Chronic sleep disturbances and borderline personality disorder symptoms

Although not traditionally thought of as a disorder associated with sleep disturbances, there is growing evidence that those with borderline personality disorder (BPD) experience a variety of problems with sleep, including: increased sleep onset latency and low sleep efficiency during polysomnograpahy assessments (Bastien et al., 2008), abnormal sleep architecture (Battaglia et al., 1999), and nightmares (Asaad et al., 2002; Selby, Ribeiro, & Joiner, in press). Sleep problems are clinically pertinent to BPD, as they are linked to functional impairment (Roth et al., 2006) and emotion dysregulation (Zohar et al., 2005). To date minimal research has systematically examined sleep disturbances in BPD, particularly chronic sleep problems. Chronic sleep problems involve difficulty sleeping most nights for an extended period of time (often lasting weeks to months), as opposed to acute sleep problems, which may last for a few days or arise intermittently, and can lead to major problems in daily functioning (Simon & Von Korff, 1997). Research is also lacking on BPD and the daytime consequences of chronic sleep problems, such as excessive daytime sleepiness, poor sleep related fatigue, and difficulties engaging in activities due to poor sleep. Importantly, BPD may increase vulnerability to sleep problems, due to issues such as emotion dysregulation, and poor sleep may result in elevated daytime functional impairment. Improving our understanding of sleep disturbances in BPD is also relevant to improving our interventions. At present, dialectical behavior therapy (DBT; Linehan, 1993) is the only psychotherapy for BPD that specifically addresses sleep problems. Improving the sleep of patients with BPD may aid in improving their ability to manage stressful situations, employ coping skills, and improve overall levels of energy and positive affect. In turn, improving the ability to manage stress may further reduce sleep problems (Carlson & Garland, 2005). Those with BPD also frequently experience suicidal ideation, the experience of which has itself also been linked to sleep problems (Sjostrom, Waern, & Hetta, 2009; Wojnar et al., 2009). This makes it important to determine if the sleep problems of those with BPD also occur beyond the context of suicidal ideation. Previous studies on sleep and BPD have involved small samples, often during acute polysomnography studies, and none to date have examined BPD and chronic sleep problems in a large epidemiological sample. One advantage to using such a sample is reduced treatment seeking bias, and increased understanding of how these issues affect people in the community at-large. Another advantage is the ability to control for Axis I disorders that are intertwined with acute and chronic sleep problems (e.g., depression, anxiety disorders) – an important issue given the role of comorbidity in BPD (Lenzenweger et al., 2007). The purpose of the present study was to examine chronic sleep disturbances, poor sleep related consequences, and social/emotional and cognitive impairment as a function of poor sleep in those exhibiting BPD symptoms with the National Comorbidity Survey Replication (NCS-R; Kessler & Merikangas, 2004).