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Sleeping Soundly When You Are HIV Positive

A Good Night's Sleep Is an Elusive Dream for Many People Living With HIV

Winter 2013

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Strategiezzz ...

Finding the solution that's right for you might not happen overnight, but persistence and trying different strategies with the support of a knowledgeable doctor can go a long way. Here are some suggestions:

Stay away from the light! Light at night is one reason why many people don't get enough sleep. Our circadian rhythms respond to the light and dark around us. Derived from the Latin words circa and diem, meaning "around a day," the term describes our sleep/wake pattern, hormone release, body temperature and other bodily functions over a 24-hour period. In the past, people would wake up with the sun and go to bed with the moon, but the lightbulb changed all that. Bathed in artificial light long after the sun has set, many of us find our patterns out of sync with our body's biological clock. And our sleep suffers from it. (Research suggests that it may also contribute to cancer, diabetes, heart disease and obesity.)

In the absence of light, our bodies release the hormone melatonin, which helps us get to sleep. When we are exposed to light, the release of melatonin is suppressed and makes sleep more difficult. Any kind of light has this effect, but the "blue light" emitted from electronic devices makes it particularly easy to disregard the body's readiness for sleep. That is why it is important to sleep in total darkness. The best way to achieve this is with a specialized window covering that blocks outside light (a "blackout blind"), but a sleep mask is effective as well. It is also important to eliminate all sources of light in the bedroom, including all blinking lights or display screens, by turning them off, taping over them or removing them altogether.

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Cut back on caffeine. Caffeine is the world's most consumed psychoactive (mind-altering) drug and can be found in coffee, tea, soda, energy drinks and chocolate. Coffee is the most popular choice, with 65% of Canadians drinking an average of 2.8 cups per day. With its ability to boost energy, increase alertness and improve mood, it is a simple solution for a quick pick-me-up. Unfortunately, it can also disrupt sleep patterns. A central nervous system stimulant, caffeine increases the heart rate, core temperature and blood pressure, which, in turn, can increase the time needed to get to sleep, decrease sleep duration and limit your time spent in deep sleep.

Caffeine has a half-life of five hours -- that's how long it takes to metabolize half the amount circulating in your system. So if you drank a 12-oz coffee containing 260 mg of caffeine at 8 am, there would be 33 mg of caffeine left in your system by 11 pm, which is more than enough to disrupt sleep.

Want to sleep better? Here are some caffeine tips:

  1. Limit your consumption after 10 am.
  2. Reduce your overall intake -- withdrawal symptoms like headaches can occur within 48 hours after you stop and can last two to nine days. If this happens, you're on the right track!
  3. Decaf does not mean caffeine-free -- that same coffee still has 20 mg of caffeine.

Check your meds and supplements. Review with your doctor all the medications and supplements you're taking to determine if any of them could be to blame. Dr. Montaner points out that it's essential to find the medication regimen best suited for each individual -- one that is highly effective and can be taken long-term without disrupting daily activities. "Antiretroviral therapy is a lifelong proposition," he says. "This is a marriage that has to work."

Some cough and cold medicines, Gravol, antihistamines and other over-the-counter remedies are used to help people sleep; however, these can exacerbate underlying sleep problems and, when used over time, can lead to anxiety and depression.

Get your vitamins and minerals. If you have a calcium or vitamin B12 deficiency, taking a B-complex vitamin along with calcium and magnesium supplements can help your muscles relax.

Seek peace of mind. If an underlying emotional issue is keeping you awake, seeing a psychologist, counsellor or other health professional can help with depression, anxiety and other issues. A healthy support system and meditation, yoga or acupuncture can also help you rest easier.

Avoid sleeping pills. Sleeping pills offer a short-term solution for some people, but using them over the long-term can create dependency, negatively impact sleep architecture and make you feel drowsy the next day.

You are getting sleepy ... A bedtime routine is essential for quality rest. We know its value for children, so why do so few adults have one? A consistent bedtime routine, which ideally starts 60 minutes before hitting the hay, helps you prepare for sleep by giving your day closure, quieting your mind and relaxing your body. A few pointers:

  1. Turn off all electronics.
  2. Dim the lights to start the release of melatonin.
  3. Listen to soft music.
  4. Set the temperature in your bedroom between 16°C and 20°C and make sure the room is well ventilated.
  5. Have a hot bath. The rapid drop in body temperature that occurs when you get out will help you fall asleep.
  6. Spend time reading, stretching or meditating.
  7. Try some deep breathing in bed: Inhale for five seconds, hold for two seconds, exhale for five seconds. Repeat until asleep.

When Jasmine gets home from her night shift, around 3 am, she says it's not as easy for her to "do the whole wind down/relaxation thing, the way a person who works regular hours would." Instead, she finds that putting on a pair of blue-light-blocking glasses for two to three hours before bed helps; in fact, she swears by it. She starts wearing them toward the end of her shift and doesn't remove them until she's in bed with the lights off. She also makes a point of exercising (cross-training, kick-boxing, roller-blading or biking) during the day, which helps with her sleep. Although working nights isn't easy, her modified regimen of anti-HIV drugs combined with these lifestyle changes has helped.

As for Terry, after years of trial and error, he now has a roster of strategies that have turned his formerly sleepless nights into long, uninterrupted deep sleeps. He tweaked his medication schedule (he now takes his meds at 7 or 8 pm in BC and at 9 or 10 pm in Asia) so that he no longer needs to call for room service in the middle of the night. He consulted with a dietitian who recommended light meals (nothing greasy) before a flight to reduce jet lag. When travelling, he routinely orders hotel turndown service, to make sure his room is completely dark at bedtime (he also tapes the curtains to the wall to make extra sure that no light comes through when day breaks). Regular Chinese acupressure massages and use of the hotel steam rooms or a bath help him relax before bed. Emotionally, he is now faring much better. When asked how he sleeps, he says unequivocally, "Like a baby."

For 23 years, David Evans woke up feeling the same way he did when he went to bed. Desperate for answers, he did his own research, met with specialists and completed an overnight sleep study. Blood tests turned up nothing. Meds for sleep, anxiety, depression and daytime drowsiness produced more side effects than benefits. His relationships and finances were a mess and he had difficulty holding down a job. He became isolated and considered suicide as he longed for a state of non-existence.

Fast-forward to today: David's sleep is under control and he is leading an energetic life. He no longer needs caffeine, naps are a rarity and he takes no sleep medication. Since transforming his own life, he now dedicates his time to helping others sleep soundly. He has delivered the workshop "Better Than Counting Sheep" at Positive Living BC and Vancouver Friends for Life Society. For more info, visit www.sleepstudent.com.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
 
See Also
Ten Things You Can Do to Enhance Your Emotional Well-Being
More Advice on Coping With HIV/AIDS
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Reader Comments:

Comment by: Julia (Bloemfontien RSA) Fri., Mar. 1, 2013 at 4:10 pm EST
Is being a week now i started to take my meds I use odimune, purbac and novavit plus, i never have a problem up to now. my cd4 count was 140. I sleep too much after work and night this is normal or not?
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Replies to this comment:
Comment by: Kevin (England) Sat., Mar. 2, 2013 at 6:55 am EST
Julia, you should go to the "Experts" area of this website and post your problem to the most appropriate expert listed there - probably one of the experts who deals with side-effects of drugs.

And be sure to give lots of information to the expert, so that he or she can understand your situation.

Good luck.


Comment by: Mico (Washington, DC) Mon., Feb. 25, 2013 at 4:34 pm EST
I'm on Isentress and Complera. I've had problems sleeping for 12 years. I've adjusted myself to it, however, two months ago, I decided to try one of those sleep masks and ordered it. When it arrived, there were earplugs with it. So, I decided to use the earplugs along with the sleep mask. For the first time in years, I slept all the way through the night! I even had several dreams which is not the same as before I may dream must mostly never did and thought I just didn't remember them.

I am not a fan of pills, I'll do the shower, the aromatherapy, which does help. But, I swear, the sleep mask (they have them so the mask doesn't set on your eyes) and the earplugs, WOW! Thankfully, these are working for me!

On average now, I'm sleeping 5 hours before I need to use the bathroom, then, I'm able to go back to sleep.

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Replies to this comment:
Comment by: Kevin (England) Wed., Feb. 27, 2013 at 7:08 am EST
Mico, I was intrigued by your praise of a sleep mask. Do you mean simply a mask to ensure you go to sleep in darkness, or are you talking about something like the Remee sleep mask (which the makers claim allows people to control their dreams)?

I go to sleep in a completely dark and silent room, so an ordinary sleep mask would not offer me anything.


Comment by: Kevin (England) Fri., Feb. 22, 2013 at 6:09 am EST
For years since becoming HIV+ and being on meds I have had awful problems with sleep. This article confirms what I have worked out: that HIV itself is screwing around with my brain. Whether it's neurotoxins and chemical balances, my brain at night goes into "overdrive" or "turbodrive", excessive mental activity. It may have been triggered by the fact that my first meds included Efavirenz, but though I've been off Efavirenz for six years I'm still having disturbed sleep.

I have tried everything under the sun to beat this problem. Everything from drinking a particular mixture of herbs that is sworn by in India to taking melatonin tablets.

Here's what I now do. The following regime does guarantee excellent sleep at all, but it has minimised the disturbance.

1. One aspirin every other evening, directly after dinner. I believe this anaesthetizes the brain, and stops the overdrive at night. (When I took an aspirin every night it really improved my sleep, but unfortunately too many aspirins caused me severe indigestion.)

2. One coffee or tea per day and never after midday.

3. One glass of wine only per day, with dinner. I've noticed that any more alcohol than this seriously increases the mental activity during sleep.

4. If you use computers and other screens after the sun goes down, then install Flux! It casts a pinkish-brown sheen over your screen that simulates candlelight, and ensures you aren't exposed to bright blue "daylight" right up until you go to bed! Get Flux, for free, from stereopsis.com/flux/. I recommend tweaking its settings so you reduce as much blue light from your screen as possible.

5. Exhaust yourself physically every day. Make your body physically exhausted. Exercise each day so that you reach breathlessness.

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Replies to this comment:
Comment by: Mico (Washington, DC) Tue., Mar. 5, 2013 at 4:07 pm EST
I use a regular sleep mask along with ear plugs. Nothing special. It darkens light to my eyes and sound to my ears.


Comment by: Paul (South Africa) Fri., Feb. 22, 2013 at 2:37 am EST
i have been on Truvada & Isentress but i do not sleep well i have resorted to taking sleeping tablets called sleep eeze is this addictive but since i have being taking this i sleep so much better please advise if iam doing the right thing
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Replies to this comment:
Comment by: Kevin (England) Fri., Feb. 22, 2013 at 12:02 pm EST
Everyone is different, Paul, so you may be fine with your tablets. However, I found that about a month after taking a Zopiclone tablet each night before bed I would suffer real depression each afternoon or evening. This was chemically induced, perhaps by the Zopiclone or perhaps by the Zopiclone interacting with my meds. Also, while one doctor told me Zopiclone was perfectly safe and not addictive, another warned me that it is addictive. Obviously because of the depression, I stopped taking it. I am content with the regime outlined above. However, my chemical make-up is not the same as yours, so you may be fine with your "Sleep Eeze". I don't know anything about that particular sleeping aid.


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