Thanks for the question. I'll have to assume that the 9AM is a typo, since most persons take their efavirenz in the evening. Perhaps you're DOT setting forces this timing.
This is a difficult situation, though in my experience, negative adverse effects of efavirenz continue to diminish with time. We've had some luck using sleep aids, like Ambien or Sonata in symptom mitigation. Alternative approaches, if the symptoms persist, particularly if the person does not have contraindications is to try (off label) once-daily nevirapine.
Good luck, let us know how the patient does. -BY
