Borderline Personality Pathology, Polysomnography, and Self-Reported Sleep Problems: A Review

Abstract

There is a growing body of research that links borderline personality pathology to sleep disturbance through polysomnography (PSG) and self-report studies. Twelve PSG studies are reviewed that found sleep differences in recordings of sleep parameters such as sleep continuity, non-REM sleep, and REM sleep in borderline personality disorder (BPD) patients compared to controls. Further, since the turn of the century, self-report methodology has been increasingly utilized to investigate this relationship, and findings from these studies are reviewed. The evidence suggests that borderline personality pathology is uniquely associated with sleep disturbance. Future directions for this research are discussed.

The sleep phenotype of Borderline Personality Disorder: A systematic review and meta-analysis

“…Also in contrast to conclusions from previous reviews (Oltmanns & Oltmanns, 2015a), we found that patients with BPD experienced significantly shorter REM latency than HCs. This finding was robust across several sub-groups, including depression status, sample type, and sex.…”

“…They did, however, demonstrate significantly less SWS. This result contrasts with previous reviews, which did not identify a difference in SWS between BPD and HCs (Oltmanns & Oltmanns, 2015a), or suggested a potential increase in SWS in BPD (Simor & Horváth, 2013). Discrepant conclusions across reviews are likely partly due to a lack of power in individual studies (i.e., null findings, which when combined in meta-analysis reveal significant associations).…”

“…Our results extend previous reviews (Hafizi, 2013;Oltmanns & Oltmanns, 2015a) by quantitatively demonstrating significant differences between BPD and HC groups across all sleep continuity measures.…”

“…This lends some support to the previous suggestion that sleep continuity problems are independently associated with BPD, rather than being a consequence of comorbid depression (Oltmanns & Oltmanns, 2015a). Subgroup analysis also demonstrated that differences between BPD and HC groups were significant in studies utilising polysomnography (rather than wrist actigraphy or other non-lab-based devices), and in inpatient populations.…”

“…Similarly, Simor and Horváth (2013) reported that sleep fragmentation, alterations in Slow Wave Sleep (SWS) -though again results were mixed, shortened REM latency, and dysphoric dreaming are prevalent in BPD. In a narrative synthesis of 12 polysomnography (PSG) studies, Oltmanns and Oltmanns (2015a) reported differences in sleep between BPD patients and healthy controls including less total sleep time (TST), decreased sleep efficiency (SE), longer sleep onset latency (SOL) and more frequent arousals. The authors concluded that BPD may be independently associated with sleep disturbances.…”