A report back on Nina Vora's and Hugh Selsick's session Zzzzzzzzz: Sleep issues beyond efavirenz. Nina Vora presented an excellent clinical case of a newly diagnosed client who had continual issues with insomnia. The client, despite a couple of changes with antiretroviral therapy, still continued to have problems. The client was also very insistent that it was the onset of ART that had started his insomnia.

When the client and Nina conducted a review of all ART, insomnia was a side effect in all of them. They then decided that there was no point in continually changing the regimen as it was of no benefit, but delved deeper into the clients lifestyle to see if there were any other issues that could resolve the insomnia.

There were other issues:

  1. irregular sleeping hours
  2. party and play or chemsex
  3. alcohol
  4. depression following diagnosis
  5. cigarettes

These issues were addressed and to some extent the client’s insomnia resolved. This highlighted to me that perhaps we need to think outside the box and instead of quickly grabbing for a sedative, we should be looking at the client’s wider lifestyle and provide education in order to correct their insomnia.

Hugh Selsick gave an excellent talk on ways to reduce insomnia.

These were things I had never really thought of and will become my new gold standard when developing care pathways or giving advice to my clients. Also, it was a huge amount of advice for myself. For example:

  1. Restless Leg Syndrome can be an alternative diagnosis and provides disruptive sleep. This can be triggered by anxiety, drugs and sciatica and can be treated pharmacologically. (Thank You Bianca Dee at O’Brien st️)
  2. Always wake up at the same time every day regardless of whether you had a good sleep or not and go to bed at the same time. Utilise the bedroom only for sleeping and sex. Your bedroom shouldn’t be warm and cosy but cool, and if you can’t sleep when in bed, then keep your eyes open. If you’re still struggling, go out of the bedroom.
  3. Last coffee should be at 2pm no later.
  4. Cigarette cessation
  5. No alcohol at nighttime
  6. Insomnia may cause depression and anxiety

Hugh taught me that there is no such thing as a perfect sleep and has provided me with oodles of information about how to better direct my care into the future.

Author bio: I am a registered nurse on the infectious diseases unit at the Royal Adelaide Hospital. I have an interest in pot-diagnosis HIV care.