context: If you have bipolar disorder, no one needs to tell you how challenging this mental illness can be. You are among millions of American adults who may also find that the mood episodes of bipolar disorder can be very disruptive at work. Take heart. There are many steps you can take to find meaningful work and develop successful relationships on -- and off -- the job. It's not surprising that work can bring special challenges for those with bipolar disorder. The stress and unpredictable challenges in the workplace can take a big toll. Managing bipolar at work -- with the highs of mania and the lows of depression -- is no small feat. In a survey conducted by the Depression and Bipolar Support Alliance ( DBSA), almost nine out of every 10 people with bipolar disorder said the illness had affected their job performance. More than half surveyed said they thought they had to change jobs or careers more often than others. And many felt they were either given less responsibility or passed up for promotions. Left untreated, the disease can greatly affect relationships and job performance. However, a combination of medicine and therapy can be effective. Working closely with your health care providers and support network, you can learn how to manage symptoms and find a balance that works for you on the job. To tell or not to tell, that can be the big question with bipolar disorder. It's your choice. There's still a stigma surrounding mental illness. Sharing medical information about yourself is highly personal and private, so you may want to be less open about it. You really don't need to tell anyone at work that you have bipolar disorder. But in certain circumstances, it can be helpful to have a conversation with your supervisor, such as when you need to take off from work for lots of appointments. Being open may be better than having your boss guess about or be surprised by your absences. Before you discuss absences or other potential accommodations you may need, it may help to educate your supervisor about bipolar disorder. A letter from your doctor or a brochure on the topic may help. Also, be sure to emphasize how any changes you request will help you be a more productive employee. Many people with bipolar disorder find themselves seeking project-oriented careers, where the work is intense for short periods. Even though this seems to fit the ups and downs of the illness, it is often better to seek more structured work with a regular schedule. Long or irregular work hours can wreak havoc with your stability and job performance. Shift work, and unpredictable or frequent disruptions to your sleep schedule, also can have a destabilizing effect on moods. Sometimes, though, full-time work feels too challenging. If that's the case for you, it may help to ask your supervisor about flexible hours, a self-paced workload, the ability to work from home, or part-time work schedules. Also, see whether you can make up lost time when necessary. Whether with work or other aspects of your day -- such as sleep, meals, and exercise -- regular schedules may be the best policy. Structure provides predictability. It also reduces stimulation and promotes organization and stability. If you have bipolar disorder, there are things you can do to make it easier to succeed at work. For starters, know your symptoms of depression and mania. That way, you can better manage them. See challenges as learning experiences and look for opportunities to learn. Give yourself lots of credit for big and small accomplishments, especially when you persevere through the hard times. Here are a few other tips that may help you with managing bipolar disorder at work. Manage stress. Remember to try the following tips at home as well. It's important to get plenty of down time. Take regular breaks -- before you think you really need them. This is particularly important if your stress levels rise. Try a relaxation exercise, such as deep breathing. Take a walk around the block. Listen to relaxing music. Call a friend. Take time off for counseling. Make other healthy lifestyle changes. Besides managing your stress well, it's important to exercise daily, get enough sleep, and eat nutritious meals. If stress is affecting your sleep, it's definitely time to take steps to get it under control. Think about stress management techniques that have worked well for you in the past. Take your medications as prescribed. It may be tempting to go without treating your mania. After all, this is when many people feel most productive. But that can be risky thinking. During mania, you're more likely to make mistakes and can become irritable, making working relationships challenging. Also, untreated mania can lead to depression. If you tend to forget your medications, it may help to set a timer or reminder on your computer. Keeping your medication in a plastic container bottle can help you guard your privacy. Keep side effects at bay. Does your medication make you sleepy or jittery at work? It's not uncommon for people with bipolar disorder to need extra sleep -- 8 to 10 or even up to 12 -- hours a day. Your doctor may be able to change your dosing time or amount to help reduce drowsiness or other side effects at work. Ask about other ways to cope with side effects. For example, taking some medication with food can sometimes lessen nausea or upset stomach. Don't ignore symptoms. Even when you're doing everything right, you may still have an episode of depression or mania. Act quickly if you feel an episode of depression or mania coming on. Take extra steps to control your stress. Your health care provider can also help guide you to even out your moods. After an episode of depression or mania, be sure to take the time you need to recover. If you've taken time off from work, pace yourself as you return. This is a time when working part-time may be the best option. Maintain concentration. See if it is possible to try any of these ideas: Reduce distractions in your work area. Use white noise or environmental sound machines. Increase natural lighting or work with full-spectrum lighting. Stay organized. Many people -- not just those with bipolar disorder -- use tips like these to stay more organized: Make daily to-do checklists and check items off as they are completed. Use electronic organizers. Divide large assignments into smaller tasks. If possible, focus on one project at a time. Ask about having written job task instructions. Use a watch with an hourly alarm to remind you about specific tasks. Develop team skills. It helps to accept that both you and others have limitations and that conflict is a natural part of working with others. It's how you manage these conflicts that can make the difference. Deal with problems as they happen, rather than letting them build up. But focus on the problem, rather than pointing fingers at the person. At the same time, stay open to others' ideas and try not to take constructive criticism personally. Make connections with people and purpose. It may help you to remember that you are not defined by your illness and your work is not your whole life. Spending time with family and friends, planning fun get-togethers, volunteering with a charity -- all of these may help you find purpose. Also, have a support system lined up -- for good times and bad. The Depression and Bipolar Support Alliance (www.dbsalliance.org) can help you find a local support group. Making job changes with bipolar disorder Are you looking for your first job or needing to find a new one? If so, it will help to assess your skills, qualities, and life experiences. Make a list of what you bring to the table. Or, perhaps you need to make changes at your present job or are returning to work after being away. Think about what you really need at work: Can you work better alone than with a large group? Do you need clear direction from others, rather than being self-directed? Do you need more breaks? What time of day are you most productive? Do you need a different kind of job than you have currently or have had in the past? Asking questions like these may help you get clear about producing the best work environment for you. As you probably know, many people with bipolar disorder struggle with impulsivity. So whatever you do, take your time to make big job changes. Talk them over with family, health care providers, and your therapist. Also, be aware of the importance of regular and predictable sleep times for managing bipolar disorder, and if your job requires shift work, speak with your boss or supervisor about making any accommodations in your schedule that may be necessary for properly managing your condition If you think you are being treated unfairly at work due to your bipolar disorder, know that you can seek help. The Americans with Disabilities Act ( ADA) protects people from discrimination, whether their disability is physical or mental. However, the law does not contain a list of medical conditions that make up disabilities. Instead, it has a general definition of disability that each person must meet. Therefore, you may or may not have a disability under the ADA. Disability is defined as impairment that substantially limits one or more major life activities, a past record of these limitations, or being regarded as having such an impairment. These laws are complex. Before taking any legal action, it is important to get professional advice. You can call the U. S. Department of Justice ADA Information Line at 1-800-514-0301 or go to www.ada.gov. If you need time off because of your bipolar disorder, in most cases, you have more than one option besides vacation and sick leave. See if your employer offers short- or long-term disability insurance, which allows you to receive a certain percentage of your salary. Your company's Human Resources department can help. The Family and Medical Leave Act ( FMLA) allows you to take up to 12 weeks of unpaid leave during a year. For more information, call 1-866-487-9243 or visit the U. S. Department of Labor web site. You can apply for Social Security Disability Insurance ( SSDI) benefits if you can't work due to a mental or physical disability. Call 1-800-772-1213 or visit the Social Security web site.