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Key points

  • Sleep is essential to physical and mental health.
  • Anxiety, depression, drug or alcohol use, and illness can contribute to sleep problems.
  • Simple lifestyle changes may be enough to help you sleep better.

Many people with HIV have problems sleeping. This can be due to being uncomfortable, worry, anxiety, depression, illness or treatment side-effects. It may also be because of drug or alcohol use.

Not getting enough sleep can cause health problems, but there are a number of practical things you can do to sleep better and in some cases medicines may help.

Why do we need to sleep?

Sleep is essential to both physical and mental health. Sleep allows the body and mind to rest and recover. Long-term sleep deprivation can cause emotional problems such as depression. Lack of, or poor, sleep can also put you at risk of medical conditions such as heart disease, obesity and type 2 diabetes. It is thought that long-term sleep problems can mean that the immune system doesn’t work properly, meaning that a person may be more likely to get ill.

Structure of sleep

Sleep follows a pattern, alternating between REM (rapid-eye-movement) sleep and non-REM sleep. In the course of a night, the body goes through cycles of REM and non-REM sleep. Five or six cycles of this pattern are needed for a good night’s sleep.

How much sleep is needed

People’s sleep needs vary but most adults need between six and nine hours each night. If you have been working or exercising very hard, are ill, or recovering from an illness or infection, you may find that the amount of sleep you need increases substantially.

Getting enough sleep is important but it’s also important not to oversleep. Sleeping too much can reduce motivation and make you feel tired.


Not being able to sleep is called insomnia. It can take many forms. Some people find it difficult to fall asleep; others wake up after just a few hours of sleep and then can’t get back to sleep; some people wake up very early in the morning; and others find that their sleep does not leave them feeling refreshed.

Causes of insomnia

For many people, worry or stress is the cause of their sleeplessness. Once a problem has resolved, then sleep patterns become better. However, more serious problems like anxiety and depression can cause sleep problems which last for very long periods. Symptoms of illnesses, such as night sweats, and pain can also interfere with sleep. It's a good idea to report these problems to your doctor.



A mental health problem causing long-lasting low mood that interferes with everyday life.




A feeling of unease, such as worry or fear, which can be mild or severe. Anxiety disorders are conditions in which anxiety dominates a person’s life or is experienced in particular situations.


An association means that there is a statistical relationship between two variables. For example, when A increases, B increases. An association means that the two variables change together, but it doesn't necessarily mean that A causes B. The relationship isn't necessarily causal.


Any perceptible, subjective change in the body or its functions that signals the presence of a disease or condition, as reported by the patient.


Although some people find that an alcoholic drink helps them to fall asleep, heavy drinking can cause sleeplessness, as can drinking coffee, tea or other drinks that contain caffeine close to bedtime. Drug use, especially use of stimulant drugs like amphetamine (speed), methamphetamine (crystal meth), MDMA (ecstasy) and cocaine also cause sleep problems.

Some drugs used to treat HIV, and illnesses associated with it, cause insomnia or other sleep problems.

In particular, vivid dreams and insomnia are among the most common side-effects of efavirenz (Sustiva, also in the combination pill Atripla). In many cases, these side-effects will lessen or go away after the first few weeks of starting treatment.

Practical factors such as your bed or pillows being uncomfortable, or the room you sleep in being too stuffy, warm, or cold could disrupt your sleep. Ideally, the room you sleep in should be cool (between 18 and 24 degrees Celsius) and well-ventilated. It should also be as dark as possible as too much light can keep you awake.

If you find noise is keeping you awake, ear plugs may help.

Managing sleep problems

In many cases, a few lifestyle changes are enough to bring back good sleep. These might include avoiding tea and coffee and other stimulants for several hours before going to bed, or not napping during the day.

"Sleeping tablets often only help people fall asleep, but don’t keep people asleep, and can make people feel drowsy the next day."

Keeping regular sleeping hours may help, if possible, so your body can get into a routine. Not going to bed until you are feeling ready to sleep may also help. If you cannot get to sleep after about 30 minutes, get up rather than tossing and turning and getting frustrated, which often makes the problem worse.

Keeping a record of your sleep, known as a sleep diary, might be useful.

Do not be frightened to mention sleep problems to your doctor. If there is an underlying medical cause, such as depression, physical illness, or treatment side-effects, it is important that your doctor knows as soon as possible so appropriate action can be taken or treatment offered.

Medication, often called ‘sleeping tablets’, are available to help sleep. Some people find that some herbal remedies can help them sleep. Medication can be used to help restore normal sleeping patterns. However, sleeping tablets often only help people fall asleep, but don’t keep people asleep, and can make people feel drowsy the next day. The use of some sleep medication over the long-term can cause dependency, although newer medications are becoming available which may not have these problems.

If you are finding it difficult to get to sleep, you could try these ideas to get you ready for bed:

  • Have a warm bath.
  • Have a warm drink, such as camomile tea or milk. But try to avoid caffeinated drinks for three to four hours before going to bed.
  • If stress or worry is keeping you awake, getting your thoughts down on paper may help. Create a to-do list of your tasks for the next day if you find you are thinking about them when you are trying to get to sleep.
  • Try relaxation or breathing exercises. Some people find that some aromatherapy oils help them to relax.
  • Read a book or listen to an audio-book or some relaxing music.
  • Try not to watch TV or use phones, computers or electronic gadgets in bed.
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