Sleep Disturbances

Lisa N. Richey, Glenn J. Treisman, M.D., Ph.D., Matthew E. Peters, M.D.


  • 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

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Last updated: March 7, 2020