Sleep disorders and kidney failure. Is there a connection?
Which are the most common sleep disorders that affect the lives of dialysis patients?
Insomnia, i.e. the difficulty to fall and remain asleep; sleep apnea (more common in obese patients); restless legs syndrome (jerking of the limbs during sleep that leads to transient arousals and sleep deprivation).
What factors are associated with the onset of insomnia?
Factors associated with the occurrence of sleep disorders in dialysis patients are as follows: old age; male gender; severe anemia; patients undergoing inadequate hemodialysis with elevated parathyroid hormone levels (a hormone for bone metabolism that increases significantly in dialysis patients); the beginning of each hemodialysis treatment (especially the first half hour); anxiety; depression; restless legs syndrome.
Do sleep disorders have a serious impact on the health of these patients?
Yes. They adversely affect the quality of life of dialysis patients and increase cardiovascular risk. Sleep apnea, in particular, has a detrimental effect on blood pressure and cardiovascular events. A key factor leading to this is low blood oxygen levels (oxygen saturation). These low blood oxygen levels can cause heart issues (coronary heart disease) or problems in the blood vessels of the brain.
Is there anything patients can do to improve their sleep quality?
Yes, there are several things that can be done to improve sleep, such as maintaining a regular sleeping schedule; avoiding sleeping during the day if possible; paying attention to the quantity of coffee and how long before going to bed it is consumed; not watching TV in bed; and avoiding having a clock or watch near the bed.
Is there a connection between sleep disorders and the time that has passed since starting hemodialysis?
Yes. It was discovered that the occurrence of sleep disorders is increased at first, but over time patients will note an improvement.
How can apnea - sleep disorders be treated?
Apnea can be treated by
- losing weight;
- changing positions during sleep; and
- wearing a mask that provides continuous positive airway pressure (CPAP) to the patient.
- Moderate exercise during the day can help (but avoid strenuous exercise before bed, since it worsens the problem).
What are some other causes of sleep disorders?
Many dialysis patients do not sleep well at night because they experience itchiness and restlessness in their legs. This is thought to be caused by nervous system disorders and the effects of various harmful substances.
1: Ren Q, Shi Q, Ma T, Wang J, Li Q, Li X. Quality of life, symptoms, and sleep quality of elderly with end-stage renal disease receiving conservative management: a systematic review. Health Qual Life Outcomes. 2019 May 3;17(1):78. doi: 10.1186/s12955-019-1146-5. Review.
2: Chu G, Choi P, McDonald VM. Sleep disturbance and sleep-disordered breathing in hemodialysis patients. Semin Dial. 2018 Jan;31(1):48-58. doi: 10.1111/sdi.12617. Epub 2017 Jun 13. Review.
3: Cabrera VJ, Hansson J, Kliger AS, Finkelstein FO. Symptom Management of the
Patient with CKD: The Role of Dialysis. Clin J Am Soc Nephrol. 2017 Apr3;12(4):687-693. doi: 10.2215/CJN.01650216. Epub 2017 Feb 1. Review.
4: Gopaluni S, Sherif M, Ahmadouk NA. Interventions for chronic kidney disease