Is it permissible for a patient with bipolar disorder, who takes a sedative that necessitates continuous sleep for at least six hours after the 'Isha prayer and cannot do without it, to break their fast in Ramadan and offer expiation for each day, knowing that not taking the medication causes severe side effects and relapses of their illness?

If it is possible to take the medication at night after dinner and immediately go to sleep, then breaking the fast is not permissible, and the intention (niyyah) should be made before sleeping. Tarawih prayers and Qiyam (night prayers) are not obligatory, and for one who misses them due to a valid excuse, their reward will be written for them, based on the Prophet's (peace and blessings be upon him) saying: "If a servant falls ill or travels, the like of what he used to do when he was healthy and at home will be written for him." If it is not possible to take the medication at night and it is indispensable to take it during the day, then breaking the fast is permissible, and it should be made up after recovery. Feeding the poor (fidya) should only be resorted to if the illness is not expected to be cured and fasting becomes impossible with it; in such a case, one breaks the fast and feeds a poor person for each day.