Introduction: A Milestone in HIV Care
The European AIDS Clinical Society (EACS) has released its 2025 guidelines and, for the first time in this comprehensive standard, includes a dedicated section on sleep disorders and sleep quality. Recognizing the clinical impact of poor sleep on health outcomes, mood, and adherence, the guidelines now advocate integrating sleep assessments into routine HIV care. This shift reflects growing evidence that sleep health is not a luxury but a foundational component of effective treatment and quality of life for people living with HIV (PLWH).
The Core Change: A Simple Question with Big Implications
One of the standout recommendations is straightforward: ask patients, “How is your sleep?” This single question is designed to flag sleep problems early, enabling timely assessment and intervention. The approach acknowledges that sleep disturbance often co-exists with other health issues common in HIV management—depression, anxiety, chronic pain, stimulant use, and metabolic changes—creating a cascade that can undermine adherence to antiretroviral therapy (ART) and overall well-being.
Why Sleep Matters in HIV Management
Sleep quality directly influences several pillars of HIV care:
- Adherence and ART effectiveness: Poor sleep is linked to diminished attention, memory, and executive function, which can reduce consistency in taking ART and attending appointments.
- Immune and metabolic health: Sleep disruptions can affect immune function and inflammatory markers, potentially impacting viral suppression and comorbidity risk.
- Mental health and quality of life: Insomnia and circadian rhythm disturbances are associated with higher rates of depression and fatigue, further impairing daily functioning.
- Risk behaviors and safety: Excessive daytime sleepiness can increase risk of accidents and reduce participation in social and work activities, hindering overall recovery and integration.
The guidelines emphasize that sleep problems may be multifactorial in PLWH, requiring a nuanced assessment rather than a one-size-fits-all solution.
Assessment and Practical Steps in Clinical Practice
Following the new recommendation, clinicians are urged to incorporate sleep screening into routine visits. Practical steps include:
- Initial screening: Use the simple “How is your sleep?” question at every major HIV care touchpoint.
- Historical and symptom review: Identify duration, severity, daytime consequences, snoring, apnea symptoms, and potential triggers such as caffeine, substances, or shift work.
- Objective tools: Consider short validated sleep questionnaires when indicated, and collate information about sleep duration, sleep efficiency, and disturbances.
- Comorbidity management: Screen for depression, anxiety, chronic pain, and substance use that can contribute to sleep problems.
- Interventions: Start with sleep hygiene education, circadian rhythm alignment, and behavioral strategies; escalate to targeted therapies for insomnia, sleep apnea, or restless legs syndrome as appropriate.
Tailored Interventions for Sleep Disorders in PLWH
Interventions are tailored to the type of sleep problem. For insomnia, cognitive-behavioral therapy for insomnia (CBT-I) is preferred, with adaptations for PLWH. For sleep apnea, referral for specialist evaluation and use of continuous positive airway pressure (CPAP) therapy may be indicated. Management considerations also include potential pharmacologic options, carefully weighing benefits against risks of interactions with ART and metabolic side effects.
The guidelines also highlight lifestyle and environmental strategies: regular sleep schedules, light exposure management, physical activity, and reductions in caffeine or alcohol intake. In some cases, addressing pain, itching, or nighttime symptoms linked to HIV or opportunistic infections becomes essential to improving sleep quality.
Impact on Policy and Patient Engagement
By formally elevating sleep health to the level of routine HIV care, EACS 2025 sets a standard that can influence practice beyond Europe. Clinicians are encouraged to document sleep assessments as part of care plans, enabling better monitoring of sleep-related outcomes alongside viral load, CD4 counts, and comorbidity management. For patients, the change signals that sleep quality is a legitimate, measurable target—one that can improve energy, mood, and everyday functioning.
What This Means for Patients Today
If you are living with HIV, consider discussing sleep with your healthcare provider during your next visit. A simple “How is your sleep?” can unlock a conversation about daytime fatigue, sleep routines, snoring or breathing issues at night, and the impact of sleep on your daily life. With sleep health now a formal part of HIV care, you have a clearer path to personalized strategies that can enhance treatment effectiveness and your overall quality of life.
