Signs of Insomnia in Borderline Personality Disorder Individuals

Abstract

Scientific inveStigAtionSStudy objectives: Recent findings suggest few differences in sleep continuity and quality between borderline personality disorder individuals (BPD-I) and good sleepers (GS). Nonetheless, BPD-I show marked discrepancies between subjective and objective sleep measures. The objective of this study was to document sleep in BPD-I, GS, and insomnia sufferers (paradoxical, Para-I; psychophysiological, Psy-I). Participants: Twelve BPD-I (mean age 33.3 years), 15 GS (mean age 34.1 years), 15 Para-I (mean age 41.1 years), and 15 Psy-I (mean age 36.6 years). Methods: Participants underwent 3 consecutive nights of polysomnography recordings. All participants completed a clinical interview and 2 weeks of sleep diaries. BPD-I received DIB-R assessment. Participants were not suffering from any other psychopathology and were drug free. Results: Subjectively, BPD-I and GS laboratory sleep reports were similar. However, Psy-I and Para-I took longer to fall asleep, were awake longer after sleep onset and during the night, slept less, and had lower sleep efficiency than both GS and BPD-I (p < 0.05). Objectively, BPD-I, Psy-I, and Para-I had longer sleep onset, shorter sleep time, and lower sleep efficiency on all 3 nights than GS (p < 0.05). Furthermore, BPD-I had more stage 4 (both in proportion and time) than Para-I on all 3 nights (p < 0.05). conclusion: Results suggest that BPD-I suffer from insomnia. While BDI-I reported feeling less refreshed upon awakening, they spent more time in stage 4 than other individuals. As BPD-I are very sensitive to loneliness and interpersonal stressors, laboratory settings might provide a secure context facilitating sleep.

Altered sleep in Borderline Personality Disorder in relation to the core dimensions of psychopathology

“…Nevertheless, recent studies have found elevated levels of SWS sleep in BPD patients (Bastien et al, 2008) and increased spectral delta power in NREM sleep (Philipsen et al, 2005). We suggest that these novel findings are due to the better control of co-morbid psychopathology and to the change in the psychiatric consensus focusing more on the "impulsivity" dimension of BPD (Zanarini, 1993).…”

“…A "NEGLECTED" SYMPTOM: DISTURBED SLEEP IN BPD Subjective sleep difficulties are often reported in BPD (Bastien, Guimond, St-Jean & Lemelin, 2008;Philipsen, Feige, Al-Shajlawi et al, 2005) and different lines of research suggest that altered sleep architectureas evidenced by polysomnographic measuresis a common characteristic of this mental disorder (Boutros, Torello & McGlashan 2003). Nevertheless, relatively few studies investigated the specific sleep profile in BPD.…”

Perceived poor sleep quality in the absence of polysomnographic sleep disturbance in women with severe premenstrual syndrome

“…A perception of poor sleep quality in the absence of objectively-measured poor sleep is not unique to severe PMS. Similarly, research has shown that patients with irritable bowel syndrome (Elsenbruch et al, 2002), borderline personality disorder (Bastien et al, 2008;Philipsen et al, 2005) and insomnia (Harvey and Tang, 2012;Krystal and Edinger, 2008) may report poor sleep quality in the absence of objective sleep disturbances. In pregnant and postpartum women, subjective and actigraphy measures of sleep efficiency are not correlated and there is a strong association between poor subjective nighttime sleep, but not objective sleep, and greater psychological disturbances (Bei et al, 2010).…”

“…These altered sleep responses may relate to the circadian rhythm disturbances that characterize this population (reviewed in Shechter and Boivin, 2010). Interestingly, patients with borderline personality disorder have higher delta power (Philipsen et al, 2005) or more Stage 4 sleep (Bastien et al, 2008) in addition to having poorer, non-refreshing sleep and feeling fatigued upon awakening. Women with severe PMS or PMDD also have distinct personality traits, particularly higher neuroticismrelated traits, such as trait-anxiety and stress susceptibility (Halbreich, 1997), and they are more likely to have traits of a personality disorder, particularly obsessive-compulsive disorder (Sassoon et al, 2011).…”

“…Interestingly, patients with borderline personality disorder have higher delta power (Philipsen et al. , 2005) or more Stage 4 sleep (Bastien et al. , 2008) in addition to having poorer, non‐refreshing sleep and feeling fatigued upon awakening.…”