By Peter Laird, MD
One of the areas of discord in my home dialysis program is the different sleep patterns my wife and I experience. When we do dialysis in the evening, my wife becomes sleepy before we finish our session, but for me, as soon as the session is over, I usually can't sleep for another two to three hours. It is not uncommon for me to still be awake at two o'clock in the morning while my wife wakes up by seven in the morning. I suspect she enjoys her quiet time to herself for different errands she does every day, but for me, when I do have to wake early, I have no choice but to condition myself for several days ahead of time and do our dialysis earlier in the day. Sleep disorders are a common complaint of patients on dialysis with insomnia noted in nearly 70% of the dialysis population.
Results. The questionnaire revealed the presence of insomnia (69.1%), RLS (18.4%), OSAS (23.6%), EDS (11.8%), possible narcolepsy (1.4%), sleepwalking (2.1%), nightmares (13.3%) and possible RBD (2.3%). Eighty percent demonstrated SLEEP+, having at least one sleep disorder. Independent risk factors for sleep disorders were advanced age (P<0.001), excessive alcohol intake (P<0.04), cigarette smoking (P<0.006), polyneuropathy (P<0.05) and dialysis shift in the morning (P<0.001).
Conclusions. The questionnaire showed a high presence of sleep disruption in dialytic populations. Awareness by Italian nephrologists regarding sleep disruption seems to be insufficient. Our data might help nephrologists to deal with uraemic patients with possible sleep disorders. Concerning the high prevalence of possible narcolepsy, further studies using polysomnographic records are necessary to confirm our results.
Increasing the frequency of dialysis improved the symptoms of restless leg syndrome (RLS) in the FREEDOM study (here) and basic sleep hygiene techniques can be helpful. Exercise is one of the key components of preserving health while on dialysis and may help reduce some of the effects of sleep disorders. For patients with obstructive sleep apnea syndrome (OSAS), prolonged nocturnal dialysis reduced the severity of symptoms by as much as 50%. (here) Conventional in-center hemodialysis is complicated by many symptoms including sleep disorders which further compromises patients quality of life.
While I do still have difficulty sleeping until late at night, overcoming the symptoms and complications of dialysis requires a true holistic approach including close adherence to proper diet, exercise and maintaining sleep habits rounds out the strategies for feeling as well as we can. Daily dialysis and nocturnal dialysis assist greatly in all of those endeavors.