Sleep and Borderline Personality Disorder
Proper socio-cultural interaction and associations are important for a person’s well-being. They are a sign of psychological well-being. They enable an individual to handle and manage stress as well as take part in cognitive-dependent activities like learning and working. A person who only achieves such levels of psychological well-being is they are mentally healthy. There are several types of mental health disorders. Lack of sleep (insomnia) is a common symptom of many types of mental illnesses- addiction disorders, PTSD, anxiety, depression and personality disorders. The process of treating mental health disorders requires mitigating insomnia as a symptom of the same. This paper seeks to analyze and explore the interrelations between borderline personality disorder and sleep (or lack thereof). It analyzes recent research articles on how borderline personality disorder is affected by sleep.
As such, this paper is a research exploration that seeks to determine the quantity and quality of current scientific knowledge on the associated relationships between borderline personality disorder and sleep. It seeks to determine the cause-and-effect relationships between borderline personality disorder and sleep. This research seeks to uncover the sleeping patterns of individuals with a borderline personality disorder, whether the causes of these associated patterns are physiological neurological) or psychological. It also seeks to uncover the effect of sleep on borderline personality disorder as a mental health condition- how does changes in sleeping patterns, quality as well as quantity affects people with borderline personality disorder (BPD).
In addition, this paper will also analyze the documented evidence-based researches on the approaches used by experts to mitigate the lack of sleep in cases of borderline personality disorders.
The Topic
The main topic in this research is the associated effects on BPD, including their cause-and-effect relationships as well as currently applied evidence-based approaches to mitigating lack of sleep in patients with BPD. BPD, as a mental health condition, is characterized by impulsivity, violent thoughts and actions in some cases, emotional instability, and dysfunctional relationships with others (Oltmanns & Oltmanns, 2015). The symptoms of the disease are discernable since there is impairment of the part of the brain that controls emotions and impulses from a hormonal perspective.
Our bodies require long periods of sleep every day since sleep is an active period in which growth, restoration, and rejuvenation of muscles and other tissues take place. It is also an active period of normal body activity where the synthesization of hormones takes place. Also, sleep is necessary for individuals since it helps in the consolidation of memory. Sleep offers a psychological avenue through which memories are processed and stored. As such, sleep is an important aspect of growth, development and overall well-being of an individual. These outcomes and objectives of sleep are the variables that determine the sleep quality (Taherifard et al., 2015). An individual’s ‘sleep quality’ is determined by the quantitative and qualitative manifestations of the above-stated aspects over relatively long periods.
Professional Experiences with Sleep and Borderline Personality Disorders
Insomnia and other sleep-related problems are common and prevalent among individuals struggling with the condition. BPD is associated with various types of sleep disturbances and interferences- altered REM (rapid eye movement) regulation, disturbances in the continuity of sleep, and frequent nightmares (Taherifard et al., 2015). These disturbances in sleep result from and individual’s interactions with people with different personality traits, eliciting different and extreme emotional and impulsive reactions and other environmental factors as well as comorbid and concomitant diseases.
However, these cause-and-effect relationships are not entirely linear- scientists discovered a synergistic effect between the two, where sleep disturbances tend to aggravate other symptoms of BPD (C, 2019) . As such, lack of sleep in patients and individuals with BPD leads to higher levels of functional impairment. BPD is associated with three forms of chronic sleep disturbances. People with BPD demonstrate difficulty in initiating and falling asleep. They experience difficulty in maintaining continuity in sleep for required periods. People with BPD also generally wake up earlier than desired (Kalpakci et al., 2018). They also experience the consequences of inadequate sleep (grumpiness, an increased sense of irritability, tiredness as well as other physiological effects of poor sleep) that further accentuate the symptoms of BPD.
BPD’s interruption of the quantity of sleep has a corresponding effect on the quality of sleep. If the quantity of sleep is altered, more so as a result of BPD, the overall quality of the sleep- rejuvenation, repair, and growth of tissues, synthesis of hormones as well as the consolidation of memories is also affected. Since these aspects are inherent measures of sleep quality, people with BPD generally experience poor sleep quality as a result of alterations in the quantity of sleep.
There are several transcending interventions used to mitigate sleep disturbances in patients with BPD that are also applicable in treating sleep disturbances in other mental health illnesses. These interventions are either behavioral (non-pharmacological) or pharmacological, with the former contributing to a bulk of the applied treatment options. Relaxation therapy often involves the teaching and practice of specific relaxation exercises and techniques with a trained professional over several sessions of treatment (Taubner & Volkert, 2019).
An example of behavioral interventions for sleep disturbances in individuals with BPD is relaxation therapy. Relaxation therapy is thought to work best in patients that demonstrate high and even extreme levels of emotional and psychological stimulation and arousal during the night-time as well as during the day. It is considered one of the best interventions for mitigating sleep in individuals with BPD since it seeks to quench the patient’s perceived inability to relax (Taubner & Volkert, 2019). The various physical and physiological strategies used in relaxation therapy include PMR (progressive muscle relaxation), autogenetic training and biofeedback mechanisms. Biofeedback is a strategy in relaxation therapy where audio-visual sensory feedback, through the use of computers, is used to help patients with sleep disturbances gradually learn to control and reduce their somatic arousal levels and in turn, enables them to fall asleep better.
Attention-focused strategies such as meditation and imagery training can help to reduce cognitive arousal associated with sleep disturbances in patients with BPD. Through meditation and abdominal breathing, one can focus on more relaxing and calming thoughts as opposed to the intrusive thoughts coupled with the state of restlessness (racing mind) that define cognitive arousal (Taubner & Volkert, 2019). These strategies are useful for initiating sleep as well as sleep maintenance in patients, which causes patients to achieve the relevant quantities (and therefore quality) of sleep.
Theory
There are limited theories that explain the associations between BPD and the associated lack of sleep. These theories arise from the limited neurological knowledge of BPD as a mental health disorder. A transcending scientific theory, however, was developed that connects the causing agents of BPD as a mental health condition with the neurological explanation of sleep.
Humans require several minutes of relaxation to calm down and eventually fall asleep. This period and experience of relaxation are needed to cause ventrolateral preoptic nucleus (VPLO) neurons in the brains to inhibit the activity of arousal-promoting centers that promote wakefulness. This inhibition, in turn, causes the brain to ‘shut down’ and therefore, the individual falls asleep. The unstable patterns of anxiety, impulsiveness, emotional instability associated with BPT inhibit this state of relaxation that is necessary to induce sleep since the imbalance causes active and extreme stimulation of the brain (Tyrer & Mulder, 2018). The individual is, therefore, incapable of attaining the pre-requisite level of relaxation to induce sleep. As such, sleep alterations are considered symptoms and indicators of BPD. Individuals with BPD generally show poor patterns of sleep.
Research Designs
A majority of the articles that link BPD and sleep disorders usually involve qualitative analysis of sleep disturbances in individuals with BPD. These qualitative researches are prudent in the comparison, exploration, and analysis of BPD and sleep disturbances since sleep cannot be quantified and thus, experimental data almost entirely depends on qualitative perceptions of patients (C, 2019). As such, most researches usually involve qualitative investigation in adults and not necessarily young children. As such, there exists a gap in research in investigating sleep disturbances in individuals with BPD. Although difficult, exploring sleep disturbances in children with BPD is possible- in terms of quality of sleep, quantity and the analysis of the various interventions used to treat sleep disorders in children. Qualitative data in young children (between 2 to 7 years old), which is difficult due to the perceived inability of children to accurately communicate their sleep experiences, can be obtained via their mothers’ or guardians’ support. Qualitative information on older children (older than eight years old) as well as adolescents, with regards to sleep disturbances in cases of BPD, may be determined via simplified questionnaires and other forms of qualitative inquiry.
Components of Scientific Merit
In as much as these approaches are difficult and inherently require cooperation between the parents (or guardians) of children with BPD, it is the best possible approach to investigate BPD’s associations with sleep in children These approaches are necessary because of the accuracy needs that may not be met in cases where qualitative information on quality and quantity of sleep is obtained from children. Also, some aspects of monitoring the progression of BPD in children such as emotional temperament, impulsivity, maladaptive and potentially destructive behavior, and deterioration of relationships with teachers, friends and neighbors are inherently monitored over time and can best be explained via their parents’ or guardians’ experiences.
Conclusion
In conclusion, borderline personality disorder is a type of mental illness (the embodiment of all personality disorders) that affects people’s reactions to others and situations. Like most personality disorders, BPD is closely associated with sleep disturbances. The proportion of patients that experiences some form of sleep disturbance is estimated to be between 45% and 95%. As such, it is important for mental health professionals to continually assess and review current knowledge and practice paradigms associated with the condition. The research articles analyzed in this paper are, however, void of significant scientific information regarding the condition and children. This offers a research gap that should be filled if the improvement of treatment options in children with BPD is to be achieved.
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