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Managing Side Effects of HIV TreatmentManaging Side Effects of HIV Treatment
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Efavirenz and insomnia
Apr 16, 2007

Hi Doc. Thanks for an outstanding website and forum. I was daignosed HIV+ about 10 weeks back and am on Efavirenz and Truvada and doing well, generally. My VL has gone from 50K to undetectable and CD4 from 167 to 407 (from initial treatment point 9 weeks ago). My only problem with Efavirenz is insomnia. I take my meds at bedtime. My physician prescribed Zolpidem for the first month to offset any possible sleep problems. i had some strnage and vivid dreams and rather erratic sleep to start with. I switched from Zolpidem to Valium as I found Valium more gentle and relaxing. Problem is is seem to be becoming tolerant of the 20 mg valium that used to get me comfortably through the night. (I go to bed around 11 pm and sleep well until around 4.30 am when I am wide awake and cannot sleep again). It's bugging me because I feel that I am not getting enough sleep at night which makes me lethargic and irritable the next day. I don't really want to get stuck on increasing doses of Valium, if I can avoid it. Any suggestions as to another suitable sedative/hypnotic that i could try as alterntives to Zolpidem or Valium? I am preapred to be patient and try other ways to get better sleep but my sleep is also imopertant to me. Is a meds time-change a worthwhile option and if so how and to when should I try and change. Thanks for your consideration. D

Response from Dr. Henry

Some patients with insomnia do better with efavirenz when taken in the AM. I have had good success with use of trazadone or amitryptiline as non-addictive sleep meds in this situation. KH

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