Disturbed sleep pattern

[hephziba]

last night was the first night all week that I had a good nights sleep, three times this week I couldn't sleep till 5 am.

do any of you suffer from disturbed sleep or no sleep ?

what do you do to kill time in the nigh ?

any good clean websites that help ?

nessie hunting for instance..no seriously anything cool that you do to kill the time.

[Bajanne]

I have been having that too. This is weird for me, since I am a sleepaholic.  I inherited the ability to sleep on a pin, from both my parents.  I used to sleep on the 15 min. flight between Antigua and Montserrat!!!
But now, I find that I spend a lot of wake time during the night.  LIke you, my sleep has been very disturbed.  But I still try to rest.  I do get up sometimes at 3 in the morning and chat with Goofynina!!
But I usually just lie down and watch Food Network, or the news.

[Black]

My husband has PKD and one of the symptoms of the progression toward kidney failure was listed as "sleep inversion".  We didn't know what that was until we realized he was sleeping better during the day than he was at night.

He says his best, sound sleep comes between 5 or 6 AM and 11 AM.  Even on the  nights when he does sleep he is up every hour to pee!  Afternoon naps are also disturbed by the hourly visits to the bathroom.

I've tried on the last two or three visits w/ the Neph to get him to try Ambien or Paxil or something.  The Neph will write the script but he still says, "No, I'm taking enough pills, maybe later."  The final decision on his treatment/care is always his.  I will mention it again on the next visit, but in between visits I rarely comment on his sleep, or rather lack of sleep.  Actually the only thing he ever complains about is his lack of sound restful sleep.

I board and groom dogs and many of the tiny ones stay in playpens in my living room or run loose in the livingroom and kitchen w/ our dogs.  Naturally as clients come and go, the dogs "announce" the visits, along w/ the visits by UPS/FedEx, and the neighbors on their lawnmowers.  On the weekends/holidays when I have many dogs he sleeps in the motorhome w/ his dog -- even then he still has days and nights of disturbed sleep.

I think it's just a fact of life for many w/ ESRD.  Considering how badly lack of sleep affects healthy people I can't help but think that lack of restful sleep is a serious problem for anyone w/ ESRD.  Next time I'm going to suggest that he try something for a month, just a trial period, and then decide if he wants to continue to take it or not.

I think sound, restorative sleep is a necessity for everyone and you need to do whatever you have to do to get it.

Lorelle

[goofynina]

Oh boy, i like this one and let me tell you WHY i cant sleep, yes, there is a reason folks,  well,  i am an addict,  i am addicted to THIS WEBSITE... Honestly, i will stay here until the wee hours of the morning (hoping someone would come in the chatroom) Just ask Bajanne and Kitkatz lol, but i always think as soon as i get off the pc, someone is going to come and post something, so i just kick back and read (posts that i have read over and over) and play games.  I am on the cycler at night so it doesnt make a difference to me,  oh, believe me, i do get a nap in in the morning but as soon as i get up, here i am. lol,  I also do send out emails to friends and families, funny cuz when they get them they email me back and say WHAT THE HECK WERE YOU DOING UP AT THAT HOUR...  i've always been a night owl (sigh)  and that is the truth your honor

[kitkatz]

I have spells where I am unable to sleep. Either because of the itchies on the body or because of a good book I am reading and can't put down.  Sometimes it is just plain old insomnia and I am up for a good part of the night.  I read stuff on the computer, work on lesson plans or school projects, or read on this site and post.  I also read my books or watch junk night TV.

Katherine

[Rerun]

Yes, inability to sleep is a symptom of kidney failure.  I'm just learning to live with it and grab sleep when it comes. 

With my transplant the first things that changed were I could PEE (of course) and I could sleep and eat.  Life was good.

[angieskidney]

It is 4:45am ... yes ... I can't sleep. I have told my Nephrologist when he comes in once a month and 2 months in a row he says he would rather not give me anything to help me sleep....

[kitkatz]

See We are not crazy when we cannot sleep!


American Journal of Kidney Diseases

Related Article, p. 277  http://www.ajkd.org/article/PIIS0272638606009449/fulltext


IN AN EXTENSIVE, well-conducted, and nicely presented study, Chen et al1 report the extraordinarily high prevalence of subjective sleep complaints in a huge sample of hemodialysis (HD) patients. This presents a special and timely opportunity to reflect on the current state of knowledge, therapeutic implications, and future research directions in the arena of sleep complaints, sleep disorders, and chronic renal failure (CRF).

This study should serve as a “wake-up call” to all nephrologists and other professionals caring for this patient population. The bad news is that sleep complaints are ubiquitous in this CRF, and may result in untold misery and medical complications. The good news is that most wake/sleep complaints are diagnosable and, more importantly, treatable. All too often, complaints of excessive daytime sleepiness and insomnia are summarily attributed to the fact that patients with CRF are undergoing dialysis and/or are receiving multiple medications.

For perspective, sleep disorders are extremely prevalent in the general population. Therefore, at least 10% to 20% of patients with CRF had insomnia, 4% had obstructive sleep apnea (OSA), and 10% had restless legs syndrome (RLS)—even before they developed CRF. Things go downhill from there.

Insomnia
This and other studies found an astonishing number (67%) of HD patients complained of insomnia. Recent advances in insomnia research have clearly indicated that in many cases there are physiologic underpinnings to insomnia, and that most cases of insomnia are not due to underlying significant psychiatric or psychological problems. Insomnia is best thought of as a constitutional symptom, like pain, fever, or weight loss. An underlying etiology can usually be identified. Once identified, the underlying cause can be treated.2 Frequent causes in this population include conditioned insomnia, RLS, and medication-induced insomnia.

Long-Term (Chronic) Conditioned Insomnia
This common form of insomnia develops after an event that triggered acute situational insomnia (anxiety, excitement, bereavement, pain, medication, etc). This short-term insomnia then becomes conditioned, or “learned.” The inciting event disappears, but the insomnia persists, and remains until treated by behavioral and/or pharmacologic means. The behavioral treatments include sleep restriction, sleep consolidation, sleep hygiene, and cognitive behavioral therapy.3 Effective pharmacologic treatment includes benzodiazepines (temazepam, clonazepam, triazolam, or estazolam) or the newer nonbenzodiazepine medications (zaleplon, zolpidem, or eszopiclone). Many medications commonly prescribed to treat insomnia (antihistamines, tricyclic antidepressants, or trazodone) are generally ineffective.4

Restless Legs Syndrome
There is a fascinating relationship between CRF and RLS. Although RLS is most often idiopathic or familial, it has long been known that conditions associated with iron abnormalities (anemia, pregnancy, and CRF) are associated with RLS. RLS is actually a neurologic sensory motor disorder that presents as severe insomnia resulting from a difficult-to-describe discomfort in the lower extremities, which is relieved only by moving or rubbing the legs, or by getting up and walking about. The discomfort returns when the patient attempts to return to sleep. There is now overwhelming evidence that the primary abnormality in many patients with RLS is a defect of iron metabolism in the central nervous system. Many RLS patients have low serum ferritin levels (despite normal hemoglobin, hematocrit, iron, and iron binding capacity determinations). Some have low cerebrospinal fluid ferritin levels despite normal serum ferritin levels. Functional neuroimaging studies support the concept of abnormal central nervous system iron metabolism.5, 6, 7

The prevalence of RLS is much greater in CRF than in the general population. It results in often incapacitating insomnia, and may be present during sedentary wakeful activities. In some HD patients, the waking restlessness is severe enough to actually interfere with dialysis sessions. RLS has been associated with increased morbidity in patients with end-stage renal disease.8

Fortunately, RLS tends to respond nicely and often dramatically to a number of medications including dopaminergic agonists (pramipexole and ropinirole), benzodiazepines (clonazepam), opiates, and gabapentin.5

Medication-Induced Insomnia
Relatively few medications are known to cause insomnia. Those pertinent to the CRF population include phenytoin and steroids (taken by a number of CRF patients). Steroid-induced insomnia may be severe, and often responds nicely to effective sedative/hypnotic medication.9

Excessive Daytime Sleepiness
Sleep Apnea
This and other studies have found a very high prevalence of sleep apnea in patients with CRF.10 The reason for this high association is elusive. That many patients with CRF and OSA are not overweight serves as a reminder that being overweight is not a necessary accompaniment of OSA. But clearly, identification and treatment of any underlying OSA is important. Untreated OSA results in daytime sleepiness and is a known risk factor for hypertension, cardiac disease, stroke, and type 2 diabetes11, 12—all of which may already be problematic for many CRF patients.

Hypersomnia Not Related to OSA
Daytime sleepiness is common in HD patients, and is not always attributable to OSA.13 The cause and treatment of this currently are unknown.

What To Do?
Wake and sleep function should be viewed as a vital sign: every patient should be asked about sleep and daytime alertness. Any complaint should be taken seriously and not simply attributed to the underlying renal disease and/or medications.

Complaints of insomnia can be evaluated with sleep diaries or actigraphy. An actigraph is a wristwatch-like device that records movement over prolonged periods (weeks). The movement is highly correlated with wake/sleep patterns. Actigraphy provides an “at a glance” overview of the wake/sleep pattern over prolonged periods.14 RLS can be identified simply by asking if, while having trouble falling asleep, the patient lies quietly in bed awaiting sleep, or is compelled to move the legs or get out of bed to walk about. Patients with RLS are virtually unable to lie still in bed trying to fall asleep. Formal sleep studies are rarely indicated in the evaluation of insomnia.

Patients with unexplained hypersomnia should undergo formal sleep studies. If significant OSA is found, nasal continuous positive airway pressure is the treatment of choice. If hypersomnia unrelated to OSA is documented, stimulant medication may be of value, however this remains undocumented.

Future Directions
Documentation of the staggering prevalence of sleep complaints in patients with CRF (including children15) is overwhelming.16, 17 Impaired quality of sleep likely impairs quality of life in CRF patients.18 Applying this information to our patients with CRF can markedly improve their quality of life. Already, there is evidence that renal transplantation can reduce the prevalence of insomnia in dialysis patients to that seen in the general population.19 Careful analysis of objective data regarding the specific relationships among CRF, sleep apnea, insomnia, and RLS will advance the fields of both sleep medicine and nephrology. Close collaboration among the fields of basic science and clinical sleep medicine and nephrology will provide important scientific and clinical information that will serve to benefit our patients.

References
1. 1Chen W-C, Lim P-S, Wu W-C, et al.. Sleep behavior disorders in a large cohort of Chinese (Taiwanese) patients maintained by long-term hemodialysis. Am J Kidney Dis. 2006;48:277–284. Abstract | Full Text | PDF (164 KB)

2. 2Roth T. Prevalence, associated risks, and treatment patterns of insomnia. J Clin Psychiatry. 2005;66:10–13.

3. 3Edinger J, Means MK. Cognitive-behavioral therapy for primary insomnia. Clin Psychol Rev. 2005;25:539–558. MEDLINE | CrossRef

4. 4Anonymous . Treatment of insomnia. Treat Guidel Med Lett. 2006;4:5–10. MEDLINE

5. 5Mahowald MW. Restless leg syndrome and periodic limb movements of sleep. Curr Treat Options Neurol. 2003;5:251–260.

6. 6Mizuno S, Mihara T, Miyaoka T, Inagaki T, Horiguchi J. CSF iron, ferritin, and transferrin levels in restless legs syndrome. J Sleep Res. 2005;14:43–47. MEDLINE | CrossRef

7. 7Trenkwalder C, Paulus W, Walters AS. The restless legs syndrome. Lancet Neurol. 2005;4:465–475. Abstract | Full Text | PDF (197 KB) | MEDLINE | CrossRef

8. 8Winkelman JW, Chertow GM, Lazarus JM. Restless legs syndrome in end-stage renal disease. Am J Kidney Dis. 1996;28:372–378. Abstract | Abstract + References | PDF (756 KB) | MEDLINE

9. 9Reckart MD, Eisendrath SJ. Exogenous corticosteroid effects on mood and cognition (Case presentations). Int J Psychosom. 1990;37:57–61. MEDLINE

10. 10Sanner BM, Tepel M, Esser M, et al.. Sleep-related breathing disorders impair quality of life in haemodialyis patients. Nephrol Dial Transplant. 2002;17:1260–1265. MEDLINE | CrossRef

11. 11Collop NA. Obstructive sleep apnea syndromes. Semin Respir Crit Care Med. 2005;26:13–24. MEDLINE | CrossRef

12. 12Vgontzas AN, Bixler EO, Chrousos GP. Sleep apnea is a manifestation of the metabolic syndrome. Sleep Med Rev. 2005;9:211–224. Abstract | Full Text | PDF (208 KB) | MEDLINE | CrossRef

13. 13Parker KP, Bliwise DL, Bailey JL, Rye DB. Daytime sleepiness in stable hemodialysis patients. Am J Kidney Dis. 2003;41:394–402. Abstract | Full Text | PDF (104 KB) | CrossRef

14. 14Ancoli-Israel S. Actigraphy. In:  Kryger MH,  Roth T,  Dement WC editor. Principles and Practice of Sleep Medicine. (ed 4).. Philadelphia, W.B: Saunders; 2005;p. 1459–1467.

15. 15Davis ID, Baron J, O’Riordan MA, Rosen CL. Sleep disturbances in pediatric dialysis patients. Pediatr Nephrol. 2005;20:69–75. MEDLINE | CrossRef

16. 16Parker KP. Sleep disturbances in dialysis patients. Sleep Med Rev. 2003;7:131–143. Abstract | Abstract + References | PDF (199 KB) | MEDLINE | CrossRef

17. 17Merlino G, Piani A, Dolso P, et al.. Sleep disorders in patients with end-stage renal disease undergoing dialysis therapy. Nephrol Dial Transplant. 2006;21:184–190. MEDLINE | CrossRef

18. 18Iliescu EA, Coo H, McMurray MH, et al.. Quality of sleep and health-related-quality of life in haemodialysis patients. Nephrol Dial Transplant. 2003;18:126–132. MEDLINE | CrossRef

19. 19Novak M, Molnar MZ, Ambrus C, et al.. Chronic insomnia in kidney transplant recipients. Am J Kidney Dis. 2006;47:655–665. Abstract | Full Text | PDF (163 KB)

[angieskidney]

last night was the first night all week that I had a good nights sleep, three times this week I couldn't sleep till 5 am.

do any of you suffer from disturbed sleep or no sleep ?

what do you do to kill time in the nigh ?

any good clean websites that help ?

nessie hunting for instance..no seriously anything cool that you do to kill the time.

I am up still and it is 3:40am. I used to play games late at night or work on my site or check email after Sandman went to bed and couldn't keep me company because he has work. Now I spend more of my time on this site

My husband has PKD and one of the symptoms of the progression toward kidney failure was listed as "sleep inversion". We didn't know what that was until we realized he was sleeping better during the day than he was at night.

I thought it was just because I am a "night owl" but I used to sleep better than this. Now I just simply seem not to be able to "fix" my sleep no matter how hard I try. It used to not be this hard...     

 lol I didn't realize I posted before in this thread ... but when I asked my Neph he wanted to wait .. well how much time has passed now??  About a week I think. And I still have this problem? My Neph refuses to give me anything 

See We are not crazy when we cannot sleep!


American Journal of Kidney Diseases

Related Article, p. 277 http://www.ajkd.org/article/PIIS0272638606009449/fulltext

Wow! Nice post! I am going to post that link on D&T City! THen the nurses will be aware too

[Mom3]

Kitkatz, thanks for the great information. I first heard of the connection at a convention a few years back and when I pressed the issues, sure enough my son was diagnosed with restless legs AND sleep apnea (seldom uses the machine!). His sleep deprivation really worrys me. Sometimes he tries to stay awake so he can sleep on dialysis, anyone else do that?

I had not heard of the sleep inversion with PKD but it does explain what is happening to me! And it is really tough when you are trying to hold down a job (or two!) The very frequent urination since the kidneys don't concentrate the urine anymore and in my case, the enlarged liver,also don't make sleeping any easier!

I'm adverse to sleep meds...what has helped me is an exercise bike. When you do it by itelf it is repetitive and boring and seems to help me relax. (If I turn on TV I get interested in it and stay awake!) I've also used herb teas that help relax me but one has to take the potassium and phosphorous of any herbal product into account--critical once on dialysis. If I get on the computer I'm usually UP!

Is your spouse still trying to work with his PKD?

Mom 3

[kevno]

kitkatz you have been on the web too long

[Sara]

Restless Legs Syndrome
There is now overwhelming evidence that the primary abnormality in many patients with RLS is a defect of iron metabolism in the central nervous system. Many RLS patients have low serum ferritin levels (despite normal hemoglobin, hematocrit, iron, and iron binding capacity determinations). Some have low cerebrospinal fluid ferritin levels despite normal serum ferritin levels. Functional neuroimaging studies support the concept of abnormal central nervous system iron metabolism.5, 6, 7

Seems like they should be treating the iron or iron metabolism problem rather than prescribing sleep aids, doesn't it?  Does this mean there's not enough iron or that the body isn't using the iron like it should?

[BigSky]

I run into not being able to sleep from time to time. 
That is how I tell that my hct is dropping below 11.  Doc said take benyadril  but it doesnt have any effect on me even at double dosage.  Stopped at that as wasnt sure how much one could take safely being a renal patient.

[deej]

I used to sleep normally when I wasn´t on dialysis but now I´m like "Old Faithful" - awake and asleep every hour on the hour! I usually just watch TV or think a lot to try to fall back asleep. I´d love to get on the computer but it´s downstairs and running up and down the sitars isn´t my strong point. My best sleep time comes at about 6:00 a.m. but then I have to get up and go to work  .  I would love to get a good night´s sleep again.

[Riki]

I always was a night owl... even when I was a kid... then I started working shift work.. mostly nights.. loved it... but after I started dialysis again, the night shifts were killing me... it seemed my whole life was work, dialysis, work, dialysis... so I got my doctor to write me a note saying that I needed day shifts.. now, I don't sleep.. have been that way for the last 6-8 months or so... when I mentioned it to the doctor, he told me to move all distractions out of the bedroom.. have it only for sleep and sex.. *LOL*  I told him that there was no way I was moving my computer out of the room... I spend a majority of my time in there... 10 hours on the cycler.. I'm not gonna sit in there and twiddle my thumbs.. I've been suffering it out... at least I'm working at home now, so I can sleep until about an hour before I need to start working.. need the hour to wake up.. *L*  and can take a 15 min nap on my lunch hour.. in my own bed....

[angieskidney]

wow! See for me .. I sleep when I am very tired .. even if that means going with hardly any sleep til I can fall asleep. I can't sleep at dialysis. I just can't sleep in those chairs and if I am totally exhausted I can only sleep for a few mintues there before I wake back up again.

That is what I did yesterday. I didn't really sleep at all the whole night or day before dialysis at 4pm. Then when I got home I talked to Sandman very shortly and went to sleep wtihout checking hardly any emails or eating. I woke up at 10am today. Yay!! I "fixed" my sleep!! Hopefully I can keep it up this time before I start working in my new position coming up!

[renal30yrs]

I've been always suffering from insomnia.   Somehow being back on HD is making my insomnia from bad to worth.

[angieskidney]

Restless Legs Syndrome
There is now overwhelming evidence that the primary abnormality in many patients with RLS is a defect of iron metabolism in the central nervous system. Many RLS patients have low serum ferritin levels (despite normal hemoglobin, hematocrit, iron, and iron binding capacity determinations). Some have low cerebrospinal fluid ferritin levels despite normal serum ferritin levels. Functional neuroimaging studies support the concept of abnormal central nervous system iron metabolism.5, 6, 7

Seems like they should be treating the iron or iron metabolism problem rather than prescribing sleep aids, doesn't it?  Does this mean there's not enough iron or that the body isn't using the iron like it should?

Hmm.. that is very interesting as just when my RLS has gone from bad to severe I found out my iron is very low and they changed my pills from one iron to ferrous fumarate! Also they changed my RLS pills from Levocarb to Mirapex!

[Rerun]

I'll probably jinks myself, but I've slept for two nights in a row.  I can't believe it when I wake up and it is 5:00 AM.  That is good for me.  I get up at 5 and feed the dogs before the eat me for breakfast!  Then I go back for a couple of hours.  But, usually I see the clock at 2:00 and 3:00.  WOW

[angieskidney]

I'll probably jinks myself, but I've slept for two nights in a row.  I can't believe it when I wake up and it is 5:00 AM.  That is good for me.  I get up at 5 and feed the dogs before the eat me for breakfast!  Then I go back for a couple of hours.  But, usually I see the clock at 2:00 and 3:00.  WOW

That's great!!!  I am tired right now at 12:15am my time. Wonder how long I will sleep this time

[angela515]

I also suffer from problems sleeping... even still after transplant. It started in April 04 when i went on HD.... i hate it... some nights i fall asleep from just being so tired, but every other night i cant sleep i stay up watching tv, or being on the comp... i just cant sleep... I have been on Ambien for so many yrs im immune to it, it does nothing for me. Right now I notice mostly I cant sleep cuz RLS... or just restlessness.... Ugh... I plan on telling my dr wednesday, i thought it would go away after transplant like last time but not gone yet so i need to tell them cuz i hate not being able to sleep!

[kitkatz]

I sleep like a rock except when I am off on vacation from work. I am pretty sure working full time makes me so tired that at night I am out like a light.  Vacation times are very restful for me and I do take it easy so the sleep pattern becomes different.

[okarol]

I am hoping Jenna's sleep problems will level out too. Her sleep drifts, like she could sleep from midnight to 8am on Mon.,
then 1am to 9am on Tues. then maybe 3am to 11am on Wed. and by Thurs. she won't get to sleep til 6 am and sleep til 2 pm.
So then she may or may not sleep on Thurs. nite and by Friday she will conk out at 8pm. It was really bad during dialysis because
she would sleep the whole time - from 2pm til 5:30pm. I know with more energy her activity level is increasing, so maybe she will
get more tired at night.

[angieskidney]

I am hoping Jenna's sleep problems will level out too. Her sleep drifts, like she could sleep from midnight to 8am on Mon.,
then 1am to 9am on Tues. then maybe 3am to 11am on Wed. and by Thurs. she won't get to sleep til 6 am and sleep til 2 pm.
So then she may or may not sleep on Thurs. nite and by Friday she will conk out at 8pm. It was really bad during dialysis because
she would sleep the whole time - from 2pm til 5:30pm. I know with more energy her activity level is increasing, so maybe she will
get more tired at night.

Sounds like a typical Night Ow!l lol Or at least that sounds like me. With a transplant however I found it was a lot easiler to have a normal sleep schedule. It should get better. But sometimes it might be that she is enjoying her energy so much that she might just love to stay up longer which would have that slowly drifting sleep times like that. Who knows?

[okarol]

Jenna's therapist thinks that Jenna's continued inverted and drifting sleep pattern is a carryover habit from dialysis, and that she will be able to change it over time. Not sure what is going to make that happen, but I guess they have been discussing ways. Jenna says that if she has something to get up for, she can do it (like her early labs at Scripps) so she just thinks she may need to schedule more stuff. She is now signed up with a trainer at the gym twice a week, so that may help too.