Sleep-Wake Patterns of Adolescents with Borderline Personality Disorder and Bipolar Disorder

Abstract

Sleep-wake patterns are rarely examined in adolescents with borderline personality disorder (BPD) or bipolar disorder (BD). Within a developmental perspective, this study explores the sleep-wake cycle of adolescents aged 12-17 years with BPD or BD and healthy controls (HC) during periods with and without entrainment by school/work schedules. Eighteen euthymic BPD, six euthymic BD, and 20 HC adolescents wore wrist actigraphy during nine consecutive days to assess sleep-wake patterns. During school/work days, BPD adolescents spent more time awake when they were in bed compared to HC and BD adolescents (p = 0.039). On schedule-free days, BPD and BD youths spent more time in bed compared to HC adolescents (p = 0.015). BPD adolescents woke up over 1 h later compared to HC (p = 0.003). Total sleep time was more variable between nights in BPD adolescents compared to the HC group (p = 0.031). Future research should explore if sleep-wake pattern disruptions are a cause or a consequence of BPD symptomatology in adolescents. Addressing sleep-wake pattern during clinical assessment and treatment of BPD adolescents may potentially reduce their symptoms; this therapeutic effect still needs to be evaluated.

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

“…Nearly all studies examining objective sleep measures used polysomnography in laboratory conditions. One study utilised a portable electroencephalogram sleep recording device (Hornung et al, 2008), while two utilised wrist actigraphy (Bromundt et al, 2013;Huỳnh, Guilé, Breton, & Godbout, 2015).…”

“…Most studies with clinical control groups included depressed patients with the exception of one group of prisoners with Antisocial Personality Disorder (Lindberg et al, 2003), one group of patients with insomnia (Bastien et al, 2008), and one group of adolescent outpatients with bipolar disorder (Huỳnh et al, 2015). Most studies reported a psychotropic medication wash-out period (usually of 2 weeks) prior to sleep assessment; five did not report a wash-out period (Huỳnh et al, 2015;Plante, Frankenburg, Fitzmaurice, & Zanarini, 2013b;Selby et al, 2013;Simor, Csóka, & Bódizs, 2010;Taherifard, Abolghasemi, & Hajloo, 2015).…”

“…Most studies reported a psychotropic medication wash-out period (usually of 2 weeks) prior to sleep assessment; five did not report a wash-out period (Huỳnh et al, 2015;Plante, Frankenburg, Fitzmaurice, & Zanarini, 2013b;Selby et al, 2013;Simor, Csóka, & Bódizs, 2010;Taherifard, Abolghasemi, & Hajloo, 2015). Adult samples were used in most studies; only three had adolescent samples (Dagan et al, 1998;Huỳnh et al, 2015;Lereya et al, 2016).…”

“…Three studies indicated irregularities in circadian rhythms in BPD. Individuals with BPD appear more susceptible to delayed sleep phase syndrome: DSPS (Dagan et al, 1998); experience greater variability in Relative Amplitude, i.e., the distribution of activity between day and night (Bromundt et al, 2013); and experience wider sleep variability between weekdays and weekends (Huỳnh et al, 2015).…”

“…Cognitive Behaviour Therapy for insomnia (CBT-I) is an effective treatment (Harvey, 2015), which may help reduce maladaptive sleep related cognitions and potentially aid recovery in BPD (Plante et al, 2013a). Considering the high incidence and potential aetiological role of nightmares in BPD , imagery rescripting and rehearsal (IRR) and imaginal confrontation with nightmare contents (ICNC) may be other evidencebased approaches for some patients (Hansen, Höfling, Kröner-Borowik, Stangier, & Steil, rhythms therapy (Harvey, 2015) are further options for disturbed circadian rhythms in BPD (Bromundt et al, 2013;Dagan et al, 1998;Huỳnh et al, 2015).…”