People with borderline personality disorder often have nightmare-related problems that are separate and distinct from other significant sleeping issues, according to new findings from a group of German researchers. People affected by borderline personality disorder (BPD) have an unusually high level of exposure to chronic sleeping problems that can substantially reduce their ability to remain alert and functional during waking hours. In a study published in February 2015 in the journal Borderline Personality Disorder and Emotional Dysregulation, researchers from two German institutions looked at the role that nightmares play in the sleep-related issues of individuals with BPD. These researchers concluded that nightmares have a damaging impact that’s separate from the impact of other chronic sleeping problems.
Nightmares and BPD
Nightmares are dreams that produce distinctly negative states of mind such as anxiety, dread or fear. Such dreams commonly occur in children between the ages of 3 and 10. They occur less often in older children, teenagers and adults. In most cases, nightmares are occasional nuisances that don’t contribute significantly to any downward turns in health and well-being. However, some people have recurring and/or severe nightmares that n diminish their ability to lead functional daily lives. Under terms established by the American Psychiatric Association, doctors can officially diagnosis a condition called nightmare disorder in individuals who experience serious nightmare-related life disruption. Nightmare disorder belongs to a larger group of sleep-related illnesses called parasomnias. Roughly half of all people affected by borderline personality disorder have recurring nightmares. In addition, people with the disorder have heightened risks for the onset of nightmare disorder. Problems linked to the development of impairing nightmares in any given person with BPD include the presence of a sense of detachment from reality (known formally as dissociation), a general decline in restful sleep and a childhood history of exposure to highly traumatic events or situations. Broadly speaking, the combination of nightmare disorder and borderline personality disorder is associated with heightened overall severity of BPD symptoms.
Chronic Sleep Disturbance and BPD
Sleep specialists and other health professionals use the term chronic sleep disturbance to refer to an unusual inability to fall asleep at appointed sleeping times, stay asleep during appointed sleeping times or avoid waking up prematurely toward the end of appointed sleeping times. The most common consequence of one or more of these problems is an elevated level of sleepiness during waking hours. Severely affected individuals may qualify for a diagnosis of insomnia disorder or other conditions belonging to a category of illness known as sleep-wake disorders. Compared to the general population, people with BPD have a significantly increased tendency to experience clinically serious problems falling asleep, staying asleep and avoiding waking up prematurely toward the end of designated sleeping times.
Nightmares vs. Chronic Sleep Disturbance
In the study published in Borderline Personality Disorder and Emotional Dysregulation, researchers from Germany’s Mannheim/Heidelberg University and University of Mannheim used a small-scale project involving 34 adults to explore the roles of nightmares and chronic sleeping problems in people with borderline personality disorder or other emotion-related mental health conditions. Seventeen of these adults experienced nightmares on at least a weekly basis, while the remaining study participants did not have any nightmare-related problems and acted as a generally healthy comparison group. For a number of reasons, the researchers only included participants who did not have a current or past history of BPD or any other diagnosable mental illness apart from nightmare disorder. All of the study participants underwent extensive, objective sleep testing that examined things such as the amount of time spent in various stages of sleep, the overall amount of time spent asleep, relative wakefulness before sleep and the length of the transition between wakefulness and sleep. In addition, all of the participants answered detailed questionnaires designed to identify diagnosable symptoms of nightmare disorder, insomnia disorder, other parasomnias and other sleep-wake disorders. The researchers compared the results of the objective sleep testing to the results of the sleep questionnaires. They found that the participants affected by recurring nightmares had a clearly increased tendency to self-report insomnia and other sleep disturbances that reduced their ability to feel awake and well-rested during the day. However, they also found that the results of the objective sleep testing did not indicate any real difference in the overall sleeping patterns of the nightmare-affected participants and the non-affected participants. In line with these findings, the researchers concluded that the damaging effects of nightmare disorder are distinct from the damaging effects of chronic sleep disturbance.