Sleep fails where needed the most: REM sleep and impaired overnight adaptation to emotional distress in Borderline Personality Disorder: clinical implications

Sleep disturbances are highly prevalent in borderline personality disorder (BPD), yet their role in the persistence of emotion dysregulation remains insufficiently understood. Sleep is not merely a period of reduced consciousness but an active neurobiological process during which emotional experiences are reorganised and integrated. Rapid-eye-movement (REM) sleep, in particular, has been proposed to support the overnight recalibration of emotional arousal while preserving the personally relevant content of emotional memories. Disturbances in this process may therefore contribute to the experience of emotions that remain unusually intense across time in BPD.

This lecture will examine sleep as a potential mechanism underlying persistent emotional distress in BPD, with particular attention to the processing of shame and other self-conscious emotions. Polysomnography and experimental emotion-induction paradigms provide complementary methods for investigating whether emotional responses are successfully recalibrated across a night of sleep and how this process relates to REM sleep physiology. Unpublished findings from women with BPD and non-psychiatric controls suggest that, whereas controls show overnight reductions in experimentally elicited distress and arousal, individuals with BPD demonstrate altered overnight emotional adaptation. The relationship between REM sleep physiology and emotional change also appears to differ between groups.

Integrating sleep research with neurobiological and psychological models of BPD may help explain why emotional experiences persist beyond the situations that originally elicited them. Sleep-dependent emotional processing may consequently represent a clinically relevant mechanism and a potential target for interventions aimed at improving emotion regulation in BPD.