Annoying Bouts of Insomnia, Med-related or no?

[newbieguy]

I posted on this before way back, but just wanted some fresh feedback. I've been on one regimen, Atripla, since I started meds in late 2010..The results have been great, I have gained weight and my VL has stayed undetectable..However, within the last few months, I have been having some bouts of insomnia..I NEVER had this issue in the past, and I wonder if it is med-related or HIV-related...Basically, my issue is I have trouble falling asleep, but once I get to sleep, I do okay mostly. And it seems to come on very suddenly, like here a few days, then gone, then here again, etc..When I do have it, like I said, my issue is falling asleep, and getting much-needed REM sleep..Whats weird is this just started a few months ago, and I was on on Atripla for over a year with no sleep issues at all! So could it be the Atripla, or just a naturally-occuring flare up of sudden insomnia? Does this sound familiar to anyone else? I have been extremely reluctant to try any sleep aids, because I was scared if I started them, it would mess with my body's sleep cycle and I would get dependent on them..I have heard of Melatonin and Valerian root, are those safe, non-addictive to try? Or should I bite the bullet and ask my doctor to give me Ambien or Lunesta for when I am having an insomnia bout? I just really hope this would resolve itself...Thanks for any responses!

[Miss Philicia]

Side effects like this from Atripla don't necessarily start in the early months of taking it, but can appear much further down the road. The only way you're going to know is if you switch to something else.

That said, I've had insomnia issues for over a decade and this time period spans several med changes, so for me I guess it's more HIV-related. But even that can be a misdiagnosis, as does that means it's "the virus" itself causing it or is it just me having elevated anxiety issues from dealing with HIV for 20 years? I've come to the conclusion that it's just the latter.

The better answer is that there's not always a particularly easy answer. That said Atripla is known to cause sleep problems so if it was me I would discuss changing medications with your doctor as a first solution.

[buginme2]

The better answer is that there's not always a particularly easy answer. That said Atripla is known to cause sleep problems so if it was me I would discuss changing medications with your doctor as a first solution.

I think I would respectfully disagree with Miss P.  Atripla may end up being the culprit however, I don't know if that's where you should start at finding a solution. 

When I started Atripla I had a difficult time falling asleep as well.  My doctor instructed me to stick with it and recommended trying Melatonin for a short term.  I took 250 micrograms before bed and it helped me fall asleep but didn't keep me tired so I was able to awake the next day rested.   I only took it for a couple of months.

I'm not saying Melatonin is the answer, just that maybe you should try some different methods prior to changing your HIV medication since it seems to be working for you.

[newt]

Pretty much with MIss P on this one if you slept well before Atripla and don't now.

- matt

[newbieguy]

All good and valid points, I really don't think I can blame anxiety for the insomnia, because I really don't have a problem with that...However, I do know some ppl can have anxiety without knowing it..That being said, I wonder if it's just one of those subtle body-chemistry things that comes up, my HIV is totally in check thanks to the Atripla, and I'd sort of be scared to change off something that's worked so well on that front..I'd likely be hard to pin down the exact cause....I actually bought some low-dose 1mg Melatonin but didn't have the courage to try it yet because I told myself I'd get dependent on it..Do you think I should stay with the Atripla, and try to tough it out, maybe adding some Melatonin or valerian root as needed, or ask for Ambien or Lunesta? I've heard some people say other HIV regimens like I+T can have insomnia side effects too, plus others I might not want I am going to ask my regular doctor next week and see what she thinks.. I might try taking the Atripla earlier than I have been, give it a little time to dissolve before I lay down..Decisions, decisions!

[Miss Philicia]

my HIV is totally in check thanks to the Atripla, and I'd sort of be scared to change off something that's worked so well on that front.

People here always say this and frankly I don't understand the logic. It's not "working well" if it's causing you side effects like insomnia. If you're specifically defining "working well" as your undetectable viral load then what do you think other HAART regimens do or don't do? ALL standard recommended HAART regimens should provide a patient with an undetectable viral load. Further, switching to another regimen (if done properly) should not render that previous regimen useless to the patient in the future.

There are, quite simply, too many great (potentially) side-effect free regimens out there to eliminate changing regiments as an option.

[Tempeboy]

People here always say this and frankly I don't understand the logic. It's not "working well" if it's causing you side effects like insomnia. If you're specifically defining "working well" as your undetectable viral load then what do you think other HAART regimens do or don't do? ALL standard recommended HAART regimens should provide a patient with an undetectable viral load. Further, switching to another regimen (if done properly) should not render that previous regimen useless to the patient in the future.

There are, quite simply, too many great (potentially) side-effect free regimens out there to eliminate changing regiments as an option.

Well said,

I think we are well beyond viral control and CD4 counts as being the ONLY measures of successful HIV Treatment.

The drug in Atripla that is most likely to be causing your sleep disturbance is Efavirenz - it is neurotoxic in both the short and long term, and can cause a number of side effects to the CNS (Central Nervous System) that manifest in a range of nasties - including disturbed sleep, energy, mood, and concentration - as well as Vitamin D hypovitaminosis, thinning of bones, facial lipo etc.

You might like to ask your doc if you can switch that part of your combo to another and see if you notice any improvements - Nevirapine is pretty cool - is one of the best for accessing HIV in reservoirs that most other drugs can not get to.

Hope things improve for you - we all deserve to be side effect free.

TB x

[newbieguy]

Tempeboy and Miss P I think you both make some good points. It isnt so much that I am in love with Atripla, because its not like I have this devotion or love affair with it, its more that since it's the only med I've been on, I guess I am a bit apprehensive about the unknown. But I certainly know there are a lot more options..I guess I am having a few delayed CNS effects from the drug. I've heard about Viramune, I am going to explore it more and just consider all other possible alternatives before my next doc visit. Meds are like men after all, I guess you got to change them up now and then if they aint working!