- Insomnia: "a persistent difficulty falling asleep, staying asleep, or non-restorative sleep associated with impaired daytime function" (American Academy of Sleep Medicine)
- Insomnia is associated with poorer HIV outcomes due to:
- Adverse effects on immune status
- Reduced medication adherence
- Increased fatigue
- Higher rates of comorbid psychiatric disorders (e.g., anxiety/depression) than the general population
- Lower quality of life
- Decreased cognitive performance (particularly on tasks of attention, but also in executive function and psychomotor/motor speed domains)
- There is limited research specifically addressing insomnia in HIV, with the majority of literature discussing sleep disturbances more broadly.
- Examples of sleep disturbances include daytime sleepiness, difficulty initiating sleep, nocturnal awakenings, and disrupted sleep architecture.
- Prevalence rates of sleep disturbance in HIV+ patients (29-97%) should be compared to sleep disturbance in the general population (~33%), as opposed to prevalence of clinically relevant insomnia in the general population (~10%).
- A meta-analysis of self-reported sleep disturbance rates in HIV+ individuals reported an overall prevalence of 58% and suggests that screening instruments, gender, and geographical location may account for some variation in estimates.
- In a convenience sample of 290 HIV+ adults, Lee et al. found the following:
- 45% slept < 6 hours per night
- 34% reported difficulty falling asleep
- 56% had fragmented sleep according to actigraphy
- 30% were "good sleepers"
- The following factors can increase the risk of sleep disturbance in HIV+ patients:
- Advanced stage or longer duration of infection
- EFV has been well-documented to cause insomnia and other sleep disruptions, especially during early weeks of therapy
- Cognitive impairment, including HIV-associated dementia
- Psychiatric symptoms, including depressive symptoms, anxiety, stress, fatigue, and substance abuse
- Cessation of chronic use of alcohol or benzodiazepines
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