CLINICAL

• Insomnia: "a persistent difficulty falling asleep, staying asleep, or non-restorative sleep associated with impaired daytime function" (American Academy of Sleep Medicine)[11]
• Has been associated with poorer outcome in HIV because it adversely affects immune status, medication adherence, and is correlated with increased fatigue and comorbid psychiatric disorders (e.g., anxiety/depression) leading to lower quality of life[15]
  • Decreased cognitive performance (particularly on tasks of attention), frontal/executive functioning, and psychomotor/motor speed have been associated with sleep disruption in HIV+ individuals[3]
• Limited literature on insomnia in HIV.[15] Much of the literature discussed "sleep disturbance."
  • Prevalence of sleep disturbance in HIV+ patients (29-97%) should be compared to sleep disturbance in general population (~33%), not prevalence of clinically significant insomnia in general population (~10%)
  • Examples of sleep disturbance include daytime sleepiness, difficulty initiating sleep, nocturnal awakenings, and disrupted sleep architecture
• In a convenience sample of 290 HIV+ adults living, Lee et al.[4] found the following:
  • 45% slept < 6 hrs per night
  • Difficulty falling asleep reported by 34%
  • 56% had fragmented sleep according to actigraphy
  • 30% were "good sleepers"
• Some correlates to sleep disturbance in HIV+ patients are[15]:
  • Advanced stage or longer duration of infection
  • Cognitive impairment, including HIV-associated dementia
  • Psychiatric symptoms, including depressive symptoms, anxiety, stress, fatigue, and substance abuse
• EFV has been well-documented to cause insomnia and other sleep disruptions, especially during early weeks of therapy[13][10]
• Cessation of chronic use of alcohol or benzodiazepines often produces insomnia