OpenPlacement Blog

Dialysis and Insomnia (Guest Post)

_insomnia_We are happy to have DevonTexas join the OpenPlacement Community and be our guest blogger this week. DevonTexas is a dialysis patient. He has been on dialysis since 2008. DevonTexas advocates for his fellow dialysis patients through the ESRD (End stage Renal Disease) Network of Texas and DPC (Dialysis Patient Citizens). Read more about DevonTexas here.

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 4/27/13: An informative article about some meds that may contribute to insomnia.  Click HERE to read it.

Read more on my blog here:

DevonTexas © 2013