Sleep Problems in People With HIV

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

Young Woman in Bed with Insomnia
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A lack of quality sleep can result in periods of fatigue during the day, making it difficult to work, go to school, or even carry on day-to-day activities. Simple tasks we take for granted suddenly become a huge drain on an already-stressed body and mind.

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 of 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 interruptions of these cycles only take away any gains you may make from having a proper, good night's sleep.

Why Sleeping Problems Occur

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

  • Anxiety is often a natural part of having a serious chronic illness. 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 is 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 can keep anyone up at night. The simple fact is that HIV costs money, even for those who have insurance and are enrolled in drug assistance programs. The stress associated with the financial impact of the disease can interfere with our ability to sleep well.
  • HIV-associated infections can also interfere with sleep patterns as they activate certain proteins that regulate sleep patterns While it is still unclear to what degrees these proteins can affect us, it does support the early start of antiretroviral therapy in order to reduce the overall burden of untreated infection.
  • HIV medications can also sometimes interfere with sleep. While most drugs used to treat HIV are not related to sleep problems, we do know that Sustiva (efavirenz) is associated with insomnia and vivid dreams in a significant number 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, however, are known to resolve within one to several weeks of starting the drug.
  • HIV-associated symptoms can often profoundly impact one'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 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 disease.

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, or seeking counseling for emotional or psychological support, the importance of a regular night's sleep can never be understated. In the end, it's not only about staying healthy; it's about maintaining a positive outlook in order to ensure a long and happy life if you are a person living with HIV.

3 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Taibi DM. Sleep disturbances in persons living with HIV. J Assoc Nurses AIDS Care. 2013;24(1 Suppl):S72-85. doi:10.1016/j.jana.2012.10.006

  2. National Institute of Neurological Disorders and Stroke. Brain Basics: Understanding Sleep.

  3. Lee KA, Gay C, Portillo CJ, et al. Types of sleep problems in adults living with HIV/AIDS. J Clin Sleep Med. 2012;8(1):67-75. doi:10.5664/jcsm.1666

By Mark Cichocki, RN
Mark Cichocki, RN, is an HIV/AIDS nurse educator at the University of Michigan Health System for more than 20 years.