Are you or a loved one a chronic kidney disease (CKD) patient that struggles with sleeping well at night? Insomnia is a common sleep disorder among all individuals but especially those with kidney failure. It is characterized by persistent difficulty in falling asleep or staying asleep and poor subjective sleep quality. Learn more about insomnia and kidney failure, including the prevalence, causes, potential consequences, and treatment options.*

How Common Is It?

On top of other burdens, many kidney failure patients also struggle with sleep disorder. It is estimated that 40-85% of dialysis patients have sleep disturbances. One study looked at 1,643 patients from 335 dialysis centers across the United States and found:

• 50% had trouble falling asleep
• 59% woke during the night
• 49% woke early in the morning

Over 53% reported one or more of these symptoms all or most of the time. 

What Causes Insomnia in Kidney Disease Patients?

Many factors have been found to contribute to a higher prevalence of insomnia, including:

• Uremia leading to a day-night reversal among kidney failure patients
• In-center hemodialysis (HD) treatments causing greater sleep fragmentation due to treatment schedules
• Other common sleep disturbances among kidney failure patients, like sleep apnea and restless leg syndrome

In addition to these issues, the COVID-19 pandemic has become a common factor and created a new type of insomnia dubbed ‘coronasomnia’. Due to increased social isolation, housing insecurity, and financial instability, the pandemic has forced added stress on many people. This stress has led to a decline in mental health and sleep patterns among dialysis patients. 

What Are the Potential Consequences of Untreated Insomnia?

Insomnia is a serious concern among dialysis patients as it may lead to:

• Depression
• Impaired immune response
• Higher risk of cardiovascular complications
• Fatigue and poor overall quality of life

What Are the Treatments for Insomnia?

Insomnia treatments are broken into two categories, cognitive behavioral therapy for insomnia (CBT-I) and pharmacotherapy. 

CBT-I is recommended as a first-line treatment and includes four components:

• Stimulus control refers to techniques to re-establish the association between bed and sleep.
• The goal of sleep restriction and consolidation is to have efficient sleep where total sleep time matches your time in bed.
• Cognitive restructuring challenges negative patient beliefs and attitudes that may contribute to cognitive awakening at night.
• Sleep hygiene describes a broad set of ‘good sleep habits’ and may include exercising regularly and avoiding alcohol, caffeine, and nicotine before bed. 

Since practitioners trained in CBT-I are scarce, many opt for pharmacotherapy as a first-line treatment instead. However, commonly used sleep medications have not been thoroughly studied in dialysis patients and concerns regarding efficacy and safety have been raised. Research is ongoing to learn more about insomnia and kidney disease patients, as many patients continue to struggle with these co-occurring conditions. 

*Cukor, D. (2021, January 21). The challenge of insomnia for patients on. . . Nature Reviews Nephrology. https://www.nature.com/articles/s41581-021-00396-5?error=cookies_not_supported&code=e092eb37-2817-425a-a2bb-6487e01454ff