Summer Holidays and Bipolar I Disorder: A Practical Guide From a Psychiatric Expert

The fireworks may have faded, but for many people living with bipolar I disorder (BD-I), the stress and overstimulation of the holiday weekend do not simply disappear when the celebrations end. Roger Rivera, DNP, PMHNP, a veteran and psychiatric nurse practitioner, knows this reality well, and the guidance he offers is as relevant today as it was before the Fourth of July.

Rivera is sharing practical, experience-backed strategies for managing mood instability, sensory overload and routine disruption during high-stimulation events, and his advice extends well beyond any single holiday. From protecting sleep and medication schedules to communicating needs without overexplaining a diagnosis, his framework applies to every summer gathering, travel plan and crowded event ahead. For anyone living with BD-I who found the past week difficult, or who wants to be better prepared for what comes next, this is the conversation worth having.

The Fourth of July can be an overwhelming time for many people. What should someone living with BD-I realistically expect when it comes to how holiday stress, noise and disrupted routines might affect their symptoms?

Roger Rivera, DNP: The Fourth of July can be overstimulating for people living with BD-I, with crowded events and spaces, along with loud, sudden noises and possible interruptions to daily routine. The resulting impact on emotional regulation can show up as mood instability, anxiety or panic.

Part of living with complex, chronic conditions like BD-I is knowing what circumstances may, even rapidly, contribute to worsening symptoms, despite being otherwise well managed with medication and therapy. It’s valuable to plan ahead for how to stay well in times of heightened stress or excitement. One of the biggest pieces of that is sleep. Overstimulation can make it harder to wind down, and when sleep becomes irregular or disrupted, it can create a feedback loop where symptoms become harder to manage. I would also recommend, if someone knows an experience coming up may be stressful for them, to talk to their provider about their medication plan or other help they can call on in the moment.

Fireworks are one of the most common triggers this time of year. What are some practical, easy-to-use strategies patients can try in the moment when noise and sensory overload start to feel like too much?

RR: When the noise and sensory overload feel like too much, relief can start to come from having access to a safe place and taking steps to dampen the sound. That may mean staying indoors during the peak time of the fireworks and having a quiet space to retreat to, with added help from noise-canceling headphones, earplugs, a white noise machine or playing calming music. For those participating in activities outside, that may require having a plan for how to efficiently get inside or return home with minimal additional stress.

In my practice, I am an advocate for grounding measures and breathing exercises as anchors in moments of acute stress. For example, when anxiety builds, use the 54321 technique to observe five things you can see, four things you can touch, three things you can hear, two things you can smell and one thing you can taste, feel or be grateful for. Box breathing, or 478 breathing, is also a powerful technique to help shift the brain out of panic or fight-or-flight and bring you back to the present moment.

I recommend not waiting until the moment of crisis to try these tools for the first time. Practice ahead of time, when you are calm and somewhere quiet and private, so that if you do get into a stressful situation, you already know how to use them.

Staying on top of medication during a holiday weekend can be harder than it sounds. What advice do you have for patients who want to protect their treatment routine when schedules, travel and social plans get in the way?

RR: In the military, we learned a principle that stuck with me: Proper prior planning prevents poor performance. The same rule applies here.

Before a holiday weekend, I encourage patients and their loved ones to think through the intricacies. Where are we traveling? Are we changing time zones? Are we going to be around substances? Are we overscheduling ourselves? With BD-I, routine is essential, and losing track of that is when people can start to destabilize.

Timing of medication and sleep should remain as consistent as possible, even when the holiday or travel shifts schedules. I tell patients to keep it simple: Take medication at the same time, go to sleep at the same time, and anchor those routines to ordinary daily activities like waking up, brushing their teeth or having their first meal. Simpler is going to be easier to follow automatically.

Questions about medication should be shared with your provider ahead of time. For example, your provider can help you plan if travel will get in the way of when you need to take your medication, how to respond if conditions like extreme heat could be a factor, or how to manage supplies and refills.

Not everyone feels comfortable telling friends or family what they are going through. How can someone living with BD-I communicate their needs around the holiday without feeling like they have to overexplain their condition?

RR: I think the biggest guidance I would offer is that you do not owe anyone a version of yourself that costs your stability. You also do not have to overexplain your condition to be able to communicate what you need. For someone living with BD-I, it can be as simple as saying, “I’m going to keep this holiday a little quieter,” “I may need to step away for a little bit,” or “I’m trying to stay on my routine, so I may not be able to stay late.” You are not asking for special treatment. You are protecting the things that help keep you stable.

This is where support systems can be valuable, understanding that support starts with communication. I advise family members and loved ones to ask, not assume. The same applies to the person living with BD-I. Let trusted people know ahead of time what would help. Maybe that is a smaller group of people, a ride home, a rest window, or simply the acknowledgment that your time and energy have boundaries.

For someone who has had a difficult Fourth of July experience in the past and is already feeling anxious about this year, what is the single most important thing they can do right now to prepare and protect their mental well-being?

RR: The single most important thing is to plan ahead. I always go back to proper prior planning, because once you are already in that overstimulated moment, it is much harder to figure out what you need.

Before this or any holiday, take the time to understand what has been difficult for you in the past and build a coping plan around that. Preparation gives you more control, whether it is having a quiet space to go to if the current environment is too overstimulating, in-the-moment grounding techniques, or a way to leave if removing yourself from the situation is the best course of action.

Do not wait for anxiety to hit to try to prepare next steps. Practice the tools ahead of time to avoid feeling pressured to come up with a coping strategy when you’re already overwhelmed. You already have the structure in place to protect your stability. Be thoughtful about your medication plan, sleep schedule and any other factors that contribute to your well-being, trusting that your needs are valid.