Why Are Sleep Disturbances So Common in Those with HIV?

Patient Expert

Sleep disturbances, such as insomnia, are common in individuals with HIV. A study published in the Journal of Acquired Immune Deficiency Syndromes found that as many as 73 percent of HIV outpatients were classified as having a sleep disturbance, as measured by the Pittsburgh Sleep Quality Index.

Why are sleep issues so common in this patient group?

A 2015 study published in the journal AIDS and Behavior set out to answer this question and to identify the factors associated with sleep disturbances in individuals with HIV.

Researchers performed a cross-sectional study of those receiving routine care at HIV clinics in France between November 2012 and May 2013.

A total of 1,354 participants with an average age of 47 were involved in the study. Seventy-four percent of participants were male. Each participant answered questionnaires to measure:

  • Sleep quality
  • Quality of life
  • Depression symptoms

Researchers found a comorbid condition in just over a third of participants, with the most common being:

When it came to measuring sleep, the study revealed that in the previous month, 8.5 percent of patients had taken sleeping pills and just under half (47 percent) were considered to be poor sleepers, as measured by the Pittsburgh Sleep Quality Index.

More specifically:

  • Forty-one percent could not fall asleep within half an hour three or more times per week
  • Fifty-seven percent woke in the middle of the night or early morning three or more times per week
  • Thirty-three percent had bad dreams at least once per week

When compared to those with good sleep quality, quality of life was significantly worse in those with poor sleep quality.

The study also found that just under 20 percent of HIV patients reported moderate to severe symptoms of depression.

Why are sleep disturbances associated with HIV?

One study found poor sleep in HIV individuals to be associated with the effects of antiretroviral drugs, immunodepression, and symptomatic infection.

New antiretrovirals are helping to minimize these symptoms, but sleep disturbances are still common. As the authors of this French study point out, this may mean that sleep disturbances are down to factors other than HIV and may be more attributable to social and psychological factors.

In fact, they found poor sleep quality to be significantly associated with:

  • Being single
  • Being female
  • Smoking tobacco
  • Being unemployed
  • Being moderately or seriously depressed

The study found the following factors were not associated with poor sleep quality:

  • Age
  • BMI
  • CDC stage C
  • Education level
  • Nadir CD4 cell counts
  • HIV transmission risk
  • Hepatitis B or C infection

What can be done to tackle sleep disturbances in those with HIV?

As the authors of this study pointed out, sleep disturbances can lead to cognitive impairment and an increased likelihood of non-compliance with drug therapy. For this reason alone, issues with sleep should not be ignored.

Screening for sleep issues in HIV patients and offering advice on the importance of good sleep hygiene could help. In addition, screening for symptoms of depression may be helpful as depression is strongly associated with sleep problems.

Martin is the creator of Insomnia Land’s free sleep training for insomnia. His online course uses CBT techniques to teach participants how to fall asleep and stay asleep. More than 4,000 insomniacs have completed his course and 97 percent of graduates say they would recommend it to a friend.