Elsevier

Current Opinion in Psychology

Volume 34, August 2020, Pages 72-76
Current Opinion in Psychology

Insomnia in personality disorders and substance use disorders

https://doi.org/10.1016/j.copsyc.2019.10.005Get rights and content

The relationship between certain personality disorders (PDs) and insomnia has been the object of few studies in recent years. Even though it is not indicated to use polysomnography to diagnose insomnia, objective measures have shown sleep abnormalities in individuals with a personality disorder and insomnia. Interestingly, there is increasing evidence that emotion dysregulation is involved in a mutually aggravating relationship between Borderline Personality Disorder (BPD) and insomnia. While BPD traits are highly associated with suicide ideation and attempts, these behaviors could be potentiated or enhanced in individuals presenting sleep disturbances. Because BPD and other mental disorders are often linked with the use of medication or other substances, it is also important to review the association between substance use disorders (SUD) and insomnia. SUD can disrupt sleep and foster insomnia, which in turn might increase motivation to use substances. Insomnia has also been shown to precede (i.e., predict) SUD, and can be present during withdrawal as well. These results highlight the need to assess and treat insomnia when working with patients who present a PD or SUD.

Introduction

Insomnia is an important health issue [1], afflicting around 10% of the general population [2]. It is associated with daily cognitive impairments (e.g., memory/attention deficits) [3] and higher rates of depression and anxiety [4]. The DSM-5 [5] defines insomnia as a difficulty in initiating or maintaining sleep which is present at least three times a week in the past three months based on subjective reports [5]. It can present itself alone or in comorbidity with another health disorder (mental, physical, or sleep-related). This paper will focus on insomnia in comorbidity with personality disorders and substance use disorders since research in these particular areas has surged in recent years.

Section snippets

Comorbidity between PDs and insomnia

A growing field of research focuses on the relationship between insomnia and PDs. Studies show that 50% to 93% of individuals with a PD experience at least one sleep problem or self-identify as insomnia sufferers [6,7,8]. Conversely, more than 50% of individuals with insomnia received at least one PD diagnosis [9]. These findings indicate that, while individuals with a PD are more likely to present sleep disturbances, individuals with insomnia may be at higher risk for exhibiting maladaptive

Comorbidity between SUD and insomnia

Systematic and narrative literature reviews indicate that the use of substances and sleep disorders share a bidirectional relationship [27, 28, 29]. Insomnia can be present before substance dependence or abuse, or be associated with withdrawal (lasting for weeks) and relapse [27]. In their literature review, Grau-López et al. [30] reported that in studies recruiting patients with a SUD, the prevalence of insomnia ranges from 30% to 85% depending on the primary substance of abuse. Conversely,

Conclusion

Only a paucity of research exists in the field of personality disorders and insomnia. The relationship between substance use disorder and insomnia, in contrast, has received more attention. Although the study of objective sleep is not recommended for the diagnosis of insomnia, this approach has highlighted peculiarities in the sleep of individuals with a PD or a SUD. For instance, individuals with a BPD present increased sleep onset latency and lower sleep efficiency. Importantly, emotion

Conflict of interest statement

Nothing declared.

References and recommended reading

Papers of particular interest, published within the period of review, have been highlighted as:

  • • of special interest

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