Sleep Problems and HIV

Identifying the Causes for Insomnia and Sleep Disturbances in People with HIV

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Photograph ©Alyssa L. Miller

At some point in time, all of us will have problems falling asleep. For some people living with HIV, other factors can seriously compound sleeping problems. Whether it be the effects of certain HIV medications or night sweats that can sometimes occur as a result of infection, the inability to fall asleep can often chip away at a person's general sense of well-being.

A lack of quality sleep can result in fatigue during the day, making it difficult to work, go to school, or carry on your day-to-day activities.

Simple tasks we take for granted suddenly become a huge drain on an already-stressed body. In time, the body's ability to fight off infection is reduced, placing a person at risk for HIV-associated illnesses and complications.

Why Do We Need to Sleep?

On average we spend about a third of our life asleep, or roughly eight hours a night. A disruption in the amount or quality of sleep we get takes a toll on mood, energy levels and concentration. Sleep also plays an important role in the state of our immune system, with chronic insomnia and sleep depletion often correlating to a poorer immune response.

A typical night's sleep is comprised of many stages ranging in length from five minutes to a couple hours. Each stage starts with light sleep, a stage where you can be awakened quite easily. From there, as your brain waves slow and you gradually progress to what is known as REM sleep, your body movement slows and you are able to achieve deep, restful sleep needed to feel fresh and clear-minded.Prolonged or regular interruption of these cycles only take away any gains you may make from having a proper, good night's sleep

Why Do We Have Problems Sleeping?

There are numerous reason with HIV may have sleep problems. Among them:

  • Anxiety - Having any serious chronic illness can cause you anxiety. Fear of the unknown, of infecting others, or of having to disclose your HIV status to others can understandably take its toll on your ability to sleep.
  • Depression - Depression is commonly characterized by an inability to fall asleep or stay asleep during the night. For people with HIV, negative feelings about their treatment or future can fuel feelings of despair. To make matters worse, some medications used to treat depression can themselves impact your ability to get a good night's rest.
  • Financial concerns - The fact is that HIV cost money, even though costs can be significantly through insurance, Medicaid, Medicare and patient assistance programs. Still, the fear of financial impact can interfere with our ability to sleep well.
  • HIV infection - Some research has suggested that certain viral proteins produced as a result of HIV infection can interfere with sleep pattern. While it is unclear what degrees these proteins can affect us is unclear, it does support the initiation of antiretroviral therapy in order to reduce the effect of viral activity in our blood.
  • HIV medications - Most drugs used to treat HIV are not related to insomnia or other sleep problem. However, we do know that drug Sustiva (efavirenz) is associated with insomnia and vivid dreams in a percentage of people on therapy. Many report that even after a full night's sleep, they don't feel refreshed or clear-headed. Most of these effects are known to resolve themselves within one to several weeks of starting the drug.
  • Common HIV-associated symptoms - HIV is associated with a number of common symptoms, each of which can profoundly impact a person's ability to sleep. These include the sometimes painful sensations of peripheral neuropathy, as well as the damp, clammy nuisance of night sweats.
  • Sleep apnea - Sleep apnea is a condition characterized by periods of absent breathing while sleeping. People with sleep apnea wake themselves choking and gasping for air. While there is no direct link between HIV and sleep apnea, there is some evidence that HIV can cause enlargement of the tonsils and adenoids, particularly in those who are untreated or have advanced infection.

Sleep is an important part of a healthy life especially for people living with HIV. Simply put, a healthy body is a well-rested body. If you have difficulty falling asleep or staying asleep, speak with your health provider to help identify or resolve these issues.

Whether it be changing medication, starting antiretroviral therapy (if you haven't already done so yet), or seeking counseling for emotional or psychological concerns, the importance of attaining a proper and regular night's sleep cannot be understated.  

It's about not only staying healthy (which is inarguably important), it's about keeping a positive outlook in order to ensure a long and happy life if you have HIV.


Taibi, D. "Sleep Disturbances in Persons Living with HIV." J Assoc Nurses AIDS Care. Jan 2013; 24(1 Suppl): S72–S85. Doi:  10.1016/j.jana.2012.10.006

Gemma, C., et al. "Human immunodeficiency virus glycoproteins 160 and 41 alter sleep and brain temperature of rats." J Neuroimmunol. June 1, 1999; 97(1-2):94-101.

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