HIV-infected patients who also have depression are more likely to have sleeping problems, which may add to the burden of their disease, according to a recent medical literature review.

The review flagged two studies that showed that HIV-positive people with major depression were more likely to have insomnia - and when their depression worsened, so did their sleep.

Study author Dr. Steven Reid explained that ongoing insomnia can affect our ability to keep up with day-to-day responsibilities, and for people with a chronic illness such as HIV, those responsibilities include sticking to a medication regimen, which is very important.

“There is also evidence that poor sleep leads to depression, so you end up in a vicious circle of deteriorating mood and overall functioning,” added the researcher, who is based at St. Mary’s Hospital in London, UK.

Reid explained that insomnia is a well-recognized symptom of depression, but because HIV-positive people have so many other health issues - they are commonly prescribed powerful medications and may have opportunistic infections - doctors may not realize that the reason patients can’t sleep is because they are depressed.

In HIV patients, “it can be difficult to identify the cause of sleep disturbance and depression may be missed,” he told Reuters Health.

In the review, published in the journal Psychosomatic Medicine, Reid and his co-author Justin Dwyer studied 29 reports, noting how many patients had insomnia and its risk factors.

They found numerous reports showing that insomnia is very common among HIV patients, regardless of the severity of their illness. One study found that nearly three quarters of 115 HIV-positive patients had insomnia, defined as taking at least 1 hour to fall asleep and sleeping 2 hours less than normal.

But not all studies were consistent. For instance, one study of a group of 169 homosexual men found that the asymptomatic HIV-positive subjects were no more likely have insomnia than their HIV-negative counterparts.

Researchers have estimated that between 10 and 40 percent of the general population struggles to get a good night’s rest.

Having cognitive impairments and taking the drug efavirenz appeared to increase HIV patients’ risk of insomnia, but the risk of insomnia appear greatest when depression was also present.

In one report that followed 98 HIV-positive men for 6 months, those diagnosed with major depression were more likely to have insomnia and their sleep deteriorated as their depression worsened.

In another study of 115 HIV patients, depression appeared to increase the risk of insomnia by 17 percent.

“Insomnia is common in HIV patients and depression is an important but often little considered cause,” Reid said.

Treating patients’ depression may help them get a good night’s rest, but further research is needed to confirm that, he added.

“Although there have been no studies specifically in HIV patients of the effect of treating depression on insomnia, there is evidence from non-HIV populations showing that treatment of depression leads to better sleep,” Reid noted.

SOURCE: Psychosomatic Medicine, March/April 2005.