Sleep disturbance in borderline personality disorder
Research type
Research Study
Full title
Sleep disturbance in borderline personality disorder
IRAS ID
246776
Contact name
Kate Saunders
Contact email
Sponsor organisation
Clinical Trials and Research Governance, University of Oxford
Duration of Study in the UK
1 years, 8 months, 14 days
Research summary
Research Summary:
Borderline personality disorder (BPD) is a psychiatric disorder characterised by interpersonal difficulties, impulsiveness, and mood instability. Sleep problems are widely reported by these patients but rarely diagnosed or treated systematically. In a previous study we found that people with BPD had a markedly delayed rest-activity profile which differed from healthy volunteers and people with bipolar disorder. Features of sleep and circadian rhythm disturbance were in turn associated with worsened mood symptoms and impulsiveness in the BPD patient group. In this new study we wish to confirm our previous findings, this time using gold standard measures of sleep and circadian rhythm function we will compare healthy controls to BPD participants.Additionally, in this study we will assess the acceptability and efficacy of a behavioural programme involving morning bright light exposure (Bright Light Therapy; BLT) combined with digital cognitive behaviour therapy for insomnia (dCBT-I) which actively restructures sleep timing and targets maladaptive beliefs and attitudes regarding sleep. The primary outcome of the study is to determine to what degree this intervention advances the rest-activity cycle to an earlier point of the day and improves sleep quality. The effectiveness of this sleep targeted approach will be compared to a non-specific positive mental training intervention promoting wellbeing which is delivered via smartphone application and to a waiting list control BPD group.
Summary of Results:
One of the key features of many mental health difficulties are disrupted patterns of sleep and wakefulness. In stage 1 of the study we compared self-reported and digital measures of sleep and daytime activity between individuals who had been diagnosed with borderline personality disorder (BPD) and participants without a psychiatric diagnosis. In stage 2 we went on to explore whether behavioural and educational techniques designed to promote better sleep were effective for individuals diagnosed with BPD.In stage 1 participants were invited to complete some questionnaires about their sleep, mood and personality traits. They then spent four weeks wearing a watch which measured their activity, and reported their sleep and mood on a daily basis. Participants diagnosed with BPD were more likely to report their mood as low or irritable compared to participants with no psychiatric diagnosis.
While both groups reported similar duration of sleep those diagnosed with BPD spent more time in bed and spent more of this time in bed awake. This suggests a lower so called 'sleep efficiency' which is a common feature among people who experience insomnia. For those diagnosed with BPD lower sleep efficiency was associated with more unstable mood the following day.
These findings suggest that sleep may be an important factor in the regulation of mood for those diagnosed with BPD. Interventions that improve sleep could be helpful in managing unstable mood.
In stage 2 of the study participants diagnosed with BPD were invited to use an online programme called Sleepio, in combination with a bright light box. Sleepio is a six-week digital sleep-improvement program which features the latest cognitive and behavioural techniques. Bright light boxes mimic natural light which keeps sleep and other body rhythms aligned with the correct 24-hour cycle. For some people, these devices may improve mood. Participants completed Sleepio and used a bright box every morning for 30 minutes for six weeks. They also reported their sleep on a daily basis and wore a watch which measured their activity. At the end of the study we asked participants to share their feedback about using Sleepio and the bright light box. Recruitment to stage 2 was significantly impacted by the pandemic and the number of participants was too low to reach any meaningful conclusions. However, there are some initial indications that the interventions may have been helpful. This provides further support for the need to explore interventions to improve sleep for people diagnosed with BPD.
REC name
South Central - Oxford B Research Ethics Committee
REC reference
18/SC/0366
Date of REC Opinion
8 Aug 2018
REC opinion
Further Information Favourable Opinion