Did you know?
Sleep disorders are very frequent in individuals with chronic kidney disease, including patients on dialysis or after kidney transplantation. The most frequent sleep disorders are:
- Sleep apnea: multiple pauses or significant decrease in airflow to the lungs in the presence of breathing effort during sleep.
- Insomnia: difficulty falling asleep, staying asleep or waking up too early even though there are adequate opportunities as well as a comfortable environment for sleep.
- Restless legs syndrome (RLS): a condition that causes an uncontrollable urge to move your legs, usually because of an uncomfortable sensation. It typically happens in the evening or nighttime hours when you’re sitting or lying down. It also happens when you need to sit for a prolonged period of time (in a movie, theater or during dialysis). Moving eases the unpleasant feeling temporarily. RLS usually causes difficulty falling asleep.
- Narcolepsy: is characterized by severe and persistent daytime sleepiness that can cause impairments in school, work, and social settings as well as heighten the risk of serious accidents and injuries.
Sleep Disorder Symptoms
These persisting or recurring sleep disorders may lead to difficulties in daytime function such as:
- Fatigue
- Sleepiness
- Problems with focusing or memory
- and also, may affect other aspects of our life
If a sleep disorder is suspected, a clinician or sleep specialist has to assess the symptoms and decide about the need for further assessment and/or treatment.
Kidney transplantation improves many physical and emotional symptoms and health-related quality of life for patients with end-stage kidney disease. Some of the sleep disorders (i.e., restless legs syndrome and insomnia) are likely to improve after kidney transplantation but restless legs syndrome might re-occur, and sleep apnea remains common in kidney transplant recipients.
Poor sleep quality or inadequate sleep is an important factor that can negatively affect quality of life for patients with kidney disease both before and after kidney transplantation. Poor sleep quality or quantity may also be caused by psychological stressors.
- Research studies report that sleep disorders are present in 30-60% of patients with chronic kidney disease and kidney transplant recipients. That means that 1 in 2 or 1 in 3 patients will have one or more sleep disorders.
- Sleep disorders may worsen high blood pressure, increase the risk of diabetes or may even have harmful effects on the transplanted kidney. They worsen the overall health of the patients, therefore proper screening and management are important.
How am I doing?
A good quality and adequate quantity of sleep are important for your health, well-being and happiness. When you sleep better, you feel better. The sleep diary (below) developed by the National Sleep Foundation will help you track your sleep, allowing you to see your sleep habits and patterns. The sleep diary can reveal some unexpected sleep barriers and what aspects of sleep can be improved. See the sleep diary.
Beyond your sleep pattern and the amount of sleep you are getting, it is also important to pay attention to the following symptoms:
- Snoring or especially loud snoring with breathing pauses – a frequent symptom of sleep apnea.
- Excessive daytime sleepiness – also a frequent symptom of sleep apnea: frequently falling asleep quickly, for example when watching TV, stopping at red light or even during conversations. People who have excessive sleepiness feel drowsy and sluggish most days, and these symptoms often interfere with work, school, activities, or relationships.
- Leg discomfort while resting – frequently described as crawling, creeping, pulling, throbbing, aching, itching, or electric twinges. Excessive leg or body movement while asleep may also occur.
These symptoms might also serve as an indication of a need for sleep assessment (seeing a sleep specialist and attending a sleep study in a sleep clinic).
What can I do?
So, how can you get the sleep you need?
Healthy sleep habits can help improve your quality of life. Try to keep the following sleep practices (“sleep hygiene”) on a consistent basis:
- Exercise is very helpful to improve sleep quality and it might help RLS, sleep apnea and insomnia, as well. However, avoid exercise 3 hours before bedtime.
- Avoid caffeinated drinks (energy drinks, coffee, tea, cola. etc.) after 3 pm.
- Avoid heavy meals, alcohol and smoking because they can interfere with sleep.
- Sleep routine is very important. Stick to a regular sleep schedule of the same bedtime and wake up time, even on the weekends.
- It is beneficial for your nighttime sleep to avoid taking naps during the day. If you prefer to nap to manage your daytime energy, do it early afternoon and for maximum of 20 minutes, otherwise it might interfere with your nighttime sleep.
- It is helpful to use other areas of your home for your activities during the day and avoid spending time in the bedroom. Keep the bedroom for sleep and intimacy only.
- Avoid using your cell phone and switch off your television and computer screens at least an hour before you plan to sleep.
- Plan and practice a relaxing bedtime ritual, like reading or listening to music at a low volume.
- If you have trouble falling asleep, relaxation techniques like meditation, mindful breathing can help you quiet your mind and calm your body.
- Use heavy curtains or an eye mask to prevent light from interrupting your sleep.
If you are still having trouble sleeping, do not hesitate to speak with your nurse or doctor or to ask a referral to see a sleep specialist.
In the case of ongoing sleep problems or nighttime symptoms such as snoring or leg movements, a sleep specialist can refer you for a sleep study if needed
How can I do it?
It may not be easy at times to stick to a schedule or follow good sleep hygiene, but it is the foundation of treatment for every type of sleep disorder. As mentioned before, physical exercise is very beneficial for several aspects of sleep.
Exercising outside also brings additional benefit because the natural light improves mood, energy and helps sleep regulation.
In addition, exercising with others would provide with social support which might be very helpful.
Here are a few other tips and tricks to help you stick to your new routine in improving your quality of sleep:
- To manage stress, find appropriate things that you like to do (e.g., a new hobby, journaling, meditation, yoga, exercise).
- You may ask a family member or a friend to review your sleep diary with you and continue to update it to see changes and progress.
- Smartphone apps like Stop, Breathe & Think and Headspace can be helpful in cultivating a practice of mindful breathing.
- Planning ahead and maintaining a diary/ journal is a tested way to track your actions, emotions and feelings and can help improve your sleep and overall quality of life.
- Assessment and management of specific sleep disorders (including sleep apnea, restless legs syndrome and insomnia) can be initiated by your family doctor and you can be referred to a sleep specialist if needed.
More Information
This section was written by Simran Chahal (Kidney Health Education and Research Group, Ajmera Transplant Centre, University Health Network, Toronto), Dr. Marta Novak (MD, Centre for Mental Health, University Health Network, Toronto), Dr. Istvan Mucsi (MD, PhD, Nephrologist, University Health Network/Toronto; Associate professor of Medicine, University of Toronto).
References
1. Babson, K. A., Sottile, J., & Morabito, D. (2017). Cannabis, cannabinoids, and sleep: A review of the literature. Current Psychiatry Reports, 19(4), 23.