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Sleep Problems and HIV

Why Do People with HIV Have Sleep Problems

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Updated June 11, 2014

Sleep problems and HIV are, pardon the pun, common bed fellows. At some point in time, all of us will have problems falling asleep. Be it the stress from a financial problem; the discomfort of soaking night sweats; or the effects of our HIV medications; at one time or another sleep will not come easy. For most it's a short lived problem; resolving on its own in short order. For others, it's a chronic problem that can slowly chip away at a person's sanity. People living with HIV are commonly troubled by sleep problems. From before diagnosis and throughout the stages of illness people living with HIV have sleep problems. This feature discusses the facts about sleep and how sleep problems and HIV are related. Before we can discuss sleep problems and HIV we first need to understand sleep.

Why Do We Need to Sleep?

On average we spend about one third of our life asleep; roughly 8 hours each night. Why do we need to sleep so much? The fact of the matter is sleep is an essential part of our good health. A disruption in the amount or quality of sleep we get takes a toll on mood, energy levels, concentration, and our health in general. Especially important to people with HIV, sleep plays an important role in immune system health and function. And because immune system health is of the utmost importance to those living with HIV, so is the amount and quality of sleep we get each night.

We Sleep in Stages

If you wouldn't know better you would think that sleep was just one long period of rest. Actually, our night of sleep is comprised of many stages ranging in length from 5 minutes to a couple hours. Each stage starts with light sleep, a stage where you can be awakened very easily. From there, as your brain waves slow you progress to a deeper sleep known as delta sleep; getting its name from the delta brain waves that dominate this sleep stage. Finally, the last stage in a typical sleep cycle is called REM sleep, characterized by rapid eye movement (REM) and very little skeletal muscle movement. Throughout the night your body experiences several of these sleep cycles, with each successive cycle having a longer REM stage. It's during the REM stage that your body gets the recuperative sleep it needs.

Why Do We Have Problems Sleeping?

Problems sleeping can be caused by a number of different factors some of which are a result of HIV infection. Let's look at how HIV affects your quality of sleep.
  • Concern / Anxiety over Illness - having any chronic, potentially life threatening illness will cause concern and anxiety. Fear of the unknown; not knowing what your health will be like in 10 years, 5 years, or next week results in increasing anxiety and worry, both of which negatively impacts your sleep quality and quantity.
  • Financial Concerns - because your health status is sometimes uncertain, your ability to work and make a living may be uncertain as well. Any uncertainty regarding where your next paycheck is coming from or if you will be able to pay your mortgage next month will result in anxiety, worry, and sleep difficulty.
  • Viral Particles - I was surprised to find in researching this article that there are studies that have actually linked certain HIV viral proteins to difficulty sleeping. Granted, studies by Diaz-Ruiz et al and Prospero-Garcia et al were both animal studies but both showed that HIV viral proteins like GP120 can affect different stages of sleep. If further human studies prove true, it could explain why such a large percentage of HIV positive people have problems sleeping.
  • HIV Medications - the very medications that help people live longer can also make it more difficult for those same people to sleep. For instance, the HIV medication Sustiva (efavirenz) causes insomnia in a small percentage of people who take the medication.
  • The Effects of HIV on the Body - HIV affects your body in many ways. The pain, numbness, and burning of peripheral neuropathy and the damp, clammy nuisance of night sweats can both interrupt your sleep. In addition to that, any opportunistic infection will make you feel lousy, making it difficult to get a good night's sleep.

Insomnia, Depression and Fatigue

Among HIV-positive people insomnia, depression, and fatigue form a very common triad of symptoms, all related to one another and all of which can impact a person's ability to get a good night sleep. Insomnia, the inability to fall asleep makes fatigue and depression worse while either depression or fatigue can make insomnia worse. Depression is commonly characterized by an inability to fall asleep or stay asleep during the night. What's more, after waking in the middle of the night, people suffering from depression find it difficult to fall back asleep. And to make matters worse, some medications that treat depression can impact your ability to get a good night sleep. A lack of quality, recuperative sleep results in fatigue during the day, making it difficult to work, go to school, or carry on your day to day activities. Simple tasks we take for granted become a huge drain on an already stressed body. Being fatigued can impact the body's ability to fight off infection and illness, making the body more at risk for HIV complications.

Sleep Apnea

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 in some people. These enlarged tissues can obstruct the airway while sleeping, resulting in sleep apnea.

Sleep is an important part of a healthy life especially for people living with HIV. A healthy body is a well rested body. If you have difficulty falling asleep or staying asleep if it's for just a few nights, speak with your provider and get that good nights sleep you so desperately need.

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