Sleep disturbance associated with efavirenz (Sustiva)

About disturbed sleep

Sleep is an essential part of a healthy life as it is a time when your body is able to rest and repair.

If you are not able to get regular, good quality sleep, either in the long or short term, your ability to think, speak and concentrate will be reduced. You can become more irritable and have slower reactions, and your memory and judgement will be affected.

Sleep problems are generally under-reported, underdiagnosed and under-treated and keeping a sleep diary for the week before you see your doctor can help diagnose some of the problems.

Factors affecting sleep include:

The diary should include when you fall asleep and when you wake up on week days and weekends. Include any naps you have during the day.

Stress and worry can easily disrupt your sleep pattern, as can ongoing health concerns, especially if they are painful or uncomfortable.

Your doctor should also give you a physical check up and blood tests to check for cardiovascular, respiratory or hormonal reasons, especially thyroid function, that may be causing sleep disturbance.

Suggestions to help

It is important that the causes of insomnia are diagnosed before any treatment is given. The wide range of possible causes mean that non-pharmaceutical approaches, such as having a warm bath or hot milky drink before bedtime, can often make a big difference and are sufficient.

Do:

Don't:

Medication

Sleeping pills are only usually prescribed when other selfhelp remedies have been tried. They are used to help reestablish a pattern or habit of sleeping – and are not recommended or generally prescribed for long-term use.

Sleeping tablets should only be used for the shortest period and at the lowest dose.

All sleeping pills work in a similar way by reducing brain activity, but the type of sleep they produce varies between different types of drug. They can help you sleep, but the depressed brain activity means that the quality of sleep is often not as good as natural sleep, and you may still not feel rested the next day.

Sleeping pills reduce the amount of ‘dream sleep’ that you get and this is an important component of good sleep. Sometimes this can leave you feeling drowsy the next day. They can become less effective after even a few days’ use, and you can develop a physical or psychological dependency if they are used for more than 1–2 weeks.

Although benzodiazepines (ie temazepam) have relatively few side effects they can interact with protease inhibitors. Non-benzodiazepines such as zopiclone and zolpidem work in a similar way, are shorter acting, and are preferred when anxiety is not a contributing factor.

Melatonin is a hormone produced at night linked to your ‘biological clock’. As a supplement it is used to help deal with jet lag and may help to help return sleep patterns to normal, although side effects also include vivid dreams.