Gina Johnson
Sleep disorders are common among patients on dialysis, and insomnia is a frequently reported issue. While sleeping pills may be a go-to solution, studies indicate that their use is associated with an increased risk of chronic kidney disease and end-stage renal disease. This correlation is especially notable in patients undergoing dialysis, with research suggesting that the elimination of sleeping pills may be impaired, leading to adverse events. Additionally, certain sleep aids, such as benzodiazepines, have been linked to a higher mortality rate in dialysis patients. As a result, it is crucial for individuals on dialysis who are considering sleep aids to consult with their healthcare providers to weigh the risks and explore alternative solutions, such as CBT-I interventions, which promote relaxation and healthy sleep habits.
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What You'll Learn
Sleep disorders and kidney patients
Sleep disorders are common in people with chronic kidney disease (CKD) and end-stage renal disease (ESRD). Sleep apnea, insomnia, restless leg syndrome, and excessive daytime sleepiness are all more prevalent in patients with CKD. These disorders can have a significant impact on the overall health and quality of life of kidney patients, and they may also be a predictor of mortality in those with end-stage renal disease.
Sleep apnea is a chronic medical condition in which a person stops breathing during sleep. There are two types: obstructive sleep apnea, caused by the throat muscles relaxing and intermittently closing off the upper airway; and central sleep apnea, which occurs when the brain fails to send the proper signals to the muscles controlling breathing. Patients with sleep apnea often snore heavily until their breathing stops, at which point they will snort or gasp for air. A doctor can diagnose sleep apnea through a physical exam and a sleep study.
Restless leg syndrome (RLS) is another common issue for kidney patients, with a prevalence of 20%-30% in HD patients, compared to 3%-7% in the general population. RLS often occurs when the legs are at rest and can cause irritating, itchy, or painful sensations. These sensations can be reduced or eliminated by moving the legs, and doctors have found that iron deficiency, caffeine, alcohol, tobacco, diabetes, and certain medications can contribute to RLS.
While sleep disorders are common in kidney patients, the relationship between sleeping pill use and CKD has not been extensively studied. However, one study found that sleeping pill use was associated with an increased risk of CKD and ESRD. The complex and dynamic relationship between sleeping pills and CKD remains relatively poorly understood, and further studies are needed to corroborate these findings. It is important for kidney patients to consult their doctor if they are experiencing insomnia or other sleep disorders, as adequate rest is an important part of CKD treatment.
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Sleep aids and their side effects
Sleep aids can be over-the-counter or prescription medications, as well as natural supplements. They are used to treat insomnia, restless sleep, or difficulty falling asleep. While sleep aids can be effective in the short term, they are not meant to be used continuously over an extended period due to the risk of side effects.
Some common side effects of sleep aids include:
- Daytime sedation or drowsiness
- Confusion, cognitive deficits, and memory problems
- Dependency and withdrawal symptoms
- Digestive problems such as constipation, diarrhea, gas, heartburn, and nausea
- Dry mouth
- Muscle weakness
- Worsening of snoring and sleep apnea
- Parasomnia, which includes unusual behaviors like walking, driving, or eating while asleep
It is important to note that older adults are at a higher risk of experiencing adverse effects from sleep aids due to the drugs staying in their system longer. Additionally, sleep aids should be avoided during pregnancy and breastfeeding. Before taking any sleep aid, it is recommended to consult with a healthcare provider to ensure it is safe and appropriate for your individual needs.
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Sleep aid dependency
Sleep aids and sleeping pills are known to cause undesired side effects and can be habit-forming. Benzodiazepines, for example, are associated with a 15% increase in the mortality rate and can lead to dependency if used for too long, at too high a dose, or even after just a few uses. Other side effects include daytime sedation, confusion, cognitive deficits, withdrawal, rebound symptoms, ataxia, dysarthria, diplopia, and vertigo. The use of sleep aids may also impair or shorten the elimination of drugs from the body, leading to a higher risk of adverse events.
People may turn to sleep aids and sleeping pills due to mental health issues such as depression and anxiety, which can make it harder to fall asleep at night. However, the continuous normalization of sleeping pills may influence one's ability to judge their impact on health in the long term.
It is important to recognize and change habits that interfere with sleep, such as exercising, drinking, or eating too close to bedtime. Other general tips for a good night's rest include getting outside during the day for physical activity and fresh air, reducing stress by sharing a joke with a friend or watching a funny movie, and maintaining a consistent sleep schedule.
If you are experiencing dependency on sleep aids, it is recommended to gradually reduce the dose with the guidance of a doctor, and psychological or therapeutic support can help with this process. It is important to have patience and strength when trying to overcome a dependency on sleep aids, as it can be physically and mentally challenging.
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Sleep aid alternatives
Sleep disorders have been associated with chronic kidney disease (CKD) and patients receiving dialysis. While sleeping pills may be an option, they are known for their undesired side effects and can increase the risk of CKD and end-stage renal disease (ESRD). Therefore, it is advisable to consider alternative sleep aid options.
One way to improve your sleep is to make lifestyle changes such as getting outside during the day, engaging in physical activity, and reducing stress by sharing a laugh with a friend or watching something funny. It is also important to avoid large meals, caffeine, and alcohol before bedtime and to maintain a consistent sleep schedule. Additionally, limiting exposure to stimulating light from electronic devices and keeping the lights off or using a flashlight during nighttime bathroom breaks can help improve your sleep.
Some natural sleep aids that you can try include:
- Warm milk: It is believed to contain chemicals that simulate the effects of tryptophan, a building block for serotonin, which is involved in the sleep-wake transition.
- Chamomile tea: This herbal tea is caffeine-free and contains flavonoids that may interact with benzodiazepine receptors in the brain, supporting the sleep-wake transition.
- Tart cherry juice: This may promote melatonin production and support a healthy sleep cycle.
- Melatonin supplements: Melatonin is a natural hormone that is released in the brain a few hours before we feel sleepy. However, it may interact with certain medications, so consult your doctor before taking it.
- Exercise: Moderate aerobic exercise increases the amount of slow-wave (deep) sleep, but avoid working out within two hours of bedtime as it can release energizing endorphins and raise your body temperature.
These natural sleep aids offer alternatives to prescription medications and may help improve your sleep quality. However, it is always recommended to consult your doctor or healthcare provider before starting any new supplement or sleep aid routine, especially if you have underlying health conditions or are taking medications.
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Dialysis and sleep
Sleep disorders are very common among people on dialysis. In fact, one study found that almost 50% of 933 patients at 26 dialysis centres in Albuquerque and Seattle had moderately severe insomnia. Another study found that sleep disorders may increase the use of sleeping pills. However, it is important to note that the relationship between sleeping pill use and chronic kidney disease (CKD) is complex and not yet fully understood.
Several studies have reported sleep disorders in patients with CKD and those receiving dialysis. Winkelmayer et al. (2007) and Natale et al. (2019) found that sleep disorders were common in these populations. Additionally, Winkelmayer et al. (2007) found that the use of benzodiazepines and zolpidem was associated with a 15% increase in the mortality rate for patients undergoing dialysis.
The use of sleeping pills has been linked to an increased risk of CKD and end-stage renal disease (ESRD). A 13-year longitudinal study conducted in Taiwan found a relationship between sleeping pill use and the risk of CKD and ESRD. However, the complex and dynamic relationship between sleeping pill use and CKD warrants further investigation.
For those receiving hemodialysis treatments at a dialysis centre, using cooler dialysate (35°C instead of 37°C) has been shown to help patients sleep longer and better after treatment. Other general tips for improving sleep include getting outside during the day, avoiding large meals, caffeine, and alcohol before bedtime, and maintaining a consistent sleep schedule. While CBT-I (a standardised intervention) has been suggested as a possible treatment for insomnia, it has not been found to help dialysis patients.
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Frequently asked questions
Insomnia is common among patients on dialysis, and there are several ways to help improve sleep. It is best to consult a doctor before taking any sleep medication, as certain sleeping pills may lead to a higher risk of adverse events and an increased risk of chronic kidney disease (CKD) and end-stage renal disease (ESRD).
The use of certain sleep aids, such as benzodiazepines and zolpidem, has been associated with an increased risk of mortality in patients on dialysis. Additionally, sleeping pills may impair or shorten the elimination of drugs in patients with CKD and ESRD, leading to a higher risk of adverse events.
Yes, physical activity and exposure to fresh air during the day can help improve sleep. Maintaining a consistent sleep schedule, avoiding large meals, caffeine, and alcohol before bedtime, and reducing screen time can also promote better sleep.
Insomnia and sleep disorders are prevalent among patients on dialysis, with studies reporting that a large proportion of dialysis patients experience sleep problems.
Cognitive-behavioral therapy for insomnia (CBT-I) is an alternative treatment option that has been studied in dialysis patients. It involves restructuring unhelpful beliefs about sleep and providing behavioral training to improve sleep habits.
