CLINICAL

• Insomnia: "a persistent difficulty falling asleep, staying asleep, or non-restorative sleep associated with impaired daytime function" (American Academy of Sleep Medicine)[15]
• Insomnia is associated with poorer HIV outcomes due to:
  • Adverse effects on immune status[19]
  • Reduced medication adherence[19]
  • Increased fatigue
  • Higher rates of comorbid psychiatric disorders (e.g., anxiety/depression) than the general population[1]
  • Lower quality of life
  • Decreased cognitive performance (particularly on tasks of attention, but also in executive function and psychomotor/motor speed domains)[6]
• There is limited research specifically addressing insomnia in HIV,[19] 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[3].
• In a convenience sample of 290 HIV+ adults, Lee et al.[7] 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:[19]
  • 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[17][14]
  • 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