Poor sleep and sleep-related breathing disorders are common in patients with End-Stage Renal Disease (ESRD), but are often unrecognized and undertreated. Sleep disorders are known to be predictive factors for morbidity (disease) and mortality. Although, several uremic (complication from kidney disease) and non-uremic factors are thought to partly cause sleep disorders in patients with ESRD, the main risk factors for insomnia are represented by old age, obstructive and central respiratory events, sleep apnea syndrome (SAS), restless legs syndrome (RLS), excessive daytime sleepiness (EDS), comorbid clinical conditions, and characteristics of dialysis.
Risk of obstructive and central respiratory events are increased by renal failure and dialysis therapy. SAS affects 30-80% of dialysis patients. RLS is independently associated with uremia, affecting up to 62% of the dialysed. Excessive daytime sleepiness (EDS) is often reported by the dialysed population which is caused by nocturnal sleep deficiency that increase daytime sleepiness. Although less frequent, the presence of other sleep disturbances (such as nightmares and narcolepsy) should be carefully evaluated in the uremic population.
KidneyBuzz.com holds the position that, "there is no standing rule for how much someone should sleep." For example, older people may need less sleep than those who are younger. Nighttime sleep can be particularly difficult for those with CKD, and typical practices will not work. Vigorous exercise is often not possible, and a person may, at times, have difficulty in getting out of bed. Also, avoiding daytime naps completely is often unrealistic for CKD patients who are very ill. For this reason, individuals with CKD should exercise moderately, and naps should be kept as short as possible, between prolonged periods of awake time before going to bed.
If you are suffering from insomnia, discuss with your healthcare team various behavioral treatment options such as stimulus control therapy, relaxation therapy, and cognitive behavioral therapy. It is difficult to know how long non-pharmacologic therapy should be tried before attempting other measures. This may depend somewhat on your preferences, and the severity of your sleep disturbance. There are many studies which show cognitive behavioral therapy to be an effective treatment regimen, if used for 7 to 8 weeks.
Obstructive sleep apnea is treated with Bi-level Positive Airway Pressure (BiPAP) ventilation at night. Though, some patients report difficulty becoming accustomed to sleeping with the BiPAP mask on, this therapy can dramatically improve symptoms. Surgery is sometimes indicated for obstructive sleep apnea.
Spiritual concerns can also be an important cause of insomnia for people with ESRD. They may be able to avoid these concerns during the day through the distraction of daily activities but have difficulty ignoring them at night. Therefore, it is important to directly address spiritual concerns, worries, and fears during the day so that you can sleep well at night; psychotherapy may be helpful.
Hence, there are several sleep disturbances, which may potentially be treated but, if left untreated, may impair health status and increase the risk of mortality. However, literature and anecdotal data suggest that undertreatment is common, calling for higher awareness of sleep disturbances among the CKD population. The treatment of sleeping disorders includes nonpharmacological and pharmacological measures that can affect the quality of life for those living with CKD.
"Fast Fact and Concept #104: Non-pharmacological Therapy for Insomnia." Non-pharmacological Therapy for Insomnia
Sleep disorders in dialysis patients. National Center for Biotechnology Information. U.S. National Library of Medicine
Sleep disturbances in dialysis patients. National Center for Biotechnology Information. U.S. National Library of Medicine