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.
