Dialysis and Insomnia

insomnia

Updated 2/11/15.  Scroll to the end for the update…

I originally published this last year but I keep getting questions about it, so I’m reissuing it now.  

Did you know that as many as 80 percent of dialysis patients experience bouts of insomnia?  I didn’t but I do now.

I’ve been taking a sleep medication for nearly three years and when I don’t take it, I don’t get a good night’s rest. I lay awake until about 6am which means I spent all night trying to sleep.  I may get a couple hours of napping in during the night but nothing close to the rest I need.  After 6am, I am often able to sleep for about three, sometimes four, hours but that’s it.  Once the sun’s up, I just can’t sleep.  There’s a hard-working, Prussian farmer lodged in my DNA (Great-grandpa) who figures if the sun’s up, I should be, too.

I never had much trouble sleeping before my kidneys failed.  I generally went to bed and slept all night.  However, with ESRD came insomnia and, in my case, it was after I had been in dialysis for a year or so.  In the first year, I think I had no trouble sleeping because I was so exhausted most of the time.  However, once my blood got cleaned up and my energy levels increased, I started to have problems with insomnia.

Some of the causes of insomnia in ESRD patients are thought to be:

  • uremic toxicity (toxins in the blood),
  • secondary hyperparathyroidism (excessive secretion of parathyroid hormone (PTH) by theparathyroid glands),
  • chronic hypoxia (inadeguate oxygen) due to anemia,
  • restless leg syndrome,
  • inadequate dialysis (not getting sufficient blood cleaning),
  • Excessive sleeping during or after hemodialysis treatments,
  • Sleep Apnea (abnormal breathing during sleep),
  • emotional issues such as depression.

In my case, none of these is considered the primary cause of my insomnia.  It could be a combination of these or none.  The problem is there are very few studies of insomnia in dialysis patients.  You’d think with such large percentages of dialysis patient experiencing insomnia, there would be more investigation into the causes and treatment.  One recent study in 2011 stated, “Epidemiology, pathophysiology and treatment of sleep disorders in CRF (Chronic Renal Failure) and dialysis patients are still unclear and require further research.” That’s an understatement. 

I’ve tried a couple sleep medications including zolpidem (Ambien) and temazepam (Restoril).  Both were effective but the Ambien cost more so I use temazepam.  I get good results from it.  I take it about 30 minutes before I want to go to sleep and it works very well. I sleep for eight hours uninterrupted.  WebMD has a page about these medication and warnings.  

So,  I take my medication each night and sleep well but I am concerned about issues such as addiction and long-term consequences.  The medication I take is a benzodiazepine that has addictive properties and can also have withdrawal difficulties if suddenly stopped.  However, if I don’t take it, I suffer those consequences, too!  When I was working, my sleep was even more important but not getting enough sleep is also important to my good health as a dialysis patient.

I’m sorry I can’t offer any good solutions to insomnia except to point out that it’s common in dialysis patients.  But, as I come across anything, I’ll pass it along.  In the meantime, you can “rest assured” (bad pun) that you’re not alone in your restlessness (another bad pun) on this issue.  It seems to be something many of us share but so little is known about why.

Update 7/7/14:  I still have bouts of insomnia even when I’ve taken my pill (zolpidem,  or generic Ambien).  I suspect that the quality of the Ambien knockoffs is not very good and we suffer as a result.  There have been a couple times when I had insomnia and the next evening,  I go to fill my medicine cup before bed and there are the pills I didn’t take last night including the Ambien.  Duh!  However, the quality of generics has been poor.  They come from foreign manufacturers and there isn’t the quality control like there in is the US.  You get what you pay for, I guess.

An informative article about some medications that may contribute to insomnia.  Click HERE to read it.

Update 2/11/15: Here’s another article about things to do if you can’t get to sleep easily.  I found it informative.  To read it, CLICK HERE. 

DevonTexas © 2013

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About DevonTexas

I am a person with ESRD (End Stage Renal Disease) which means my kidneys don't work. Forty or so years ago that would have been a death sentence but today there is Dialysis which means I can be hooked up to a machine that will clean my blood as the kidneys should. Three days a week, I go to a center and have too very large needles stuck in my arm to remove and replace my blood as it passes through a process where it's cleaned and the fluid is removed, a process taking a little over four hours each time. I want to advance knowledge about dialysis so that other patients can learn from my experience and mistakes. We shouldn't have to reinvent the wheel, eh? There is so much to be learned and experienced about our predicament. There are vast resources available to support us and enrich our lives but many patients don't know about them. There are also many issues that we have to deal with whether we want to or not. So I blog about them. All comments are confidential until I approve them. If you don't want your comment public, let me know and I will respect that. So, feel free to leave a comment. Enjoy.
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10 Responses to Dialysis and Insomnia

  1. pena47 says:

    I sleep in ierms spurts 1or 2 hours at time get up sit for awhile .Is this normal pena47

    • DevonTexas says:

      It’s not normal for non-dialysis patients but sleep disruption is “normal” for dialysis patients. Speak with your doctor about it and see if a sleep medication might help.

  2. nachomama311 says:

    Interesting… I’ve had a lot of insomnia (esp lately) and thought it was just me. Glad to know it’s simply just another of the many issues we have as dialysis patients. Weeeee!

  3. m2g says:

    Thanks for sharing.

  4. hollybernabe says:

    Ugh. You have my sympathy on the insomnia thing. I’ve been an insomniac for much of my life. Melatonin helps some, but not always. My husband, who is on dialysis, doesn’t seem to have trouble with the sleeping. However, his restless legs keep ME awake. He sleeps right through it, but he wakes me up by flopping his legs all over me and kicking me from time to time. When it gets bad I have to go sleep on the couch, but by then it is usually too late. There’s no going back to sleep for me.

    • DevonTexas says:

      There are medications for RLS (Restless Leg Syndrome) and I’ve heard drinking Quinine such as in Tonic Water helps. I take a med for it and it really helps but sometimes I feel really drunk the next morning. I wouldn’t suggest it for days when you need all your cognitive functions. With RLS, neither of you are getting a good night’s sleep.

  5. John says:

    I use a mild opiod for my sleeplessness (oops, time for meds), along with an anti-depressant that brings drowsiness. Both of these help, but not always. The single most helpful thing, especially now that I am retired, is a consistent schedule. I don’t always keep one, and when I don’t I feel worse. You don’t have to get up with the sun (or the cat…wait I’m on home-dialysis, WHY do I have a cat? Is must be a death-wish!), but getting up the same time (or nearly) every day and going to bed around the same time every day helps both with the body and the psyche.

  6. Hugo says:

    I have been on Dialysis for about almost 5 years (I’m 31 years old this year of 2013) Anyways, the first two years I was able to sleep good and then after that I just could not sleep just like you I may fall asleep in very short time; but most of the time I am awake. I also suffer with epilepsy before Dialysis but never had a problem with insomnia at all but related with being on Dialysis for so long I have this question for ya…..do you sweat when you sleep? I do and it is so frustrating I dislike it a lot and like I mention never had that issue before :-\ and another thing I do have LRS and I sleep through it (when I nap) but the main problem is the sweat part though when I sleep oh another thing I wanna throw there I have been on my seizure meds for years before Dialysis due of a couple of concussions in the past. Do you know what I can do with the sweating part? Hugo

  7. Louise says:

    I just started peritoneal dialysis and always used to sleep well prior to all this. I appear to have restless leg syndrome now and am wondering if the glucose or starch in the dialysate (increased at night) has something to do with it. Is the extra sugar we are absorbing making us more restless?

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