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Why Does Kidney Disease Cause Sleep Problems

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If Youre Not Sleeping Well There May Be A Medical Cause

Chronic Kidney Disease Treatment: How to beat insomnia & sleep better with kidney disease

People who feel they sleep perfectly well may still be troubled by excessive daytime sleepiness because of a variety of underlying medical illnesses. A sleep disturbance may be a symptom of a health issue or an adverse effect of therapy to treat the problem. The stress of chronic illness can also cause insomnia and daytime drowsiness.Common conditions often associated with sleep problems include heartburn, diabetes, cardiovascular disease, musculoskeletal disorders, kidney disease, mental health problems, neurological disorders, respiratory problems, and thyroid disease. In addition, a number of prescription and over-the-counter medications used to treat these and other health problems can impair sleep quality and quantity .

Kidney Disease: 11 Ways It Can Affect Your Skin

If you have kidney disease, you wont see early warning signs on your skin. However, as the disease progresses, you may develop one or more of the following:

  • Extremely dry skin. Skin can become so dry that it:

  • Becomes rough and scaly
  • Feels tight and cracks easily
  • Develops fish-like scales
  • Itchy skin. Extremely itchy skin is a common symptom of advanced kidney disease. The itch can range from irritating to life-disrupting. Your skin may itch all the time.

    Some people have itch on one area of their skin. The itch can also spread across most of your body.

  • Scratch marks and other signs of scratching. When you scratch often, it affects your skin. You can develop:

  • Raw, bleeding skin or sores
  • Thick, leathery skin
  • Firm, very itchy bumps
  • Color changes to your skin. When the kidneys stop working as they should, toxins build up in your body. This build-up can cause color changes to the skin. You may see any of the following:

  • An unhealthy pale color
  • Areas of darkened skin, as shown here
  • Yellowish, thick skin with bumps and deep lines
  • Cysts and spots that look like whiteheads
  • Nail changes. Kidney disease can affect the appearance of your fingernails, toenails, or both. People who have advanced kidney disease can develop:

  • A white color on the upper part of one or more nails and a normal to reddish brown color below, as shown here
  • Pale nails
  • White bands running across one or more nails
  • Legs
  • Face
  • Hands
  • Feet
  • Side
  • Belly
  • Lower back
  • Areas of hard, shiny skin that become too tight to pinch
  • Healthy Diet Options For Ckd Patients

    CKD Patients should follow a stricter diet to maintain good health. Even if you are only in Stage 1 of kidney disease, adopting this diet can slow the diseases progression and even keep you from reaching End-Stage Renal Failure.

    Since kidneys play such a huge part in balancing the nutrients and minerals in your body, damaged kidneys will need some help in this regard. Many CKD patients meet with a dietitian for specific meal plans and guides to get their diets on track.

    There is no one-size-fits-all diet for CKD patients, but in general, they are advised to control their intake of certain vitamins and minerals, such as protein, sodium, and potassium.

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    What We Know So Far

    People with kidney disease can have trouble sleeping while poor sleep may accelerate kidney disease. Its reported that as much as 80 percent of people with end-stage renal disease have sleep complaints and daytime sleepiness.

    Research by Brigham and Womens Hospital in Boston examined the sleep habits of women and found that those who slept for 5 hours or less each night had a 65 percent risk of a rapid decline in kidney health. Lead researcher, Dr. Ciaran McMullan, cautioned that the study only showed the association of decreased kidney function and less sleep. It didnt point to less sleep causing this decrease. He theorized that short sleep alters the kidneys physiology and this could cause damage. He said that kidney function is also regulated by the sleep-wake cycle and if its compromised it can affect chronic kidney disease.

    In another study published in the Journal of the American Society of Nephrology, researchers found that people with kidney disease may be particularly vulnerable to the negative effects of poor sleep. They reported that sleep was seriously impaired in the 431 participants they studied who had chronic kidney disease. They slept for an average of 6.5 hours a night and experienced interrupted sleep and significant wakeful periods. The study spanned 5 years and during this time, 70 participants developed kidney failure and 48 died.

    Stay Away From Caffeine And Alcohol

    Why does chronic kidney disease cause hypertension?

    Caffeine and alcohol keep you up and can disrupt sleep even if you manage to fall asleep. Try to avoid nightcaps and dont consume coffee later than 2 pm. If you must have a nightcap, have it a few hours earlier than your bedtime. It takes an hour for your body to metabolize a serving of alcohol so you should have it well before you sleep.

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    Changes In Sleep Architecture

    Patients with ESRD typically exhibit poor sleep architecture as measured objectively on polysomnographic studies. In a comprehensive review, ESRD patients had short, fragmented sleep with total sleep times between 260-360 min. Sleep efficiencies ranged between 66%-85% and time spent awake ranged from 77-135 min. Sleep latencies were reported between 10-30 min and REM latencies between 92-64 min. There was a pattern of increased stage 1 and stage 2 sleep while slow wave sleep and REM sleep were decreased. Daytime sleepiness is a parameter not measured by polysomnographic studies but is still considered an important marker of inadequate sleep. Multiple sleep latency tests objectively measure daytime sleepiness by having the patient take five scheduled naps throughout the day separated by 2-h breaks. Time to onset of sleep, also known as sleep latency, of less than 5 min is considered to be pathological and may be exacerbated by various sleep disorders. A study conducted by Parker et al in 2003 also found that out of 46 ESRD patients, 46% had abnormal MSLTs. Another study conducted by Stepanski et al on peritoneal dialysis patients reported a MSLT of 6.6 ± 3.7 min.

    Why I Urinate Frequently At Night

    Chronic renal failure patients will have increased urine output and the frequency of urination will also increase especially frequent urination at nights. This will severely affect patients sleep quality and it has bothered a lot of patients especially the elderly patients.

    Here I will tell you why renal failure patients will urinate frequently at night.

    Usually when GFR reduces to 10%-25% and creatinine is elevated to 450-707, there will be obvious increased night urination and at the same time there will be anemia, water and electrolyte disorder, blood in urine and bubbles in urine.

    Under normal circumstances, urine output at night is less than that during the daytime because of low metabolism and slow blood flow at nights.

    However if there is frequent urination at night and much increased night urine output and this condition lasts for a long time, it usually indicates kidney problems.

    In case of many kidney diseases—glomerular diseases, chronic tubular interstitial diseases, the first symptom and sign will be frequent night urination due to declined renal function of concentration. High blood pressure and diabetes are common factors that can damage renal concentration function and cause frequent night urination and increased night urine output.

    Of cause frequent urination at night is not definitely related to kidney problems. The following are some conditions that need to be first ruled out.

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    Signs Of Kidney Disease

  • You’re more tired, have less energy or are having trouble concentrating. A severe decrease in kidney function can lead to a buildup of toxins and impurities in the blood. This can cause people to feel tired, weak and can make it hard to concentrate. Another complication of kidney disease is anemia, which can cause weakness and fatigue.
  • You’re having trouble sleeping. When the kidneys aren’t filtering properly, toxins stay in the blood rather than leaving the body through the urine. This can make it difficult to sleep. There is also a link between obesity and chronic kidney disease, and sleep apnea is more common in those with chronic kidney disease, compared with the general population.
  • You have dry and itchy skin. Healthy kidneys do many important jobs. They remove wastes and extra fluid from your body, help make red blood cells, help keep bones strong and work to maintain the right amount of minerals in your blood.Dry and itchy skin can be a sign of the mineral and bone disease that often accompanies advanced kidney disease, when the kidneys are no longer able to keep the right balance of minerals and nutrients in your blood.
  • You feel the need to urinate more often. If you feel the need to urinate more often, especially at night, this can be a sign of kidney disease. When the kidneys filters are damaged, it can cause an increase in the urge to urinate. Sometimes this can also be a sign of a urinary infection or enlarged prostate in men.
  • Diagnosing Chronic Kidney Disease

    Kidney (Renal) Disease Signs & Symptoms (ex. Peripheral Edema, Fatigue, Itchiness)

    If you suspect you have kidney damage, your doctor will administer a blood test known as eGFR . This test measures how well your kidneys are cleaning your blood.

    Doctors can also test your blood pressure since high blood pressure is often a precursor to kidney disease .

    Your doctor will diagnose which stage of kidney disease you are in based on your eGFR results and/or your symptoms. Other diagnosis options include:

    • Blood pressure test
    • Persistent puffiness around the eyes
    • Muscle cramps

    Sometimes chronic kidney disease goes undiagnosed in the earlier stages because its symptoms are similar to those of other diseases or conditions. Only 10% of people who have kidney disease know they have it, so understanding the risk factors and paying close attention to your symptoms can lead you to a firm diagnosis.

    Always talk to your doctor if youre experiencing any of the above symptoms. The progression of CKD is often slow and gradual, so take precautions now if you think you are at risk.

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    Sleep Disorders And Kidney Disease

    A 2016 study published in Sleep evaluated the connections between early-stage CKD and sleep disorders, particularly sleep-disordered breathing and restless leg syndrome. They found that patients with chronic kidney disease, even in the early stages, had a higher incidence of these sleep disorders compared with healthy patients.

    Other studies have linked CKD with excessive daytime sleepiness, less time spent in slow-wave and REM sleep, and lower melatonin levels at nighttime. A review of 17 CKD patient studies found that an average of 44% of people with the disease dealt with some kind of sleep disturbance.

    Sleep disorders have short and long-term effects, making life unpleasant for anyone who has to deal with them. Below are the most common problems stemming from poor sleep.

    Short-Term Effects of Sleep DeprivationLong-Term Effects of Sleep Deprivation
    Poor memory retention
    Increase in risk-taking behaviorsHigh cholesterol

    If youre dealing with chronic kidney disease and irregular sleep patterns, your health-related quality of life is most likely poor.

    A 2017 report found that adults who slept less than 7 hours in a 24-hour period were more likely to report chronic health conditions, including chronic kidney disease. 80% of ESRD patients report sleep problems, with daytime sleepiness being the most common reported symptom.

    Swollen Or Puffy Face

    Why this happens:

    Failing kidneys don’t remove extra fluid, which builds up in your body causing swelling in the face.

    What patients said:

    My sister, her hair started to fall out, she was losing weight, but her face was really puffy, you know, and everything like that, before she found out what was going on with her.

    My checks were always puffy and tight. Sometimes they would even hurt.

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    When To Get Medical Advice

    See your GP if you have persistent or worrying symptoms that you think could be caused by kidney disease.

    The symptoms of kidney disease can be caused by many less serious conditions, so it’s important to get a proper diagnosis.

    If you do have CKD, it’s best to get it diagnosed as soon as possible. Kidney disease can be diagnosed by having blood and urine tests.

    Find out more about how CKD is diagnosed.

    Page last reviewed: 29 August 2019 Next review due: 29 August 2022

    Insomnia Raises Risk Of Kidney Disease

    How diabetes can cause kidney disease

    The researchers studied renal health and all-cause mortality outcomes for a nationwide group of 957,587 veterans with no kidney-related health issues at baseline. Of these, 41,928 participants had chronic insomnia.

    To ensure the consistency of the results, adjustments were made for relevant impacting factors, including body mass index , blood pressure, comorbid conditions, and socioeconomic status.

    During a median follow-up period of 6.1 years, 23.1 percent of the study participants died, while 2.7 percent exhibited an accelerated decline of kidney function. Also, 0.2 percent of the participants had kidney failure.

    The researchers noted that chronic insomnia was tied to a 1.4 times higher risk of mortality for any cause, as well as a 1.5 times higher risk of kidney decline, and an even steeper increase in risk of kidney failure: 2.4 times.

    These results indicate that consistent sleeplessness could play a role in the development of chronic kidney disease , as well as shorten life expectancy overall.

    risk factors for CKD, researchers name obesity, smoking habits, diabetes, and hypertension. If the disease progresses, it could require dialysis or even a kidney transplant.

    Dr. Kovesdy and team suggest that their studys findings should lead to more attentive management of insomnia, as this might have wider reaching benefits in the long run, and help prevent the development of other chronic health conditions, such as CKD.

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    Living Comfortably With Ckd

    If youve been diagnosed with CKD, you may be experiencing sleep problems as well. Healthy adults should get 7-9 hours of total sleep time every night for optimal health, and CKD patients usually experience uncomfortable symptoms and health problems that disrupt sleep. One 2016 study found that one hour of additional sleep was linked to a 19% lower risk of kidney failure.

    Beyond medical intervention, creating a healthy sleep environment and bedtime routine can lead to better sleep, which can result in a happier, healthier life. While better sleep wont cure CKD, it can dampen the symptoms and even slow the progression of the disease if its in its earlier stages. On the other hand, poor sleep can make CKD worse, so making time for it along with other CKD treatments should be a high priority.

    Reach Your Blood Glucose Goals

    Your health care professional will test your A1C. The A1C is a blood test that shows your average blood glucose level over the past 3 months. This is different from the blood glucose checks that you may do yourself. The higher your A1C number, the higher your blood glucose levels have been during the past 3 months.

    The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be. Reaching your goal numbers will help you protect your kidneys.

    To reach your A1C goal, your health care professional may ask you to check your blood glucose levels. Work with your health care team to use the results to guide decisions about food, physical activity, and medicines. Ask your health care team how often you should check your blood glucose level.

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    Assessment Of Individual Sleep Disorders


    Difficulty in falling asleep, frequent awakening with difficulty in falling asleep once again and early morning wakefulness were considered as insomnia symptoms. According to Ohayon et al. and Terzano et al. , patients were asked two more questions that investigated tiredness and mood affected consequent to sleep loss , in order to divide insomnia into two levels: level 1, insomnia without day-time dysfunction and level 2, insomnia with day-time dysfunction. Dialysis patients were considered positive for level 1 insomnia if they responded yes to any of questions 13 and no to questions 4 and 5. Instead, patients were considered positive for level 2 insomnia if they reported yes to any of questions 13 and yes to questions 4 or 5 . The frequency cut-off for a positive answer was three times or more per week.


    We included the four questions proposed by The International Restless Legs Syndrome Study Group for the clinical diagnosis of RLS . Only patients who fulfilled all four criteria were requested to answer 10 additional questions in order to assess RLS severity using the IRLSSG Rating Scale . We used the appropriate translation of the severity scale into Italian, obtained from Mapi Research Institute.


    Using the Berlin Questionnaire we divided dialysis patients in two groups: at high risk for OSAS and at low risk for OSAS .


    Possible narcolepsy

    Sleepwalking and nightmares

    Possible RBD

    Phobias And Panic Attacks

    Do you have a kidney disease and suffering from sleepless nights? Check out why?

    Phobias, which are intense fears related to a specific object or situation, rarely cause sleep problems unless the phobia is itself sleep-related . Panic attacks, on the other hand, often strike at night. In fact, the timing of nocturnal attacks helped convince psychiatrists that these episodes are biologically based.

    Sleep-related panic attacks do not occur during dreaming, but rather in stage N2 and stage N3 , which are free of psychological triggers. In many phobias and panic disorders, recognizing and treating the underlying problemoften with an anti-anxiety medicationmay solve the sleep disturbance.

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    Chronic Insomnia Linked To Kidney Dysfunction

    We were unable to process your request. Please try again later. If you continue to have this issue please contact .Csaba P. Kovesdy

    Patients with chronic insomnia had a higher incidence of progressive loss of kidney function, incident chronic kidney disease and all-cause mortality in study findings presented at the American Society of Nephrologys Kidney Week.

    Previous studies have showed that sleep disorders have adverse effects on the hypothalamicpituitaryadrenal axis and/or the sympatho-adrenal system, which may cause abnormalities in the cardiovascular system and in metabolic pathways,Csaba P. Kovesdy, MD, director of the clinical outcomes and clinical trials program, division of nephrology, University of Tennessee Health Science Center, told Healio Family Medicine. However, there is inadequate evidence of an association between chronic insomnia and adverse renal outcomes.

    Researchers studied associations between chronic insomnia with all-cause mortality and renal outcomes including end-stage renal disease, estimated glomerular filtration rate of less than 45 mL/min/1.73 m2, and eGFR slopes of less than 3 mL/min/1.73 m2, in a cohort of 957,587 US veterans with an eGFR greater than 60 mL/min/1.73m2. .

    Reference:Li J, et al. Abstract 2771381. Presented at: American Society of Nephrology Kidney Week. Annual Meeting. Oct. 31Nov. 5, 2017 New Orleans.

    Disclosures:The authors report no relevant financial disclosures.

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