Here's info from American Association of Kidney Patients
Question: I Have Had Trouble Sleeping Since Starting Hemodialysis. What Causes This and What Can I Do?
Answer: Sleeping disturbance is a common problem among hemodialysis patients. In a recent study involving more than 700 Italian hemodialysis patients, 45 percent complained of insomnia, defined by either delayed sleep onset and/or nighttime walking. Similar prevalence of insomnia has been reported in other, smaller studies, showing that insomnia occurs much more frequently in the hemodialysis population than in the general population (prevalence of nine – 21 percent). In general, insomnia presents as trouble falling asleep, trouble staying asleep or feeling non-restored from sleep. Persistent insomnia is a strong risk factor for depression, but may also be an early symptom of depressive disorders. Insomnia may have serious daytime consequences, such as bodily fatigue, diminished energy, memory impairment, loss of productivity, accidents and marital and social problems.
There may be various causes for insomnia in dialysis patients. Many patients with chronic kidney disease (CKD) do develop some form of sleep disturbance some weeks before they are put on dialysis and these problems are viewed as symptoms of uremic toxicity, because they tend to get better with adequate dialysis treatment. However, uremic toxicity may also be a cause of insomnia in patients on dialysis when the delivered dialysis dose is insufficient. Adequacy of dialysis can be assessed by urea removal and is expressed as the treatment index ‘Kt/V.’ This index should exceed the value of 1.2 (single pool Kt/V) per treatment. Time on dialysis may also be a factor to consider and many doctors recommend a dialysis time of at least three times, four hours per week. Groups performing slow nocturnal hemodialysis have reported improvement of sleep disturbances. Therefore, intensifying dialysis may be the first approach to deal with sleep problems.
Another factor to consider is secondary hyperparathyroidism. High PTH levels, bone pain and pruritus, all typical symptoms of renal bone disease, may be important factors for sleep disturbances and sleep behavior may improve after successful medical or surgical treatment of hyperparathyroidism (vitamin D analogues or parathyroidectomy). Chronic hypoxia due to anemia may also cause insomnia and it has been reported that increasing hemoglobin levels to > 13.5 g/dl by higher doses of erythropoietin and iron may improve sleep quality. It needs to be mentioned that hyperthyroidism should always be excluded as an underlying cause of insomnia.
One of the most common sleep disorders associated with disturbed sleep onset is ‘restless leg syndrome,’ which manifests as peculiar, distressing and painful leg sensations during drowsiness which are relieved by walking or other measures that are incompatible with sleep. Dopaminergic medication has been shown to be effective and safe during long-term nightly use in this case.
In case none of the above-mentioned measures lead to sleep improvement, a specialist should evaluate the presence of chronic anxiety and depression disorders. Especially in hemodialysis patients, there is a high prevalence of depressive disorders, which are not easily detected. Anxiety and depression can be treated and sleep quality may improve.
Sleep rhythm is another factor to consider. Excessive sleeping during or after hemodialysis treatments can decrease the underlying biological drive for sleep at nighttime. If this is the case, stimulus-control therapy may be useful, simple and effective. One should go to bed only when sleepy and not use the bedroom for reading, watching TV, eating or working. If one is unable to sleep after 15 to 20 minutes in bed, one should get up and go into another room, where one should avoid exposure to bright light, like watching TV. One should only return to bed when sleepy. The aim is to restore the psychological connection between bed and sleeping, rather than the bedroom and insomnia. One should get out of bed at the same time each morning, regardless of how much sleep one got during the night. Daytime napping should be minimized and, if necessary, not exceed 30 minutes.
In case sleeping medication is prescribed, these pills should be taken at fixed times way before midnight and not during the early morning hours after repeated awakening.
Answer provided by Martin K. Kuhlmann, MD, Research Laboratory Director, Renal Research Institute, New York.
http://www.aakp.org/aakp-library/trouble-sleeping-with-hemodialysis/
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