Psychiatr. praxi. 2026;27(2):99-106 | DOI: 10.36290/psy.2026.017

Insomnia in patients with personality disorders: connections, mechanisms, and therapeutic possibilities

prof. MUDr. Ján Praško, CSc.1-4, MUDr. Boris Dvořáček1, MUDr. Kamila Bělohradová1, 2, MUDr. Jakub Vaněk, Ph.D.5, MUDr. David Pánek, Ph.D.1, doc. PaedDr. et Mgr. Marta Zaťková, PhD.3, doc. PhDr. Miloš Šlepecký, CSc.3, PhDr. Marie Ocisková, Ph.D.2
1 Centrum duševní rehabilitace, Jessenia, Rehabilitační nemocnice Beroun, Akeso holding, a. s.
2 Lékařská fakulta a Fakultní nemocnice Olomouc, Klinika psychiatrie, Univerzita Palackého v Olomouci
3 Fakulta sociálnych vied a zdravotníctva, Katedra psychologických vied, Univerzita Konštantína Filozofa v Nitre, Slovensko
4 Katedra psychoterapie, IPVZ Praha
5 Beskydské centrum duševního zdraví, Moravskoslezská nemocnice Frýdek-Místek, p. o.

Background: Personality disorders are often accompanied by significant sleep disturbances, particularly insomnia and nightmares. Despite their high prevalence, these sleep issues are frequently overlooked in clinical practice. This article aims to provide an overview of current knowledge regarding the prevalence, underlying mechanisms, and treatment options for insomnia across different personality disorders, with a focus on practical clinical applications.

Methods: A narrative review was conducted using literature from PubMed and Web of Science, supplemented by summary tables and clinical recommendations.

Results: Insomnia is common in various personality disorders, with the strongest association seen in borderline personality disorder, where it is linked to emotional dysregulation, dissociative symptoms, and increased suicide risk. Insomnias are also observed in narcissistic, avoidant, and schizotypal personality presentations. Contributing mechanisms include hyperarousal, maladaptive cognitive patterns, and abnormalities in REM sleep. Cognitive Behavioural Therapy for Insomnia (CBT-I) has proven effective and can be successfully tailored to individuals with personality disorders.

Conclusion: Timely recognition and treatment of insomnia can play a critical role in stabilizing individuals with personality disorders. Increased research efforts and enhanced clinician training in this area are urgently needed.

Keywords: sleep disorders, insomnia, personality disorders, CBT-I, emotional dysregulation, psychiatry, therapeutic alliance.

Accepted: June 10, 2026; Published: July 21, 2026  Show citation

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Praško J, Dvořáček B, Bělohradová K, Vaněk J, Pánek D, Zaťková M, et al.. Insomnia in patients with personality disorders: connections, mechanisms, and therapeutic possibilities. Psychiatr. praxi. 2026;27(2):99-106. doi: 10.36290/psy.2026.017.
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