Sleep and circadian dysregulation as predictors of suicidality in BPD

Abstract

Sleep and circadian disruption are common in borderline personality disorder and may predict suicidal thoughts and behaviors. Were analyzed systematic reviews, meta-analyses, large observational cohorts, dailydiary and actigraphy studies in adults. Exposures: insomnia, nightmares, short sleep, night-to-night variability, evening chronotype, circadian misalignment. Outcomes: suicidal ideation, suicide attempts, suicide deaths; secondary: self-harm and emergency presentations. Across recent studies, poor sleep is highly prevalent in borderline personality disorder: insomnia or markedly poor sleep quality in ~60–80%, frequent nightmares in ~25–50%. Insomnia and nightmares are consistently linked to higher suicidality; pooled estimates from highrisk psychiatric samples show ≈2-fold higher odds of suicidal ideation and attempts when these sleep problems are present. Daily-monitoring studies indicate that nights with shorter sleep and more awakenings are followed by next-day increases in suicidal thoughts; greater night-to-night sleep variability (≥60 minutes) is associated with more frequent suicidal thoughts and urges. Evening chronotype and delayed sleep timing are common (roughly 40–60%) and associate with higher suicidality scores. Clinically, routine screening for insomnia, nightmares, and circadian delay, stabilization of sleep timing, and targeted treatment of sleep problems should be integrated into suicide-risk management in borderline personality disorder.