Can HIV affect your sleep?

Key points:

Having HIV can affect your sleep
An HIV infection can affect the biological systems that regulate sleeping patterns, as well as stress caused by mental health conditions and other health issues
Lifestyle changes can help reduce the severity of sleep disturbances, but medical interventions may be necessary

You wouldn’t think a virus that affects your immune system would affect your…sleep?

Well, according to new studies, this may be the case. Some people who live with HIV may experience significant sleep disturbance. But how is this possible?

Keep reading to find out.

The more you know about your sexual health, the quicker you can take action.

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What is HIV?

HIV stands for Human Immunodeficiency Virus, and it’s a virus that attacks the body’s immune system—specifically the CD4 cells (also known as T cells), which help fight off infections.

Most people get HIV through sexual activity, primarily through anal sex and vaginal sex via infected bodily fluids like semen, vaginal fluids, mucus from the rectum, and blood. It’s incredibly rare for the infection to spread through oral sex. It can also be passed on through blood-to-blood contact, like through sharing needles during drug use.

If left untreated, HIV can lead to AIDS (Acquired Immunodeficiency Syndrome), the most advanced stage of HIV infection.

How does HIV affect sleep?

A new study published in Open Forum Infectious Diseases sought to compare the sleep and rest activities of people living with and without HIV.

For this study, all participants living with HIV were virally suppressed and on stable antiretroviral medication for at least one year. Differences in sleep and rest patterns were adjusted for factors like age, sex, race, body mass index, education, and employment.

The results showed that people who live with HIV tended to go to sleep later in the day than those who didn’t. They also tended to have less consolidated nighttime sleep, with less robust rhythms and more variable nightly sleep. They also seemed to experience more day-to-day variability in both sleep and rest patterns.

The study authors explain that “[disrupted] circadian rhythms may contribute to the excess cardiovascular, metabolic, and psychiatric morbidities observed in [people living with HIV].”

This is important because the quality of your sleep can have a massive impact on your overall health. “[Individuals] with highly variable sleep patterns from night-to-night are at elevated risk of developing metabolic syndrome. Similarly, the risk of suffering a cardiovascular event increases with greater sleep irregularity. Moreover, reduced strength of circadian rhythms […] is associated with a greater risk of all-cause mortality. Delayed timing of sleep and activity patterns are also associated with adverse health outcomes, predicting greater risk of anxiety, depression, and substance use.”

People living with HIV are also more likely to experience sleep disorders like sleep apnoea, chronic insomnia, and restless leg syndrome.

How does this happen?

Infection with HIV directly impairs the biology of the systems that regulate a person’s sleep.

Proteins associated with HIV infections, called transactivator of transcription (Tat), can disrupt an individual’s circadian pacemaker.

However, biology only plays one role. Reduced social interactions in people living with HIV may also play a role in sleep disturbance, resulting from HIV-related stigma, discrimination, and mental health issues. The study authors state that “[as] abnormal circadian timing […] may contribute to a broad range of physiologic derangements.”

The investigators concluded that “advancing and increasing the robustness of circadian rhythms may be a novel intervention to reduce the risk of non-AIDS comorbidities among [people living with HIV].”

Altered sleep is also a feature of ageing, and it has been well documented that people living a long time with HIV experience premature ageing. This may also be a contributary factor.

How can this be treated?

While HIV can directly affect the biological systems that regulate a person’s sleep, there are ways to counteract this.

Maintaining your sleep hygiene is essential. This can include:

Keeping regular sleeping hours
Sleeping in a dark room
Keeping sleeping quarters cool, between 18 and 24 degrees C
Creating a consistent bedtime routine, which may include activities like journaling, taking a warm shower, reading, avoiding screens like smartphones and TV, and avoiding caffeine later in the day as much as possible
Keeping a sleep diary – if you identify either a constant difficulty getting to sleep or maintaining sleep, speak to your doctor about this. If you think this is due to anxiety or depression, this would be another reason to get medical help.
Go to bed only when you are truly tired and nodding off, and make sure you have no tasks left to do, like brushing your teeth, taking your makeup off, etc.
If you wake up and cannot go back to sleep for the next 20 minutes, get up, distract yourself by reading a book or watching television until you again feel that true tiredness and can’t stay awake. At this point, jump back into bed. If you wake up again, do the same. You will slowly adjust and your sleep will improve over the following nights.

Those interested in improving their sleep may also wish to avoid:

Consuming caffeinated drinks like tea or coffee several hours before going to bed
Napping during the day
Alcohol
Stimulant drugs like amphetamines, MDMA, and cocaine
Vaping and smoking

Interventions like cognitive behavioural therapy (CBT), herbal remedies, and taking doctor-prescribed sleeping pills may also help.

What are the more typical symptoms of HIV?

It’s tough to know if you have HIV, especially in the early stages. When symptoms do appear, they often occur within the first six weeks of exposure.

The initial symptoms of an acute HIV infection include flu-like symptoms such as fever, nausea, sore throat, fatigue, and swollen glands. This is likely indicative of “seroconversion”, where your body tries to produce antibodies to fight the infection.

These symptoms will eventually go away on their own. The infection then becomes latent, meaning it will continue to multiply within your body without producing noticeable symptoms.

As HIV advances in the body, symptoms of a weakened immune system start to appear.

Common symptoms include:

Unintentional weight loss
Chronic diarrhoea
Recurrent infections, such as chest infections
Skin rashes, especially on the face, genitals, or anus
Increased Herpes ulcers or thrush infections on and around the mouth and genitals
Sweats, especially at night
Unusual tiredness
Nausea or loss of appetite
Swollen lymph glands in the neck, groin, or armpits