Overview: A New Focus on Sleep in HIV Care
The European Aids Clinical Society (EACS) 2025 guidelines introduce a new section dedicated to sleep disorders as a key component of comprehensive HIV management. Recognizing the clinical impact of poor sleep on treatment adherence, quality of life, and overall health, the guidelines now explicitly recommend that clinicians routinely ask patients living with HIV, “How is your sleep?” This simple question is intended to prompt timely assessment and intervention for sleep problems, which are common in people with HIV and can worsen metabolic, cognitive, and mood-related outcomes.
Why Sleep Matters in HIV Management
Sleep disturbances in people living with HIV are more than an inconvenience. Chronic poor sleep correlates with reduced medication adherence, higher fatigue, and impaired daily functioning. It can also exacerbate cardiovascular risk factors, mental health conditions, and metabolic syndrome — all pivotal concerns in long-term HIV care. The updated EACS guidelines emphasize that good sleep hygiene and timely treatment of sleep disorders can improve ART (antiretroviral therapy) efficacy, enhance quality of life, and reduce healthcare utilization.
Key Sleep Disorders to Screen For
The new section outlines a practical approach to identifying common sleep problems in the HIV population, including:
- Insomnia: difficulty initiating or maintaining sleep, often linked to stress, anxiety, or medications.
- Sleep-Disordered Breathing: including obstructive sleep apnea, which may be more prevalent in people with HIV and metabolic risk factors.
- Restless Legs Syndrome: uncomfortable leg sensations that disrupt sleep, sometimes associated with iron deficiency or neuropathy.
- Parasomnias: abnormal movements or behaviors during sleep, sometimes influenced by medications or mood disorders.
The guidelines recommend a symptom-based approach to screen, followed by targeted diagnostic steps as needed, balancing feasibility with patient safety.
Practical Steps for Clinicians
1) Start with a Routine Question: The guideline’s core recommendation is to integrate the question “How is your sleep?” into regular HIV care visits. This opens a non-stigmatizing dialogue and helps identify patients who need further assessment.
2) Use Brief Screening Tools: If sleep concerns are raised, clinicians can use validated instruments such as the Athens Insomnia Scale or the STOP-BANG questionnaire for sleep apnea risk, alongside general mood and fatigue scales.
3) Assess Contributing Factors: Sleep problems often arise from a combination of behavioral, environmental, pharmacologic, and comorbidity-related factors. Review medications for sleep-related side effects and evaluate caffeine use, shift work, noise, or pain management needs.
4) Develop a Stepwise Management Plan: Start with sleep hygiene education, cognitive-behavioral strategies for insomnia when appropriate, and consider treating underlying conditions such as sleep apnea or restless legs syndrome. When pharmacologic options are considered, favor agents with the least interaction risk with antiretrovirals and the lowest abuse potential.
5) Coordinate Care Across Disciplines: Collaboration with sleep medicine specialists, mental health professionals, and primary care teams is encouraged to optimize outcomes, particularly for patients with complex comorbidities.
Impact on Patient Outcomes
Implementing routine sleep assessment can lead to earlier identification and management of sleep disorders, which in turn supports better ART adherence, improved daytime functioning, and enhanced metabolic and cardiovascular risk profiles. By explicitly recognizing sleep as a health determinant in HIV care, the EACS guidelines aim to normalize discussions about sleep, reduce stigma, and empower patients to engage in their own care more effectively.
What This Means for Practice
Clinicians should begin incorporating the “How is your sleep?” question into HIV treatment conversations, document sleep-related concerns, and refer patients for further evaluation when indicated. Training and resources on sleep hygiene, behavioral therapies, and safe pharmacologic options should be made available within HIV care settings to ensure consistent, high-quality care across Europe.
Conclusion
The 2025 EACS guidelines mark a meaningful shift toward holistic HIV care by elevating sleep health as a modifiable determinant of treatment success and life quality. By prioritizing sleep during routine visits, clinicians can detect problems early, tailor interventions, and support people living with HIV in achieving better long-term health outcomes.
