Sleep and HIV

A lot of things can affect the CD4 count. These include the time of day it is taken, exercise, diet etc. Stress and lack of sleep can also affect your CD4 count. Let us focus on sleep here.

People with HIV should sleep the normal 7 to 9 hours a day. Our bodies need to rest and recuperate. If we deprive ourselves from sleep we are allowing ourselves to be prone to infections. We tend to be weaker when we lack sleep and we become very vulnerable to illnesses like cold and flu. 

Sleep problems and HIV are common bed fellows. At some point in time, all of us will have problems falling asleep. Be it the stress from a financial problem; the discomfort of soaking night sweats; or the effects of our HIV medications; at one time or another sleep will not come easy. For most it's a short lived problem; resolving on its own in short order. For others, it's a chronic problem that can slowly chip away at a person's sanity. People living with HIV are commonly troubled by sleep problems. From before diagnosis and throughout the stages of illness people living with HIV have sleep problems. This feature discusses the facts about sleep and how sleep problems and HIV are related. Before we can discuss sleep problems and HIV we first need to understand sleep.

Why Do We Need to Sleep?

On average we spend about one third of our life asleep; roughly 8 hours each night. Why do we need to sleep so much? The fact of the matter is sleep is an essential part of our good health. A disruption in the amount or quality of sleep we get takes a toll on mood, energy levels, concentration, and our health in general. Especially important to people with HIV, sleep plays an important role in immune system health and function. And because immune system health is of the utmost importance to those living with HIV, so is the amount and quality of sleep we get each night.

Why Do We Have Problems Sleeping?

Problems sleeping can be caused by a number of different factors some of which are a result of HIV infection. Let's look at how HIV affects your quality of sleep.

• Concern / Anxiety over Illness - having any chronic, potentially life threatening illness will cause concern and anxiety. Fear of the unknown; not knowing what your health will be like in 10 years, 5 years, or next week results in increasing anxiety and worry, both of which negatively impacts your sleep quality and quantity.

• Financial Concerns - because your health status is sometimes uncertain, your ability to work and make a living may be uncertain as well. Any uncertainty regarding where your next paycheck is coming from or if you will be able to pay your mortgage next month will result in anxiety, worry, and sleep difficulty.

• HIV Medications - the very medications that help people live longer can also make it more difficult for those same people to sleep. For instance, the HIV medication Sustiva (efavirenz) causes insomnia in a small percentage of people who take the medication.

• The Effects of HIV on the Body - HIV affects your body in many ways. The pain, numbness, and burning of peripheral neuropathy and the damp, clammy nuisance of night sweats can both interrupt your sleep. In addition to that, any opportunistic infection will make you feel lousy, making it difficult to get a good night's sleep.

Insomnia, Depression and Fatigue

Among HIV-positive people insomnia, depression, and fatigue form a very common triad of symptoms, all related to one another and all of which can impact a person's ability to get a good night sleep. Insomnia, the inability to fall asleep makes fatigue and depression worse while either depression or fatigue can make insomnia worse. Depression is commonly characterized by an inability to fall asleep or stay asleep during the night. What's more, after waking in the middle of the night, people suffering from depression find it difficult to fall back asleep. And to make matters worse, some medications that treat depression can impact your ability to get a good night sleep. A lack of quality, recuperative sleep results in fatigue during the day, making it difficult to work, go to school, or carry on your day to day activities. Simple tasks we take for granted become a huge drain on an already stressed body. Being fatigued can impact the body's ability to fight off infection and illness, making the body more at risk for HIV complications.

Many sleep problems can be improved by changing your sleep habits, reducing stress, improving your diet or exercising. If problems persist, it may be time to seek professional help.

• Consume less or no caffeine, nicotine and alcohol. Watch out for the caffeine in soft drinks and chocolate as well as in coffee. Nicotine can inhibit sleep as well. Although alcohol may initially cause sleepiness, it can interrupt your sleep later in the night because alcohol becomes a stimulant when the body metabolizes it.

• Exercise regularly, but do so in the daytime. Exercising regularly can greatly improve the quality of your sleep and increase the amount of deep sleep, but do it at least three hours before bedtime. Some people may need to exercise up to six hours before bedtime in order to allow themselves enough time to unwind. The best time to exercise to benefit sleep is in the afternoon.

• Don't stay in bed tossing and turning. If you can't go to sleep after 30 minutes, get up and involve yourself in a relaxing activity until you feel sleepy. Remember, try to clear your mind; don't use the time to solve your daily problems.

• Go to bed at the same time every night and get up the same time every morning. This is one area where the body craves consistency. Don't sleep in on the weekends to make up for lost sleep. If you do end up suffering from sleep deprivation during the week, go to bed earlier but get up at the same time on Saturday and Sunday.

• Establish a regular bedtime routine, such as walking the dog, taking a bath, and reading a book. It doesn't matter what you do. Just be consistent and your routine will signal your brain that it's time to snooze.

• Use the bedroom for sleeping or sex only. Leave TV-watching, bill-paying and other activities to another part of your home so that your brain associates the bed and bedroom with sleep.

• Try a relaxing routine before bedtime, like soaking in hot water (a hot tub or bath), reading a book, listening to relaxing music, or practicing deep breathing. You can also try drinking a glass of warm milk, which is high in L-tryptophan (a natural sedative).

• Drink less fluids before going to sleep.

• Avoid heavy meals and foods and drinks high in sugar close to bedtime.
• Use sleeping pills sparingly or not at all. Although sleeping pills are temporarily helpful for addressing sleep disorders, they should be used for the shortest possible time, and in the smallest effective dose. Sleep-promoting medications can eventually cause sleep disturbance, side effects, a sleep "hangover" during the day, and dependency on the drug.

Sleep is an important part of a healthy life especially for people living with HIV. A healthy body is a well rested body. If you have difficulty falling asleep or staying asleep if it's for just a few nights, speak with your doctor and get that good nights sleep you so desperately need.




Credits:

http://aids.about.com/od/otherconditions/a/Sleep-Problems-And-Hiv.htm
www.thebody.com/content/art32801.html

                                                                   

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Email 21

“Hi Pozziepinoy,

I hope you are doing well.  I have my result and it's confirmed.  

My big problem now is my work.  I have decided to resign but as per law here, I have to render XXX notice else I have to pay an amount because of breach of my contract.  I already informed my employer that I need to go back to the Philippines for medical treatment.  They would only allow me to cut my notice period short if I have a medical certificate to show them that I need to undergo medical testing....  I actually informed them that I may have a XXX problem.  Right now, I'm so confused because all I want is to go home.  If only I could tell them that I'm HIV positive, then they will let me go right away.

I'm having a hard time sleeping now thinking what to do. I already accepted the fact that I am HIV positive but I'm always afraid of every moment I spend here. I'm losing appetite and I believe I'm losing weight too.  This is not because of HIV... this is because of the depression that I don't know how can I go back to the Philippines the soonest possible time without creating any questions or conclusions with all the people I know here in XXX.

I hope to hear from you soon.

Thank you.

XXX”


POZZIEPINOY'S REPLY

Hi XXX,

Thanks for your email. 

I know what you are feeling right now. I know how heavy it is for you to carry this new load, especially when you are all alone, in a foreign land. I know how hard it is to give up one’s job, and leave our friends because of our illness, not primarily because we are sick but because of the law of a certain country where we are working in. I understand the feeling of depression that is getting on to you.

You are doing the right choice at the moment. Your priority should be your health first. Everything will crumble, if we allow ourselves to get sick. You are still lucky because no matter what you are still healthy and still capable on focusing on getting treatment.

Coming back home is the wisest choice for me. Your family is here. I tell you, you can have 100% support from them. Also, here you can get tested for free. HIV treatment is absolutely free. The only financial burden will be if you have infections already in which case you have to finance the treatment straight from your pocket. 

For now, focus on getting strong, physically and emotionally. You have to fight by focusing on what you can do for now which is finishing everything there even though you have to stay for another XXX days and planning what you need to do here. You need to get peace of mind. Praying can help. If you need to relax, get a diversion while you're there. Read books, get a temporary hobby, meditate. When you return I will help you, so don’t worry. 

Depression can eat you alive, and make you feel weak, so don’t allow it. It is a matter of choice. Either we succumb to it or fight it. Eat and stop wasting time on overly thinking about things. Stay strong because that is the only way of beating our disease. You have to stay focused in getting as healthy as possible so that when you come back home, you are ready to face what ever is in front of you. But for now, stay as positive as possible. Always put it in your mind that HIV can be beaten with medicines and a inner strong will. I know you can do it, like most of us who have done it before.

There is life, which is a better life, you will see. You just have to see beyond HIV and later on you will tell yourself that you have beaten it, tamed our illness as if it never happened to you at all.

Stay safe and I’ll wait for your return to the country.

Pozziepinoy

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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In Need of Help!!

Another patient is asking financial help for his hospital bills. He is an HIV patient having thoracostomy. Bill has been outrageous so RITM-ARG asked me to gather support for him.

Once again, I am asking for financial support for The Love Fund. Details are below this entry.

So for all those who are reading my blog and who have a generous heart to help, please do so.

Thank you so much.


   
FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com
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Email 20

I just opened my mailbox and read an email. Really it’s heartwarming to know that people appreciate you.

Hi Pozziepinoy,

I read your last post regarding HIV+ who are in need.

I'm going to send this month some amount and I'll try my best to send every month.

I hope that even in small amount it will be of big help.

Thanks for doing your part and for helping others.

XXXX

There are more HIV people who are in need of help. Today as I passed by RITM-ARG, I talked to the staff and inquired about the 2 year old HIv patient who is needing help. The staff told me that they have 2 kids now who have HIV, a 2 and a 3 year old. They promised to email me the details based on their DSWD files.

By the way, a good samaritan from twitter, @HIVPLUS2012 is going to help me out with one of the 2 kids. He texted me that doctors from a hospital, a few friends and some foundations are willing to help out as long as I would forward their details to him. I contacted the RITM staff late afternoon today and they said they will forward the details as soon as they get them.

This person has a great heart so if you find him in twitter tell him how grateful the world would be to a kind hearted person like him. Message him and tell him that he will be an angel to these kids and may he continue to shower love and support to our indigent HIV patients who may still need him in the future.

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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My CD4 Result!

Got my actual result!! 

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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Asking for Help!

There are more HIV/AIDS patients who are needing help for their prophylaxis and medications for their OI's. There are a lot of CMV and PTB patients and price of their medications are expensive. Please help them by donating any amount to the Love Fund.

I am calling all those who are reading my blog to help out. Most of us are out danger now and yet there are a lot more who are still struggling. Let's help all of them to stand up once more and fight back the ill effects of HIV. Please help support the Love Fund!!



   
  

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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Email 19

“Hi Pozziepinoy,

First and foremost, I would like to thank you for your blogs.  All your words are so encouraging and all the information you share lift up my spirit.  I just have known that I have HIV last June 28 but yet to be confirmed by my Western Blot test (hopefully this Thursday).  HIV may not kill me at this time but depression does.  From the moment those 2 lines showed up in the rapid test, everything fell apart.  It was my darkest day.  I don't know what to do, who tell and what to tell.  I can't eat, I can't sleep and I want to stop time.  I'm so glad that I came across your blog because it's the only thing that I have for now and reading it makes me strong and gives me the understanding of what to face whatever lies ahead.

I'm still here working in XXXX.  I've been here for XXXX years.  I know and if I remembered it correctly, I got my infection last XXXX.  I pray that the XXX would not know my situation. Else, they would cancel my employment pass immediately and I have to leave the country ASAP.  If that happens it would be harder for me to explain to those who know me what is the reason and hopefully the XXX wouldn't disclose anything to my employer.  I don't know if I should expect that to happen but now I’m starting to pack my things (anyways, I still need to send some of my things back).  I couldn't decide at the moment until I have the WB result.  If I will be given the chance, I would like to stay here as long as I can to earn and save money for my lifelong medication but it also frightens because I know it would be hard when I start taking any medication.  I'm also thinking to just resign and go back to my family but I’m not sure either if I should or how can I tell them or how can I hide it from them.  I may have my savings but I’m not sure if it's enough for my treatment and I don't know if I can get a job when I go home.

Please advise me.  If ever I got that WB result, how long or should I wait for a certain period to do the entire test required?  Is 1 week enough to do the entire test? If I still be working here, I may be able to get a maximum of 2 weeks leave.  Can you also help me and refer me to your doctor?  RITM is the ideal hub for me because it's accessible to where I stay.  Please tell me what should I prepare - financially, emotionally, and physically.

Right now, I have so many questions in my mind.   There are so many information that I need to digest.   I have a big plan to make. It was just a week ago where everything is normal.  If only I could turn back the time, but I can't do that and what only I can do is move my life forward.  I have to stay strong. I have to live healthy. I want to be a fighter like you.

Hope to hear from you soon. 

Thanking you much!

XXX

P.S.

I hope that I would have the chance in meeting and talking to you in person.  I need your counselling.  You are the first person that I told about this.”

POZZIEPINOY’S REPLY

 Hi.

Thanks for your email. Thank you also for reading my blog. It is my diary of my second journey, well after I was diagnosed. 

I salute you for taking the HIV test. It is really hard for most of us to take it, to really admit that we have done something wrong in the past and acknowledge that HIV is real. You are one courageous person that other people should look up to. I am glad that you took it early, unlike me, who got tested when I was already sick with opportunistic infections, when I already have AIDS.

I know it is a serious matter to you since you are living and working abroad and having HIV would really compromise your job especially in the country you are in right now. I know it really is scary but more importnat now is your health. It is the greatest treasure that we all can only have so we really have to focus on it no matter what. You might be earning to live your dreams but what is important at present is for you to keep on living a healthy life. There are many decisions that we have to take but we have to choose what is best for our health. You really have to make a hard decision later on. I don't know how long you can keep it a secret in your company and from the country you are in but that feeling that anytime, someone will know your status is really scary. I know it is hard but let's face it, some countries really ban people with HIV. That's the reality, well, for now.

While waiting for your WB result, you should start reading about HIV. Most are in my blog already and the status of medical care in the country. 

Regarding your questions about the the length of time that you have to stay here for your tests, you have two options:

1. You can finish everything in one day in RITM and go back to work the following day (as simple as that) if:

    a. your CD4 is above 350. This means that you don't have to take your ARV's yet which are free in the Philippines.

    b. your CBC result is normal

    c. your other special tests are normal 

        i. Chest xray

        ii. AFB Smear

        iii. Toxoplasma IgG

        iv. HBsAg

        v. Herpes Simplex II (igG)

        vi. VDRL

        vii. anti HCV

     **** if there are abnormalities or there are signs of infections, better for you to have medical treatment first before going back.

2. When all the results are out (one day only in RITM) and if your CD4 is below 350:

    a. You have to take ARV's and monitoring is usually 2 weeks to one month, which means that you have to go back to the hub either after 2 weeks or after 1 month. This period is your monitoring period for any side effects of the ARV's.

Let's pray that you don't fall to option 2 yet because that will really have an impact in your decision of either staying here or working there still.

My advice to you is as soon as you get the result of your WB and in case it turns out to be positive, get a 2 week leave of absence fast, if possible, and get tested here in the Phils for all the tests that I mentioned above. Your priority is your health so this is important. The chances of getting better fast is at the highest is when the HIV is detected at an earlier stage and the immune system strength known (high CD4) so come home fast. Get all the tests done in RITM-ARG because I'm pretty sure that the results come out on the same day so no need to wait for a long time. I can also refer you to my doctor in case your CD4 is low, well in case you really want to. Else, if your CD4 is still high, you will just be asked to come back again after 6 months to be tested again.

For now, while waiting you just have to be strong. In my blog entries I wrote a lot of things that you can do while waiting. Check Things to do while waiting. Physically, you have to stay healthy. Don't get sick. Financially, the costs of all the tests won't go above P10,000. The ARV's are free, Your biggest baggage will be your travel expenses. Emotionally, just try to be strong and positive. There is life after HIV. Even though it is not the life we want for ourselves, at least we are still alive and living.

Thanks for making me the first person to confide your status in. I appreciate that. Talking is a good way of venting our fears and emotions. Later on, the challenge will be accepting what it is and by accepting it means telling our loved ones our health status.

I'll be here for you. You can email me anytime and we can communicate once you decide to come back to the country.

Stay healthy,

Pozziepinoy

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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Day 271

Hey guys I am still counting. Counting the days I've been taking my ARV's and counting my blessings. It is important for me to know Ho long I've been on these meds and the impact that it has given to my life.

First of all, to give you an update, today is my 271st day of taking my ARS. This is the ARV history as I wrote it in my notebook:

Day 1: CD4 70, ALT 115, with Oral Thrush
Dr. T from my private hospital through the help of Dr. T's (consultant) and Dr. R (resident) of -PGH SAGIP prescribed Lamivudine, Tenofovir and Efavirenz. Dr. T prescribed Fluconazole for 14 days and prophylaxis: cotrimoxazole 800mg once a day and azithromycin 1250 mg once a week.

Day 11-13: Skin rashes, whole body. Dr. T prescribed Xyzal and Afarax

Day 18: ALT increased to 328; PGH-SAGIP consultants wanted to switch to 2nd line

Day 20: Met Dr. Ditangco and recommended to stay with current ARV's (first line); switched hub to RITM-ARG.

DAY 24: Viral Load: 107,216 copies/mL

Day 34: ALT dropped to 110!!!

Day 109: Vaccinations: Flu, Hepa B, Pneumonia, Meningococcemia

Day 124: Went back to work

Day 139: Vaccinations: 2nd Hepa B shot

Day 159: Vaccinations: 3rd Hepa B shot

Day 265: CD4 487!

Current status: In good health. Not been sick for almost nine months.

So far so good!

FOR TOPIC SUGGESTIONS, please email me at pozziepinoy@yahoo.com

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