Overview: Sleep disorders enter the EACS 2025 guidelines
The European AIDS Clinical Society (EACS) has released its 2025 guideline update, and one of the most notable additions is a dedicated section on sleep disorders. This change reflects growing evidence that sleep quality profoundly affects overall health, treatment adherence, and quality of life for people living with HIV. The simple, patient-centered adjustment—asking every patient, “How is your sleep?”—is designed to normalize conversations about sleep and identify treatable issues early.
Why sleep matters for people living with HIV
Sleep health is a fundamental component of physical and mental well-being. Poor sleep is linked to impaired immune function, increased inflammation, mood disturbances, daytime fatigue, and reduced cognitive performance. In the context of HIV, where people may be managing complex antiretroviral therapy (ART) regimens, lifestyle factors, and co-occurring health conditions, sleep problems can undermine treatment outcomes and daily functioning. The EACS guidance underscores that sleep disturbances should not be overlooked or dismissed as merely incidental symptoms.
What the new section covers
The updated guidelines provide a structured approach to screening, evaluation, and management of sleep disorders within routine HIV care. Key elements include:
- A standard screening question integrated into regular visits to identify sleep issues early.
- An overview of common sleep problems in HIV patients, such as insomnia, sleep apnea, restless legs syndrome, and circadian rhythm disorders.
- Evidence-based strategies for non-pharmacologic interventions (sleep hygiene, cognitive-behavioral approaches, and optimization of ART timing when appropriate).
- When to consider pharmacologic treatment or specialist referral, with attention to potential drug interactions and side effects relevant to HIV therapy.
- Guidance on monitoring progress and adjusting care plans as sleep health evolves with aging, comorbidities, or changes in ART.
Practical steps for clinicians
Adopting the new sleep-focused practices involves simple, repeatable steps integrated into routine care:
- Ask the standardized question: “How is your sleep?” at least at every annual review and whenever new symptoms arise.
- Document sleep quality, duration, and daytime symptoms to identify patterns and risks.
- Screen for common sleep disorders using validated tools, and consider referrals to sleep medicine when indicated.
- Collaborate with patients on non-drug strategies first, including sleep hygiene education and behavioral therapy where available.
- Assess ART timing and potential interactions that may affect sleep or daytime alertness.
<h2Impact on patient care and outcomes
By formalizing sleep assessment in HIV care, the EACS guidelines aim to improve adherence to ART, reduce daytime impairment, and enhance overall quality of life. Improved sleep can lead to better mood, cognitive function, and engagement with care, which in turn supports sustained viral suppression and long-term health. Clinicians are encouraged to tailor sleep interventions to individual needs, considering age, comorbidities, and psychosocial factors that influence sleep.
Implementation challenges and opportunities
Integrating sleep assessment into busy HIV clinics may require workflow adjustments, training, and access to referral pathways for sleep medicine services. However, the guidance emphasizes feasibility, recommending a minimal, repeatable screen rather than a comprehensive sleep workup at every visit. Health systems can leverage interdisciplinary teams, including primary care, psychiatry, and behavioral health, to address sleep problems holistically. The updated guidelines also advocate for patient education materials that empower individuals to improve sleep health alongside HIV management.
Conclusion: A more holistic approach to HIV care
The 2025 EACS updates recognize that sleep health is inseparable from effective HIV management. By asking a simple question, clinicians can uncover sleep disorders early, deploy non-pharmacologic strategies, and ensure timely referrals when needed. This shift supports not only viral suppression but also the broader goal of improving daily living and long-term well-being for people living with HIV.
