A new longitudinal study highlights why sleep deserves a place in conversations about BPD recovery.
by Brian Curtis, PhD, DBSM
Every few months, a new study adds another piece to the puzzle connecting sleep and mental health. In July of 2025, researchers David Plante, Isabel Glass, and Mary Zanarini published findings from the landmark McLean Study of Adult Development examining sleep in individuals with borderline personality disorder (BPD).
Their findings were both important and unsurprising.
Compared to individuals who had recovered from BPD, those who had not recovered reported poorer overall sleep quality, more sleep disturbance, greater daytime impairment, higher use of sleep medications, and more unhelpful beliefs about sleep. These differences remained even after accounting for other demographic and clinical factors.
This doesn't mean poor sleep causes BPD, nor does it mean improving sleep alone leads to recovery. But it does strengthen a growing body of evidence suggesting that sleep is an important part of the larger recovery process.
Anyone who has experienced chronic sleep difficulties knows that poor sleep affects much more than energy.
When we're chronically sleep deprived or sleeping poorly, we often become more emotionally reactive, less patient, less able to think flexibly, and more likely to interpret situations through the lens of threat or hopelessness. Solving problems becomes more difficult. Relationships often become harder to navigate. Activities that once felt meaningful can begin to feel overwhelming.
In other words, sleep influences many of the very capacities that support psychological well-being.
For clinicians, this may help explain why clients sometimes struggle to consistently apply skills they've worked so hard to learn. For clients, it offers an important reminder that difficulties using coping skills aren't necessarily a sign of failure. They may also reflect the understandable effects of persistent sleep disruption.
One of the most interesting findings from this study was not simply that sleep was worse. It was that individuals who had not recovered also reported more unhelpful beliefs about sleep, as measured by the Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS-16).
These beliefs might sound familiar, with examples including:
While these thoughts are completely understandable, decades of insomnia research suggest they can unintentionally increase anxiety about sleep and make restorative sleep even harder to achieve.
The encouraging news is that these beliefs and their associated sleep difficulties are treatable. Cognitive Behavioral Therapy for Insomnia (CBT-I) specifically targets these patterns, helping people develop a healthier and more flexible relationship with sleep-related beliefs, and sleep as a whole.
One of the themes I return to often is that recovery rarely depends on a single intervention.
Sleep is one piece of a much larger picture that includes relationships, emotional awareness, meaningful activities, physical health, values, trauma recovery, and many other factors.
At the same time, sleep often provides an important foundation that makes those other changes easier.
When people are sleeping better, they often have greater emotional resilience, improved attention, more cognitive flexibility, and increased capacity to engage in therapy, connect with others, and move toward what matters most in their lives.
From this perspective, treating sleep is not simply about helping someone sleep better.
It's about helping create the conditions where change becomes more possible.
If you're living with BPD, or supporting someone who is, it may be worth asking an important question:
How much attention has sleep received in the overall treatment plan?
For clinicians, this study reinforces the value of routinely assessing sleep as part of comprehensive care. Screening for insomnia, nightmares, circadian rhythm disorders, sleep apnea, restless legs syndrome, and sleep-related beliefs can help identify barriers that may otherwise go unnoticed.
For clients, the message is equally hopeful. Sleep problems are common, they're real, and they are often highly treatable. Improving sleep is unlikely to solve every challenge, but it may make many other aspects of recovery feel more manageable.
Perhaps the most important takeaway from this study is not that sleep is the answer.
Rather, it reminds us to stay curious.
When someone is struggling, it's natural to focus on the most obvious symptoms. But sometimes meaningful progress begins by looking a little deeper and asking what other processes may be contributing.
Sleep is one of those processes.
As this body of research continues to grow, I hope we'll see sleep become a more routine part of comprehensive mental health care. Not because it replaces treatments like DBT, ACT, CBT, or trauma-focused therapies, but because it can strengthen the foundation upon which those treatments are built.
The authors conclude by calling for future research to determine whether interventions that improve sleep also improve recovery from BPD.
I think that's exactly the right question.
Plante, D. T., Glass, I. V., & Zanarini, M. C. (2025). Sleep disturbance and maladaptive sleep-related cognitions in borderline personality disorder in the longitudinal McLean study of adult development. Journal of Clinical Sleep Medicine.
