Why do bipolar manic episodes happen even when you take all your meds? mania has kept me up and i sleep for 4 hours a night.

Breakthrough mania: Unfortunately, in spite of our best efforts, manic and depressive breakthrough episodes are not only possible but all too frequent even when taking medications. The medication regimen then has to be rethought and sometimes it can feel like we are chasing the illness. This can be an extremely frustrating time. One thing that we do know about bipolar disorder however is that control of sleep is critical. If you have even two nights of insomnia, you should contactyour psychiatrist and see what can be done to bring your sleep cycle back to normal. Just doing that alone may prevent a breakthrough episode. Sometimes all that takes is a simple dose adjustment or the simple addition of a sedative hypnotic. Best wishes for both happy and healthy holidays.

It can happen: Manic episodes can still happen, but the likelihood is much less if you take all your meds than if you don't. Sleeping only 4 hours per night is not sustainable for you, and could make you worse overall. Please contact your psychiatrist asap.