselves can interfere with routine-building."

During depressive episodes, for example, completing daily tasks may feel overwhelming, and during manic or hypomanic episodes, individuals may feel less inclined to follow a structured schedule, and routine may seem less important, he says.

Why a Routine Matters if You Have Bipolar Disorder

When you have bipolar disorder, not having a structured routine with predictable habits can lead you to feel destabilized, and that can increase your risk of mood episodes, says Dr. Glowiak. It can also have a ripple effect on your physical and cognitive health.

Why Starting a Routine Can Be Challenging

Even when you know a routine will be helpful for managing your bipolar disorder, it can be difficult to establish one, in part because change is hard for many people, not just those with mood disorders, says Glowiak.

"People are naturally creatures of habit who often resist change," he says. "Meaningful routines require discipline and consistency, particularly during times when motivation is low. For those with bipolar disorder, the challenge is not being uncertain about what to do, it's about maintaining consistency when symptoms make routine feel difficult. That can be discouraging."

There may also be obstacles to creating a routine, such as an unpredictable work schedule or conflict with people around you who may not support your new habits, says Naomi Torres-Mackie, PhD, a clinical psychologist at Northwell Health’s Lenox Hill Hospital in New York City. Recognizing these variables is an important aspect of developing a meaningful routine.

"Be mindful of what these roadblocks look like so you can sidestep them," she says. "Also keep in mind that no matter what these challenges might be, they're usually manageable, and it's worth addressing them for the stability and structure that routines can bring."

What a Routine for Bipolar Disorder Should Include

A healthy routine should focus on consistency, balance, and maintaining overall wellness, says Joshua Norman, DO, a psychiatrist with the Ohio State University Wexner Medical Center in Columbus. He says core elements could include:

• A consistent sleep and wake schedule, ideally allowing seven to nine hours of sleep per night
• Regular, nutritious meals at the same time each day
• Medication, taken as prescribed by your healthcare provider
• Work, school, or other daily responsibilities
• Physical activity
• Social connection, including supportive relationships
• Stress-management practices such as mindfulness, relaxation exercises, or hobbies

"Importantly, routines should not consist solely of responsibilities," says Glowiak. "Enjoyable and rewarding activities should also be incorporated to support overall quality of life and emotional well-being." Simply checking in with a friend regularly, for example, can give you a sense of connection that makes that habit feel more meaningful.

How to Start a Routine for Bipolar Disorder

Because it's easy to feel overwhelmed by too many elements in a routine, Dr. Norman says it's helpful to identify one or two high-priority habits — such as maintaining a consistent bedtime or taking medications as prescribed — and building on these. These so-called keystone habits have a ripple effect that helps you establish other elements of your routine.

Also, planning as much as you can in advance can help kick off new routines. "Use reminders or calendars to reinforce routines," he says. "From there, you can start to stack new habits onto those keystones and create a larger routine." For instance, you might start a bedtime routine that first consists of going to bed at the same time every night, even on weekends or during vacations. From there, you can stack other habits like listening to a meditation app, prepping coffee and clothing for the next day to minimize morning stress, and doing some light stretching to prepare for sleep.

But the starting point is that single habit, done for at least a few weeks, until it becomes routine, says Norman. Write down when you started the habit in your calendar, as a way to hold yourself accountable, and also as a way to appreciate your efforts.

Tips for Sticking to Your Routine

Once a routine is started, the next step is maintaining that routine so it feels predictable and consistent, even during mood episodes. Dr. Torres-Mackie suggests the following to help stick to a routine:

• Consider a routine to be a form of nourishing self-care, not a set of rigid rules or habits that create stress.
• Create a "why" mantra, or a short phrase that you repeat, reminding yourself of why maintaining a routine is important.
• Enlist an accountability partner who can gently keep you on track.
• Recognize that setbacks are normal; missing a day or two doesn't mean failure, and you can return to practicing your routine as soon as possible.
• Consider trying interpersonal and social rhythm therapy (IPSRT), a form of psychotherapy, which research shows can stabilize daily routines and reduce symptoms of bipolar disorder.

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• Check in with your health provider if you feel that your medications or other treatment may be interfering with aspects of your routine, such as getting enough sleep.
• Most of all, celebrate your wins and appreciate a "streak" of maintaining a routine for a certain number of days.

"For individuals living with bipolar disorder, routine is not about rigidity," says Glowiak. "It's about creating the structure needed to support wellness, resilience, and recovery."