This is a difficulty with sleeping, waking early or getting off to sleep. Sleep disturbances are more common among HIV-infected adults and children than among non-infected individuals.

Causes

Insomnia is commonly caused by psychological or emotional problems such as stress, anxiety, worries and depression, or the effects of stimulants including caffeine. Physical problems, particularly pain, fevers, night sweats and general ill health, can all contribute to poor sleeping patterns. HIV-associated dementia can also alter your sleeping pattern. Some anti-HIV drugs can also cause insomnia if you take the last dose of the day at bedtime. The anti-HIV drug efavirenz commonly causes sleep disturbances and vivid dreams, especially during the first few weeks of treatment.

What to do

Sleeping well or having a good night's rest is essential and every effort should be made to find out the causes of insomnia and either treat or rectify these. Simple practical measures like ensuring a comfortable, warm, noise-free bedroom and avoiding stimulants like coffee or tea during the late evening may help. A hot milky drink about half an hour before bedtime may also be helpful, since this will promote the circulation of brain chemicals which make you feel sleepy. However, taking efavirenz with a high fat meal increases blood levels by 60%, so if you take efavirenz just before going to bed, avoid full fat milk or ice cream.

If you are having problems sleeping, try to make a note of how frequently the problem is occurring, and, if you have recently changed medication, how much you used to sleep before you changed drugs. This will help your doctor to understand how serious the problem is.

Sleeping tablets should only be used as a last resort and for short periods only, to avoid dependency. Low dose tricyclic anti-depressant medication may be helpful. If you are considering sleeping tablets and you are currently taking anti-HIV drugs, consult your doctor about possible drug interactions. Some anti-HIV medications may intensify the effects of certain sleeping pills (e.g. ritonavir prolongs and magnifies the sedative effects of the benzodiazepine triazolam).

Also see Anxiety and Depression in Symptoms and illnesses: A to Z of symptoms.