Poor quality of sleep (QOS) is frequently reported in HIV-positive individuals; however, despite its clinical and public health significance, few studies have examined the correlation between QOS and antiretroviral (ARV) adherence. The objective of this study was to estimate the prevalence of sleep disturbances, determine the characteristics of those with poor QOS, and establish the relationship between QOS and ARV nonadherence among HIV-positive individuals. We conducted a cross-sectional secondary data analysis of 2845 HIV-positive adults taking ARV therapy from the Healthy Living Project baseline cohort. Mean self-reported ARV nonadherence was estimated using a 3-day measure. QOS was assessed using three questions regarding sleep pattern changes, amount of bother from difficulty falling/staying asleep, and amount of bother from vivid dreams. Over 68% of individuals reported sleep pattern changes, 50.3% reported difficulty falling/staying asleep, and 20.5% reported bother from vivid dreams. Depression, suicidal ideation, unemployment, use of illicit substances, history of incarceration, and HIV viral load were all independently associated with poor QOS. Individuals reporting feeling bothered about difficulty falling/staying asleep had a 1.66 higher odds of nonadherence (95% confidence interval [CI]=1.18, 2.33; p=0.004). Those reporting the highest degree of bother from difficulty falling/staying asleep and from vivid dreams had a 1.42 (95% CI=1.13, 1.78; p=0.002) and 1.31 (95% CI=0.98, 1.75; p=0.07) higher odds of nonadherence, respectively. With higher incremental reports of poor QOS there were considerable increases in ARV nonadherence. Recognition and timely treatment of sleep difficulties may result in reduced ARV nonadherence with beneficial clinical and public health implications.