Sleep Issues and Chronic Kidney Disease

People with chronic kidney disease (CKD) often have trouble falling asleep and staying asleep. Your physical and mental health can contribute to your sleep problems. Common causes for disrupted sleep patterns in kidney disease patients include: restless leg syndrome, sleep apnea, inadequate dialysis clearance, emotions, changes in sleep patterns, and caffeine.

Restless leg syndrome

Some renal patients wake up in the middle of the night because of an uncomfortable sensation they feel in their legs. Their legs feel itchy or tingly, or may jerk or move on their own, waking them up. People may even experience leg cramps while they are awake, usually during a hemodialysis session. This is called restless leg syndrome. It often occurs when the legs are at rest, such as when a person is sitting or lying in bed.

Mild cases of restless leg syndrome occur periodically, while moderate to severe cases can occur regularly. The sensation varies from patient to patient. It can be irritating, itchy or painful. Some patients find that moving their legs makes the uncomfortable sensations lessen or go away entirely. Because restless leg syndrome occurs when you are trying to relax or fall asleep, it can leave you feeling tired from lack of rest.

Doctors have pinpointed several factors that can contribute to restless leg syndrome. They are:

  • Iron deficiency or anemia
  • Caffeine, alcohol, tobacco
  • Diabetes
  • Certain anti-nausea, anti-seizure and allergy medications

Tell your doctor if you experience feelings in your legs or limbs that prevent you from falling asleep. Your doctor may want to adjust your treatment to ease the symptoms of restless leg syndrome and help you get a better night’s sleep.

Sleep apnea

Sleep apnea is a sleep disorder. It is a condition that causes your breathing to be interrupted or stopped during sleep. Breathing can stop for more than 10 seconds while you are in a deep sleep. These non-breathing intervals are called apneas. They are usually followed by sudden attempts by your body to breathe. One of the symptoms of apnea is snoring. Patients with sleep apnea often snore heavily. The snores continue until breathing is interrupted or stops, which signals an apnea. The person will then snort or gasp to take in air and the snoring continues until the next apnea. Many patients do not remember the apneas they experienced during the night. However, because their sleep is interrupted, they will often feel tired and drowsy during the day.

A slight or complete obstruction to the airways can cause sleep apnea. This blockage can be in your mouth, nose or throat. A doctor can determine if you have sleep apnea by conducting a physical exam and a sleep study. If you are diagnosed with apnea, your doctor can discuss treatment options with you.

Inadequate dialysis clearance

A build up of waste in the blood can cause you to feel ill and uncomfortable. This could make sleeping difficult. If you are on peritoneal dialysis, your doctor will occasionally test your dialysate to make sure it is pulling enough waste and toxins from your body.

Patients on peritoneal dialysis and hemodialysis will also have their Kt/V rate tested. The Kt/V rate tells your doctor how well your dialysis treatment is working. Hemodialysis patients should have a target Kt/V of at least 1.2. Peritoneal dialysis patients should have a Kt/V of at least 2.1. In order to meet the target Kt/V, you should not skip dialysis sessions. Missed dialysis sessions can mean a build up of waste and fluid, leading to other complications besides sleepless nights.

Emotions

Worry, anxiety and sadness can keep you up at night. Also, if you find yourself able to fall asleep, but then awaken in the early morning hours unable to return to sleep, this is a sign of clinical depression. Talk with your doctors and social worker. They are there to help. If your sadness, anxiety or depression lasts more than two weeks, tell your doctor immediately.

Changes in your sleep pattern

Sometimes patients who have chronic kidney disease are more tired than usual. They tend to fall asleep earlier than their normal bedtime or nap during the day. This could affect your ability to fall asleep or stay asleep at night.

Although naps can be refreshing, naps that are too long can interfere with your ability to fall asleep and stay asleep at night. If you are tired and feel that a nap can help you, limit your nap time. Naps that last longer than an hour can disrupt your sleep cycle.

Caffeine

Caffeine is a stimulant; it jump starts your body, making you feel more alert and less tired. Many people drink caffeinated coffee, tea or sodas in the morning to wake up, especially if they have not had restful sleep the night before. This lack of sleep can lead to tiredness later in the day. Some people reach for a late afternoon caffeine “pick me up.” Unfortunately, too much caffeine late in the day can affect your ability to fall asleep later that night. In the morning, the caffeine cycle starts again.

If you’re having trouble sleeping, try reducing the amount of caffeine in your diet.  Keep an accurate food diary to show your renal dietitian. She can help you identify drinks and certain foods that contain caffeine.

For those on cycler-assisted peritoneal dialysis

Patients who depend on Continuous Cycler-Assisted Peritoneal Dialysis or Nocturnal Intermittent Peritoneal Dialysis may find the cycler noises wake them up. Sometimes the sensation of the exchanges can awaken them from sleep.

Many patients grow accustomed to the sounds and sensations of the cycler over time. But if you are losing sleep because of this type of treatment, talk to your doctor about alternatives.

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Tips for getting and staying asleep

The following are things you can do if you experience sleeplessness. If you have insomnia for more than a week, check with your doctor.

Expend energy during the day with exercise

Exercise can help you feel tired so that you can fall asleep faster and sleep soundly. Ask your doctor about starting an exercise program. He can recommend a program based on your physical abilities and current state of health. Try not to exercise two hours or less before bedtime. This can prevent some people from falling asleep.

Adjust your sleep clock

You can train your body to get the right amount of sleep each night. This means keeping to a sleep schedule. You should go to bed at the same time each night and wake up at the same time each morning.

First, determine how many hours of sleep you need each night. Some people feel refreshed after five hours. Others need eight or nine hours to feel rested. Once you know how many hours of sleep are optimal for you, determine what time you need to get up in the mornings. Then count backwards the number of hours of sleep you should get each night. This should tell you what time you should go to bed.

Limit your nap times

Too long of a nap can mean you won’t be able to fall asleep later that night. Try to limit the number of naps and the amount of time you sleep during the day.

Cut back on caffeine, alcohol and tobacco

Caffeine and nicotine (found in tobacco) are stimulants. They can keep you awake longer than you wish. Cutting back can help you return to normal sleep patterns. Try limiting your caffeine intake to 2 cups a day before noon and avoid smoking before bedtime or during the night.

Some patients believe alcohol relaxes them, but it can disrupt sleep. Limit your alcohol intake, especially before bedtime.

Find ways to relax before bedtime

Some people like to watch television or read a book until they fall asleep. Others prefer to turn off the lights and close their eyes. Relaxing is an important part of getting to sleep. Find a light activity that you can enjoy before bedtime.

Comfortable surroundings can mean a sounder night’s sleep

A comfortable bed and bedding can lessen the amount of times you get up during the night. A darkened, quiet room will have fewer distractions to wake you up.

If you still have trouble sleeping, or if you experience insomnia for a week or more, tell your doctor. Adequate rest is an important part in your chronic kidney disease treatment.


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