Treating Insomnia May Be Important for Borderline Personality Disorder

A growing body of evidence is strengthening the connection between sleep and borderline personality disorder (BPD). In a new study, researchers in the Czech Republic found that addressing insomnia may play a role in helping manage the condition.

BPD is a personality disorder characterized by varying moods, self-image, and behavioral issues. Sleep disturbances are a commonly known symptom in people who live with this personality disorder. For the systematic review, researchers examined 42 papers to see how insomnia may play a role in exacerbating behaviors associated with BPD, including:

• Non-suicidal self-harm
• Suicidality
• Substance abuse disorders

The researchers found a correlation between insomnia and worsening of some of these behaviors, pointing to the need for BPD treatment to incorporate a plan for managing sleep disturbances. "Recognizing and managing dreaming and sleep disorders in patients with BPD may help alleviate the disorder’s symptoms," the researchers wrote. The study was published in February in the Nature and Science of Sleep journal.

"[For] somebody who's not sleeping, if we can help them in any way to sleep better, to reduce that insomnia, that's automatically going to give them more resources to do the work that they need to do in therapy and interpersonally and that introspective work." Jennifer Dragonette, PsyD, executive director of Newport Institute in California, who was not involved with the study, tells Verywell.

Sleep and Regulating Emotions

As the systematic review highlighted, both BPD and insomnia can interfere with emotional regulation and cause emotional dysregulation.

"Insomnia can make emotion regulation more difficult, and then emotion regulation problems result in strong emotions and distressing thoughts that can make it harder to sleep, which makes emotion regulation even more difficult," Aimee Daramus, PsyD, a licensed clinical psychologist based in Ilinois, tells Verywell.

A 2020 study published in the Personality Disorders journal found that higher sleep efficiency and fewer sleep disturbances for people who have BPD would likely increase emotional regulation. The researchers found that abnormalities in time in bed and sleep efficiency increased emotional dysfunction for people with BPD.

Insomnia Can Impact Paranoia Symptoms

BPD can present itself in different ways for different people, like many mental health disorders. According to the National Institute of Mental Health, fears of abandonment for people who have this personality disorder may lead them to swing between extreme closeness with friends and family, to expressing extreme dislike towards the same people.

"The difficulty in maintaining interpersonal relationships is a symptom, and so you tend to find things because you're exhausted to correlate with your own insecurities that make sense to you," Alyza Berman, LCSW, RRT-P, founder and clinical director of the Berman Center in Georgia, tells Verywell.

For patients who have or may have BPD, one of the first questions that Berman tends to ask is how much sleep they are getting. When people get enough rest, Berman believes that people may be able to cope with their symptoms better. "The symptoms oftentimes decrease because you feel recharged, and you feel more secure to conquer the world the next day," she says.

Research suggests that people with BPD may experience paranoid ideation, which typically involves paranoid around feeling threatened, persecuted, or conspired against. A January 2018 study suggests that insomnia and other sleep disturbances may impact paranoid ideation negatively.

"If insomnia increases paranoia that [could] very easily play into increase the capacity of what we see with borderline personality disorder, leading to increased self-harm, increased suicide attempts, more difficult relationships with loved ones," Dragonette says.

The Importance of Dialectical Behavioral Therapy

In the systematic review, researchers suggest that dialectical behavioral therapy (DBT) could play a role in helping people with BPD sleep better.

DBT is a type of therapy that was developed to help people with BPD manage their symptoms. According to the National Institute of Mental Health, DBT uses concepts of mindfulness and also helps people become attentive to their current situation and emotional state—teaching people skills to help:

• Control intense emotions
• Reduce self-destructive behaviors
• Improve relationships

"Once you've had that skill down...you can relax, you're not overthinking, you understand how your thoughts, feelings and behaviors, all connect you can refrain [from other thinking]," Berman says. She adds that after someone practices DBT, they may be able to rest their mind better, which can help them sleep.

Dragonette also believes that practicing mindfulness through DBT may help a person with BPD sleep better. Medication can be used to address insomnia and sleep disturbances, but Dragonette cautions against long-term use of medication for insomnia for people with BPD.

"Sometimes, people can then get in the habit of feeling like they can't sleep without medications," she says. "I would just hope that people are utilizing them with somebody who's prescribing carefully, and with the understanding that the goal is to help get them through a period of sleeplessness, and then ultimately taper off with that medication."

People with BPD can also practice general good sleep hygiene. The Centers for Disease Control and Prevention suggests you:

• Go to bed at the same time each night and get up at the same time in the morning
• Make sure that your bedroom is quiet, dark, and relaxing
• Keep your bedroom at a comfortable temperature
• Avoid large meals, caffeine, and alcohol before bedtime