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Nightmares, Daymares and Sleeping Difficulties

Part of A Practical Guide to HIV Drug Side Effects


Anxiety, mental problems, depression, nervousness, dizziness, insomnia and nightmares are all possible side effects of certain HAART drugs. Specifically, the neurologic problems caused by the non-nucleoside analogue efavirenz (Sustiva) can occur both during the day (muddled or unfocused thinking, feelings of paranoia and disorientation, depression) and night (insomnia and, when you get to sleep, vivid dreams and nightmares). Some people report feeling "stoned." In many PHAs, these side effects disappear gradually after several weeks on the drug, so waiting out the problem for at least a month is advisable, if you can stand it. For others, the problems continue and stopping the drug is the only solution for those in whom the symptoms are just not bearable. Generally speaking, it is best to avoid recreational drugs, including alcohol, when starting efavirenz.

For some helpful "Tips and Tricks on Taking Sustiva," go to

The following anti-HIV meds may also cause mental or sleep problems:


  • indinavir (Crixivan) -- in some users can cause chronic feelings of anxiety, usually low-level but sometimes more severe; the symptom normally remains until the drug is discontinued
  • ddI (Videx EC) -- same as above; can also cause nervousness and sleeping difficulties, although these are not very common
  • abacavir (Ziagen, ABC) -- can cause dizziness and trouble sleeping, problems which may or may not disappear after a period of a few weeks on the drug
  • nevirapine (Viramune) and saquinavir (Fortovase) -- can cause depression

As with efavirenz, all of the above side effects may diminish or disappear after a period of days, weeks or months on the problematic drug but may also remain long-term, with drug discontinuation the only solution.

Tips for Handling Sleeping Difficulties

There may be approaches that will help with at least some of the problems. Certain efavirenz problems can be resolved by rescheduling the dose. If it's causing insomnia, talk to your doctor or nurse about taking it in the morning instead of at bedtime. If daytime drowsiness is the problem, take it earlier in the evening.

With any insomnia problems, there are different approaches you can try, alone or in combination, to help improve your sleep, including:

  • Try to avoid drinking or eating anything with caffeine, sugar or alcohol for 4-6 hours before bedtime.
  • Try to avoid nicotine for 4-6 hours before bedtime.
  • Try to avoid strenuous exercise, bright lights and television before bedtime.
  • Try relaxing before bedtime by doing peace-inducing yoga or breathing exercises, indulging in a soothing bath, or sipping calming herbal teas like chamomile. Drinking a glass of warm milk may help since it provides a dose of tryptophan, a precursor to the chemical serotonin, which is involved in the induction of sleep.

For some people, medications may also help to counter certain problems:

  • For sleep problems, standard sleep medications may help. There are several effective, non-addictive drugs available for short-term use. Gravol (anti-vomiting med) or Benadryl (antihistamine) can usually be used safely for the occasional bout of insomnia. With any such drugs, keep in mind this important caution: Mixing many of these meds with herbs and/or antiretrovirals can result in dangerous interactions. Always check with your doctor and pharmacist before use.
  • For anxiety, the standard anti-anxiety drugs may reduce that symptom, but note that such medicines are potentially addictive. Many psychiatrists believe that antidepressants are a better choice for long-term use.

It is important to remember that other causes of depression or anxiety may be contributing, including deficiencies of certain nutrients (the entire vitamin B complex, especially B6 and B12) and testosterone (often deficient in both men and women PHAs and a major contributor to depression; if testing shows inadequate levels, replacement is crucial).

Don't ignore the possibility that stress may be causing you symptoms of anxiety or insomnia. At times, therapy with a good mental health therapist or psychologist can work wonders, especially if you have a lot going on in your head and your life.

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This article was provided by Canadian AIDS Treatment Information Exchange. Visit CATIE's Web site to find out more about their activities, publications and services.
See Also
Side Effect Chart: An Abbreviated, At-a-Glance Guide to HIV Drug Side Effects
Other Side Effects
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