LIVING WITH HIV

Menu open

People living with HIV commonly experience sleep problems that can impact their physical, cognitive, or emotional well-being.[1] Fortunately, there are practical lifestyle changes and medications available that can help improve sleep quality, ultimately improving overall quality of life for people living with HIV.[2]

Causes of sleep problems In people lIvIng wIth HIV

Several factors are thought to contribute to sleep issues in people living with HIV.
Although the specific reasons are not completely understood, studies suggest that they may be due to these factors:[3,4]

  • The immune system's response to the HIV virus, which results in inflammation that can lead to insomnia and obstructive sleep apnoea (OSA).
  • The effect that HIV may have on parts of the nervous system responsible for regulating sleep, which results in sleep disturbances and persistent fatigue.
  • Insomnia may also be a side effect of one of the antiretrovirals (ARVs) you are taking.

Additionally, other HIV-related conditions such as chronic pain and depression can make sleep disturbances such as insomnia and OSA worse.[5,6]

It is important to understand the different types of sleep problems that people living with HIV experience and the factors that can contribute to them.

How does HIV affect sleep?

Studies show that around 58% of people living with HIV report sleep disturbances such as insomnia, OSA, and overall poor sleep quality.[3] While sleep disturbances can occur at any stage of HIV, it is more common in the advanced stages of the condition.[1]

Sleep problems in people living with HIV are often overlooked, however, they can be one of the more intense and distressing challenges.[1] Always talk to your doctor about any sleep problems you may be experiencing.

  • Insomnia

    Insomnia refers to difficulty falling asleep or staying asleep, as well as waking up too early, feeling unrefreshed upon waking, or irritability.[2] This condition can be triggered in people living with HIV by the psychological stress associated with HIV or anxiety about HIV-related stigma.[2,7] Research suggests that up to 70% of people living with HIV experience insomnia at some stage of their condition.[8]

    Some antiretrovirals (ARVs) can cause insomnia, vivid dreams, nightmares, and daytime sleepiness at any stage of treatment.[3] These sleep disturbances are commonly associated with certain ARV drug classes, particularly some non-nucleoside reverse transcriptase inhibitors (NNRTIs), and some integrase strand transfer inhibitors (INSTIs).[2,9,10]

    These side effects usually resolve on their own after a few months, but if they persist, you should speak to your doctor about the possibility of switching your antiretroviral therapy (ART) regimen.[2]

    Other factors that may be unrelated to HIV can also contribute to insomnia; these include:[5,11]

    • Substances such as alcohol, nicotine, and caffeine.
    • Recreational drugs such as marijuana, cocaine, and ecstasy.
    • An uncomfortable environment that is too hot, cold, or noisy.

    Pay attention to how you feel upon waking and throughout the day. If you feel sleepy, tired, irritable, or have trouble concentrating, it may be a sign that you are experiencing insomnia.[11] Speak with your doctor about your symptoms so that possible management strategies can be explored.

  • Obstructive sleep apnoea (OSA)

    OSA occurs when the airway becomes too narrow during sleep, causing breathing to stop temporarily.[2,12] This can lower oxygen levels in the blood and force people to wake up multiple times during the night to start breathing again, leading to broken and poor-quality sleep.[2,12] OSA can affect anyone, but it is more common in men, more frequent in people with obesity, and becomes more likely as we age.[13]

    However, people living with HIV can develop OSA without these traditional risk factors. While the exact reasons are unknown, studies suggest that the HIV virus and HIV medications may contribute to OSA.[6]

    One reason may be that some types of ARVs can lead to abnormal fat buildup in the neck, chest, and abdomen.[2] Increased fat in these areas can put pressure on the airways, making breathing more difficult during sleep and contributing to the development of OSA.[2,5]

    It is important to discuss any ART drug side effects with your healthcare provider, who may be able to adjust your ART regimen or provide guidance on how to manage the side effects.

    The following symptoms are possible signs of OSA:[12]

    • Gasping, snorting, or choking noises during sleep
    • Breathing that stops and starts while sleeping
    • Waking up frequently at night
    • Loud snoring
    • Being very sleepy during the day
    • Mood swings

    OSA may be difficult to identify by yourself because it occurs during sleep, so you may need to ask a partner, friend, or relative if they notice any of these symptoms. If you suspect you are experiencing OSA, it is important to mention it to your doctor.[2,12]

  • Ageing with HIV and sleep

    Elderly people living with HIV may be more likely to experience sleep disturbances compared to younger adults with HIV.[5,14] This is because the chronic pain associated with HIV worsens with age, which may make insomnia more severe in the elderly.[5]

    Older adults with HIV are also more likely to develop multiple health conditions and therefore use several medications, both of which can contribute to a higher prevalence of sleep disturbances such as insomnia and OSA.[5,15]

    As HIV is a manageable condition with a near-to-normal life expectancy, it is important to recognise and address the unique challenges that may arise as people age while living with HIV.[3,16]

How does a lack of sleep affect your health?

For people living with HIV, sleep disturbances have been linked to disease progression, a weakened immune system, lower adherence to ART, and an overall poorer quality of life.[1,3,7]

Sleep disturbances can negatively affect many other factors of your health, including:[1,3,5,17]

Mental health, increasing the risk of depression and anxiety.

Physical health, leading to chronic fatigue and an increased risk of high blood pressure, diabetes, and cardiovascular disease (CVD).

Cognitive health, slowing down decision-making and problem-solving abilities, as well as impairing focus and productivity.

How much sleep do you need?

Everyone needs a different amount of sleep, but on average, adults require between seven and nine hours of sleep each night.[11,14] Additionally, the quality of your sleep, which refers to how well you rest, and the amount of sleep you get are both important.[14]

How to get better sleep

Sleep disturbances in people living with HIV can occur due to various factors, so you should speak with your doctor, who can recommend treatments tailored to your particular sleep disturbances.[3,5]

Addressing chronic pain in people living with HIV can help reduce sleep disturbances.[5]
For insomnia, cognitive behavioural therapy (CBT) is the recommended first-line treatment.[2] Other non-drug approaches, such as auricular plaster therapy (APT) and acupuncture, may also improve sleep quality in people living with HIV.[7]

Medications such as antidepressants, benzodiazepines, and other sleeping pills may be considered for insomnia if needed.[2,18,19] However, some of these drugs may have potential interactions with your ART, so it is important to discuss them with your doctor.[20] Additionally, certain medications to promote sleep may be habit-forming.[21,22] When stopped, insomnia can return or they may lead to withdrawal symptoms, so particular care should be taken with drug approaches for insomnia.[2,21,22]

If you have OSA, you may benefit from a continuous positive airway pressure (CPAP) device.[2,12] This device works by delivering a constant flow of air through a mask to keep the airway open during sleep. Other options, such as oral appliances or surgery, may be considered to manage OSA.[2,12]

You may also find it helpful to keep a sleep diary to monitor your activities, mood, and sleep to help identify any patterns.

There are also many lifestyle changes that can help you restore good sleep, such as:[11]
  • Establishing a regular sleeping pattern by going to bed and waking up at the same time every day.
  • Exercising during the day, but ideally not within four hours of bedtime.
  • Avoiding caffeinated drinks or alcohol.
  • Avoiding naps during the day.
  • Limiting the use of phones, laptops, or devices before bed because blue light makes you more awake.

Abbreviations:

APT, auricular plaster therapy; ART, antiretroviral therapy; ARV antiretroviral; CBT, cognitive behavioural therapy; CPAP, continuous positive airway pressure; CVD, cardiovascular disease ; OSA, obstructive sleep apnoea.

References:

  1. Mengistu N, Azale T, Yimer S, Fikreyesus M, Melaku E, Shumye S. Quality of sleep and associated factors among people living with HIV/AIDS on follow up at Ethiopian Zewditu memorial hospital, 2018. Sleep Sci Pr. 2021 Dec 4;5(1):1–8. doi:https://doi.org/10.1186/s41606-020-00056-w
  2. Taibi DM. Sleep disturbances in persons living with HIV. J Assoc Nurses AIDS Care. 2013 Jan;24(1 Suppl):S72–85. doi:https://doi.org/10.1016/j.jana.2012.10.006
  3. O’Brien KE, Riddell NE, Gómez-Olivé FX, Rae DE, Scheuermaier K, von Schantz M. Sleep disturbances in HIV infection and their biological basis. Sleep Med Rev. 2022 Oct 1;65(101571):101571. doi:https://doi.org/10.1016/j.smrv.2021.101571
  4. AIDSMAP. Wilberg M. Sleep and HIV. 2024 Available from: https://www.aidsmap.com/about-hiv/sleep-and-hiv [Accessed: March 2025]
  5. Cody SL, Hobson JM, Gilstrap SR, Thomas SJ, Galinat D, Goodin BR. Sleep disturbances and chronic pain in people with HIV: Implications for HIV-associated neurocognitive disorders. Curr Sleep Med Rep. 2022 Dec 12;8(4):124–31. doi:https://doi.org/10.1007/s40675-022-00236-3 
  6. Orr JE, Edwards BA, Schmickl CN, Karris M, DeYoung PN, Darquenne C, et al. Pathogenesis of obstructive sleep apnea in people living with HIV. J Appl Physiol. 2021 Dec 1;131(6):1671–8. doi:https://doi.org/10.1152/japplphysiol.00591.2021 
  7. Meng J, Zheng C, Wang H, Välimäki M, Wang M. Non-pharmacological interventions for improving sleep in people living with HIV: a systematic narrative review. Front Neurol. 2023 Nov 20;14:1017896. doi:https://doi.org/10.3389/fneur.2023.1017896
  8. Omonuwa TS, Goforth HW, Preud’homme X, Krystal AD. The pharmacologic management of insomnia in patients with HIV. J Clin Sleep Med. 2009 Jun 15;5(3):251–62. doi:https://doi.org/10.5664/jcsm.27496
  9. National HIV Curriculum. Adverse Effects of Antiretroviral Medications. 2025. Available from: https://www.hiv.uw.edu/go/antiretroviral-therapy/adverse-effects/core-concept/all  [Accessed: March 2025]
  10. Apostolova N, Funes HA, Blas-Garcia A, Galindo MJ, Alvarez A, Esplugues JV. Efavirenz and the CNS: what we already know and questions that need to be answered. J Antimicrob Chemother. 2015 Oct 22;70(10):2693–708. doi:https://doi.org/10.1093/jac/dkv183
  11. NHS. Insomnia. 2024. Available from: https://www.nhs.uk/conditions/insomnia/ [Accessed: March 2025]
  12. NHS. Sleep apnoea. 2022. Available from: https://www.nhs.uk/conditions/sleep-apnoea/ [Accessed: March 2025]
  13. Senaratna CV, Perret JL, Lodge CJ, Lowe AJ, Campbell BE, Matheson MC, et al. Prevalence of obstructive sleep apnea in the general population: A systematic review. Sleep Med Rev. 2017 Aug;34:70–81. doi:10.1016/j.smrv.2016.07.002
  14. Chaput JP, Dutil C, Sampasa-Kanyinga H. Sleeping hours: what is the ideal number and how does age impact this? Nat Sci Sleep. 2018 Nov 27;10:421–30. doi:https://doi.org/10.2147/nss.s163071
  15. Tatineny P, Shafi F, Gohar A, Bhat A. Sleep in the elderly. Mo Med. 2020 Sep;117(5):490–5. PMCID: PMC7723148
  16. AIDSMAP. Hayes R. Life expectancy for people living with HIV. 2023. Available from: https://www.aidsmap.com/about-hiv/life-expectancy-people-living-hiv [Accessed: March 2025]
  17. NIH. Hanson JA, Huecker MR. Sleep deprivation. 2023. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547676/ [Accessed: March 2025]
  18. Goldschmied JR, Sengupta A, Sharma A, Taylor L, Morales KH, Thase ME, et al. Treatment of insomnia with zaleplon in HIV+ significantly improves sleep and depression. Psychopharmacol Bull. 2021 Jun 1;51(3):50–64. PMID:34421144
  19. Madari S, Golebiowski R, Mansukhani MP, Kolla BP. Pharmacological management of insomnia. Neurotherapeutics. 2021 Jan 1;18(1):44–52. doi:10.1007/s13311-021-01010-z
  20. Yanofski J, Croarkin P. Choosing antidepressants for HIV and AIDS patients: Insights on safety and side effects. Psychiatry (Edgmont). 2008 May;5(5):61–6. PMID:19727253
  21. Hood SD, Norman A, Hince DA, Melichar JK, Hulse GK. Benzodiazepine dependence and its treatment with low dose flumazenil: Benzodiazepine dependence and its treatment. Br J Clin Pharmacol. 2014 Feb 22;77(2):285–94. doi: 10.1111/bcp.12023
  22. Pétursson H. The benzodiazepine withdrawal syndrome. Addiction. 1994 Nov;89(11):1455–9. doi: 10.1111/j.1360-0443.1994.tb03743.x

NP-GBL-HVX-COCO-250011 August 2025

Reporting of side effects

If you get any side effects, talk to your doctor, pharmacist, or nurse. This includes any possible side effects not listed in the package leaflet. You can also report side effects directly via the GSK Reporting Tool link https://gsk.public.reportum.com/. By reporting side effects, you can help provide more information on the safety of this medicine.

If you are from outside the UK, you can report adverse events to GSK/ ViiV by selecting your region and market, here.