My health often deteriorates for short periods of time, perhaps a day or two, sometimes a week or so. In these situations there is often some trigger - high workload, poor sleep hygiene etc. My mood doesn't usually reach such an extreme that it causes any significant difficulty day to day.
Episodes of illness that have a significant detrimental impact on day to day life seem to build up slowly. They start out like the episodes described above but they just keep on going until my mood is so extreme that day to day life becomes very difficult to deal with.
My most recent episode of this nature was probably caused by the stress of a couple of deaths in the family, a daughter who doesn't want to sleep, a wife commuting across country to work, a high workload myself and (frustratingly) mental health services not providing care when I could see my health was deteriorating.
It's been around 6 years between my last two episodes of that nature.
Poor sleep hygiene is by far the biggest risk for me and it becomes a vicious cycle if I'm in a manic phase. Other than that, continued high levels of stress are a problem but only really if I'm dealing with multiple stressors.
