Chronic Kidney Disease and Sleep

Chronic kidney disease is one of the most prevalent diseases in the United States, affecting an estimated 37 million people. Many of us know about heart disease and cancer, but kidney disease is an under-recognized health crisis— currently, kidney disease is the 9th leading cause of death in this country, and many people who have it don’t even realize it.

What’s more, 1 in 3 Americans are at risk for developing CKD— common precursors to the disease include diabetes, obesity, and high blood pressure. The relationship between Chronic Kidney Disease (CKD) and sleep has not been fully explored, but studies have shown people with chronic disorders such as CKD experience a high prevalence of sleep disorders compared to the general population— including sleep apnea, insomnia, restless leg syndrome, and daytime sleepiness.

Improving sleep hygiene can lead to better overall health, including the health of CKD and ESRD (End Stage Renal Failure) patients. This article will discuss the various connections between chronic kidney disease and sleep disorders, as well as viable treatments to ensure you get a restorative, good night’s sleep no matter your health.

What Do the Kidneys Do?

In a healthy individual, the kidneys work to filter waste and extra fluids from the blood. Each of us has two kidneys at birth and they are located just below the rib cage, one on either side of the spine.

Without working kidneys, your body cannot maintain a healthy balance of sodium, calcium, phosphorus, and potassium. An imbalance of these minerals can cause other issues, like nerve, muscle, and tissue malfunction. The kidneys also regulate blood pressure, make red blood cells, and maintain bone health. As you can imagine, a damaged kidney leads to a domino effect of other health problems.

What is Chronic Kidney Disease?

Chronic kidney disease occurs in five different stages. In each stage, the kidneys’ ability to filter the blood decreases until Stage 5, which is End Stage Renal Disease (ESRD), or kidney failure. At this stage, patients must undergo dialysis or get a kidney transplant.

Unfortunately, kidney damage is permanent, but if you catch it at an earlier stage, you can slow its effects and possibly prevent kidney failure. Treating kidney disease involves adhering to healthy habits, such as regular exercise, watching your blood pressure, eating a nutritious diet, and controlling your blood sugar.

Risk Factors of CKD

CKD is more common among African Americans, Asians, Native Americans, Hispanics, women, and people aged 60 or older. Because kidney disease has no cure, kidney transplants are the second most common transplant behind liver transplants (19.7% of organ transplants in 2018 were kidney transplants, and 25.2% were liver transplants).

Other risk factors for CKD include a medical history of heart disease or a family history of kidney disease.

Diabetes

As of 2016, diabetes was the leading cause of ESRD (end-stage renal disease, or kidney failure). Diabetes patients should get screened regularly for kidney problems since 1 in 4 diabetes sufferers also has kidney disease.

High blood sugar (caused by diabetes) damages the blood vessels in the kidneys. Then, damaged kidneys can’t filter blood properly, causing waste to build up in the body. It’s a vicious cycle, but it can be slowed by properly monitoring your blood sugar levels. If you’re at risk for diabetes, it’s better to start preventative treatment now— exercise regularly, avoid processed, sugary foods, and make time for a healthy amount of sleep each night.

High Blood Pressure

High blood pressure, or hypertension, is the second leading cause of kidney failure next to diabetes. Unaddressed HBP can spiral out of control, leading to narrowed, hardened, and weakened arteries. As a result, these damaged arteries cannot deliver enough blood to the kidneys, and the delicate filtration system of your body is compromised.

The blood “filters” in your kidneys are called nephrons. These nephrons receive their blood supply through capillaries. If your arteries are damaged, these nephrons do not receive enough oxygen and nutrients, and thus their “filtering” ability is damaged or destroyed.

Managing your blood pressure involves a few simple lifestyle changes. First, get your blood pressure checked regularly. A healthy blood pressure is less than 120/80 (120 refers to systolic blood pressure and 80 refers to diastolic). Other changes you can make include the following:

  • Eat a healthy diet that’s low in salt
  • Exercise regularly
  • Manage your stress
  • Maintain a healthy weight
  • Take medications properly
  • Have regular check-ups with your doctor

Family History

If you have a family history of kidney disease, get regular kidney screenings and talk to your doctor about preventative measures. Living a healthy lifestyle— following the guidelines we’ve already listed in previous sections— is your best bet for avoiding kidney disease.

Additionally, if you have a family history of high blood pressure or diabetes, you’re at a higher risk for CKD.

Age

After your 40th birthday, your kidney function begins to slide by approximately 1% every year. Since older people are at a higher risk for co-occurring medical issues such as diabetes, high blood pressure, and heart disease, their risk for CKD is equally high.

According to a Centers for Disease Control and Prevention survey in 2015-16, the prevalence of CKD jumped from 9.2% to 21.5% at age 60. After age 70, that number increased even more to 44 %. The survey also found that this number was generally higher among females, African-Americans, and people with diabetes and hypertension.

Since none of us can stop the process of aging, the most effective treatments here are preventative— even as you get older, maintain a healthy lifestyle.

Diagnosing Chronic Kidney Disease

If you suspect you have kidney damage, your doctor will administer a blood test known as eGFR (estimated glomerular filtration rate). 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 (and it’s also caused by 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
  • Urine test
  • Imaging tests
  • Kidney biopsy

Symptoms of Chronic Kidney Disease

CKD symptoms are not always obvious or even prevalent, especially in the early stages. That’s why you should get checked if at least one of the risk factors applies to you— and especially if you have more than one.

The most commonly reported symptoms of CKD include:

  • Urinating more or less than usual
  • Unexplained shortness of breath
  • Pain or pressure in the chest
  • Seizures
  • Drowsiness, fatigue
  • Confusion
  • Nausea
  • Swelling (edema), especially in legs, ankles, and feet
  • Dry, itchy skin
  • Severe weight loss
  • Abnormal heart rhythm
  • Trouble concentrating
  • Trouble sleeping
  • 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 you’re 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.

Stages of Chronic Kidney Disease

Each stage of kidney disease is based on your eGFR blood test number, which measures how well your kidneys are filtering your blood. Your doctor can administer this test during any stage, so if you suspect you have CKD, ask for the test to determine how advanced it is.

However, note that the eGFR number is not the sole indicator of CKD in the earlier stages, especially because the number registers as normal during Stages 1 and 2. Signs of early kidney damage are often protein in the urine or physical kidney damage. Usually, the GFR number is an indicator of CKD at Stage 3, which is separated into two stages.

  • Stage 1 eGFR number: eGFR is normal at this point (greater than 90)
  • Stage 2 eGFR number: eGFR is relatively normal at this point (60-89)
  • Stage 3a eGFR number: 45-59
  • Stage 3b eGFR number: 30-44
  • Stage 4 eGFR number: 15-30
  • Stage 5 eGFR number: less than 15

Stage 1: Mild Kidney Disease

At this point, your kidneys have sustained mild damage. Your eGFR number is still showing as normal, so if you catch CKD at this point, you’re in a good place to slow it down and prevent it from progressing. Symptoms of CKD in Stage 1 are protein in the urine or evidence of physical kidney damage (via X-ray, ultrasound, or MRI).

To treat CKD at this stage, start eating a healthy diet, including foods low in saturated fat and cholesterol. Limit your intake of processed foods or cut them out completely if you can. Exercise every day and ask your doctor about medications you can begin taking.

Stage 2: Mild Kidney Disease

At stage two, your kidney damage is still mild and you may not be experiencing any symptoms. Your kidney function is only slightly lower than it was in Stage 1. Treating CKD at this stage involves taking the same steps you did at Stage 1: monitoring your blood sugar, eating healthy, exercising, and taking any medications your doctor prescribes.

Stage 3a and 3b: Moderate Kidney Disease

Most people begin to experience symptoms when they are in Stage 3, which is separated into two parts based on the eGFR number. As the kidney function declines in Stage 3, waste begins to build up in the blood (this is called “uremia”).

Your symptoms at this stage may include high blood pressure, anemia, and even bone disease. Some start to feel pain in their lower back where the kidneys are located. Restless Leg Syndrome may develop, as well as other sleep disorders.

Treating CKD at Stage 3 requires more intervention— along with following the healthy lifestyle suggestions from Stages 1-2, you need to meet with a nephrologist along with your regular doctor and possibly a dietitian.

Stage 4: Severe Kidney Disease

Stage 4 should be taken very seriously since it is the last stage before kidney failure. You most likely will be having symptoms of CKD at this point, including swelling in the hands and feet, back pain, and irregular urination. You may also develop bone disease, heart disease, and anemia.

If you are at Stage 4, it’s time to prepare for hemodialysis or an organ donation.

Stage 5: Kidney Failure

In Stage 5 CKD, symptoms are impossible to ignore since the kidneys have lost their ability to filter blood at this point— renal function is almost nonexistent. Patients in Stage 5 begin dialysis and/or prepare for a kidney transplant.

Symptoms during stage 5 include:

  • Itching
  • Muscle cramps
  • Loss of appetite
  • Swelling in hands and feet
  • Back pain
  • Trouble breathing
  • Trouble sleeping
  • Changes in skin color
  • Tingling or numbness
  • Headaches
  • Nausea or vomiting

Besides visiting a nephrologist, you will need to begin dialysis— either hemodialysis or peritoneal dialysis (PD). You will also need to consider a kidney transplant, either from a cadaverous kidney (which requires joining a waitlist) or finding a living donor.

Stage 5 patients should regularly meet with a dietitian along with their nephrologist since a strict diet is crucial in keeping you feeling as well as possible.

Co-Occurring Medical Issues

Kidney disease commonly occurs alongside other medical issues. Some of these are precursors to kidney disease, while others are the result of poor kidney function.  No matter when they appear, you should seek medical treatment. Sometimes the diagnosis of one of these conditions can lead to an early CKD diagnosis.

Note that treatments for many cormobid diseases often overlap with CKD treatments, such as controlling the blood sugar.

Most common comorbidities (co-occurring diseases):

  • Diabetes
  • High blood pressure
  • Cardiovascular disease (CVD)
  • Congestive heart failure
  • Lung disease
  • Peripheral vascular disease
  • Major neurological problems, such as neuropathy
  • Malnutrition
  • Anemia
  • Bone disease
  • Depression and anxiety

More uncommon comorbidities:

  • AIDS (a precursor to kidney disease)
  • Hepatitis C (a precursor to kidney disease)

If you are diagnosed with one of these conditions along with CKD, you’ll most likely need to take a number of medications to keep symptoms under control. On top of taking medications, you should exercise regularly and adjust your diet. You may need to see different specialists for each condition as well.

Treatment of CKD and ESRD

Treatment of Chronic Kidney Disease varies depending on the stage you are in— in earlier stages, most treatment is preventative and follows the same patterns for regular healthy living (exercising, eating right, sleeping enough, and so on).

Later stages, known as End-Stage Renal Disease, require more medical intervention. Obviously, once you are in Stages 4 and 5, you need specific treatments to survive. The most common treatments are dialysis or a kidney transplant.

Hemodialysis

Patients undergo hemodialysis at a dialysis center, at a hospital, or at home if they have a caretaker. A dialysis machine, or dialyzer, removes a small portion of the blood, cleans it, and then puts it back in the body. In order for the dialyzer to access your blood vessels, your doctor normally has to perform minor surgery on your arm.

The dialyzer machine removes waste from your blood such as urea, creatinine, and potassium. Patients have to undergo dialysis about 3 times a week for 4 hours at a time. If you do dialysis at home, you can opt to do it more frequently for shorter periods of time.

Peritoneal dialysis (PD)

Peritoneal dialysis, or PD, removes waste from your blood like hemodialysis, but it’s a little bit less invasive. PD can also be done at home, at work, or while traveling; however, it’s only a good option for people who are more mobile or have a caretaker.

Because peritoneal dialysis can be done more frequently, patients who choose this treatment option don’t have to restrict their diet as much, and they also have more independence since they can move around while the treatment is being done.

PD involves placing a catheter in the peritoneum, or lining of the abdomen. Once the catheter is in place, a dialysis solution flows from a bag to the catheter in the abdomen. After the bag empties, you can disconnect it from the catheter and go about your normal daily activities. The dialysis solution works inside of you to absorb waste and extra fluid; as the fluid removes more waste, the dialysis process slows down.

Patients empty the bag about 4-5 times a day to keep the solution fresh.

For more information about PD and hemodialysis, visit the National Institute of Diabetes and Digestive and Kidney Diseases website.

Kidney Transplant

Kidney transplants are the preferred treatment for ESRD; while dialysis is extremely helpful, it’s only a temporary solution. There were 3.7 kidney transplants per every 100 dialysis patients in 2016. As of September 25th, 2019, there were 112,947 candidates in the United States waiting for an organ donation, and of that number, 94,717 were waiting for a kidney— nearly 84%.

A transplant team will evaluate whether or not you are ready for a kidney transplant; you will then work with them to find a kidney match. Evaluating you for a kidney transplant includes a few different procedures and tests:

  • Blood and tissue tests
  • Kidney and liver tests
  • Colonoscopy
  • Heart and lung exams
  • Mental health evaluation
  • Health insurance and finances evaluation

Once you’ve been cleared for a kidney transplant, you will be added to a waitlist unless you have a living donor ready to give you a kidney— at that point, you may get a kidney transplant as soon as possible.

If you have other serious health issues or untreated mental health disorders, you may not be qualified for a kidney transplant.

Finding a Kidney Match

An organ transplant is a major surgery, and finding a good match is crucial for your body to accept the organ. When you receive an organ donation, your immune system “notices” and begins to attack that organ as if it were a disease. To minimize the risk of this happening, a good kidney match’s blood type should be compatible with yours.

Your Blood Type Compatible Blood Type
O Type O
A Type A or Type O
B Type B or Type O
AB Type A, Type B, Type AB, or Type O

Kidney Transplant Surgery

If you’re lucky enough to have a living organ donor, you can schedule your kidney transplant as soon as possible. If you’re on a waiting list, you’ll get a call as soon as one becomes available— however, you’re not in the clear yet. You’ll still need to undergo a blood test to determine if the donor’s blood type is compatible with yours.

Recovering from surgery is a lengthy process and requires close care. Somebody will need to be available to drive you wherever you need to go, you will not be able to lift any heavy objects, and you should avoid stressful situations whenever possible. It takes about six weeks to fully heal from a kidney transplant surgery. After that, you’ll continue to follow up with your doctor, who will monitor your body’s response to the transplant.

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 disease’s 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.

Protein

None of us can go without protein, but CKD patients should limit how much they consume. When your body uses protein, it produces waste which your kidney works to remove. If your kidneys are already damaged, they will not be able to remove this waste as effectively, leading to other health issues.

If you’re used to eating lots of protein, start by reducing your portion sizes. You can get protein from both plant and animal-sources— if you find you eat more animal than plant proteins, switch it up and go for plant proteins every once in a while. This can also reduce your risk of heart disease and high cholesterol.

Plant-based proteins:

  • Beans
  • Nuts
  • Grains

Animal-based proteins:

  • Chicken
  • Fish
  • Eggs
  • Dairy

Sodium

Patients in any stage of CKD should limit their sodium intake, as a high-salt diet can lead to high blood pressure, which is one of the most common precursors to CKD. The worldwide dietary sodium intake is typically higher than recommended limits, so even if you don’t think you’re at risk for CKD, lowering your daily salt intake most likely won’t hurt your health. Avoiding processed food is a good first step in reducing your sodium intake since it contains more sodium than most of us realize.

For optimal health, your daily diet should contain less than 2,300 milligrams of salt.

Potassium

Healthy kidneys remove excess potassium from the blood; when it builds up, you may experience nausea, weakness, numbness, or a slow pulse. CKD patients should avoid these high-potassium foods whenever possible:

Foods High in Potassium Foods Low in Potassium
Nuts, beans, legumes Apples, peaches
Potatoes Carrots, green beans
Bananas White bread, pasta, and rice
Dairy Rice milk
Avocados Apple, grape, cranberry juice
Oranges, orange juice Cooked rice cereal

Phosphorus

Patients with CKD have to look out for foods with phosphorus since too much phosphorus in the blood can result in weakened or brittle bones.

Foods Low in Phosphorus Foods High in Phosphorus
Fresh fruits and veggies Beef, poultry, fish
Bread, pasta, and rice Bran cereals and oatmeal
Rice milk Full-fat dairy
Corn and rice cereals Beans, lentils, nuts

What should CKD patients eat?

Perhaps you’re overwhelmed at all the foods you should avoid if you have CKD or are at risk for developing it. That’s understandable! Thankfully, there are still quite a few things you can eat that will provide you with the energy and nutrients your body needs.

  • Spices and herbs with no added salt
  • Fresh food (non-processed foods)
  • Rinsed canned foods (such as beans, meats, or fish)
  • Heart-healthy foods such as salmon, olive oil, berries, and leafy greens
  • Foods low in saturated and trans fat (trans fat is most often found in processed foods)
  • Low-fat dairy products

If you are in the later stages of CKD or already on dialysis, you should establish an emergency meal plan in case you cannot make it to dialysis for some reason. This diet is very strict to control the buildup of toxins. For a meal plan and emergency checklist, please see Kidney.Org.

Medical Nutrition Therapy (MNT)

Figuring out what to eat when you have Chronic Kidney Disease can be stressful— and CKD patients don’t need any more stress. Medical Nutrition Therapy involves talking to a registered dietitian who can plan your meals and give professional nutrition counseling. Some insurance policies cover MNT. You can find a qualified nutritionist by visiting eatright.org and clicking on the “Find a Registered Dietitian” tab. There’s even a filter for “Renal Nutrition” in the specialty field.

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 Deprivation Long-Term Effects of Sleep Deprivation
Poor memory retention Obesity
Inhibited work performance Cardiovascular disease
Impaired driving Diabetes
Anxiety Alzheimer’s Disease
Increased stress High blood pressure
Mood disorders Cancer
Poor food choices Metabolic diseases
Increase in risk-taking behaviors High cholesterol

If you’re 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 (End-Stage Renal Disease) patients report sleep problems, with daytime sleepiness being the most common reported symptom.

Some of the most common sleep disorders affecting CKD and ESRD patients include Restless Leg Syndrome, sleep apnea, and insomnia. The reasons for these connections have not been fully studied, but some possible links include stress, pain, and swelling or fluid retention.

Restless Leg Syndrome

Restless Leg Syndrome, also known as Willis-Ekbom Disease, affects up to 10% of the US population, and it most often occurs in tandem with other conditions, such as CKD, anemia, or pregnancy.

RLS is characterized by uncontrollable movement or twitching of the leg muscles when sitting or laying down and is closely related to periodic limb movements that occur during sleep. Not only does RLS interrupt or delay sleep, but it can also be incredibly painful.

About 20-30% of CKD patients undergoing dialysis experience RLS, compared to 3-7% of the general population. Symptoms of RLS are usually worse at night, and the fastest way to relieve symptoms is to constantly move the legs— hence the interrupted or delayed sleep.

CKD patients sitting or laying down during dialysis often experience RLS. Many precursors to RLS are also precursors to CKD, including diabetes, neuropathy, and low iron levels. Because RLS leads to sleep deprivation, it can cause other health issues. RLS is associated with higher mortality rates in End-Stage Renal Failure patients.

Treatment

Treating RLS is fairly non-invasive. Patients can try massage, warm baths, warm or cool compresses, relaxation techniques, an adjustable bed, and regular exercise. There are some medications for severe RLS, too— talk to your doctor about the right medications, especially if you are currently being treated for CKD as well.

Sleep Apnea

Sleep apnea occurs when the airway is obstructed during sleep, temporarily cutting off oxygen to the body and interrupting sleep. The most common type of sleep apnea is obstructive sleep apnea (OSA), occurring when the throat muscles relax and collapse.

Symptoms of OSA include snoring, gasping for air during sleep, insomnia, dry mouth, headache, and excessive daytime sleepiness. OSA sufferers often deal with sleep deprivation symptoms because the constant interruptions prevent them from spending much time in slow-wave and REM sleep.

The prevalence of sleep apnea in the general population is 2-4%, but in ESRD patients it jumps up to 50-60%. The actual connection between sleep apnea and CKD is unclear, but some studies point to the excess fluid in the legs shifting towards the legs, restricting the airway and causing obstructive sleep apnea.

Sleep apnea itself is connected to depression, hypertension, and heart disease.

Treatment

Depending on the severity of the sleep apnea, patients may need to use a CPAP machine while sleeping (CPAP stands for continuous positive airway pressure). Getting used to a CPAP machine takes some time, and some prefer other options before resorting to a CPAP, such as changing sleeping positions, using an adjustable bed, or losing weight.

 

If you’re a back-sleeper, you’re at a higher risk for sleep apnea and snoring; try sleeping on your side for a more open airway. Additionally, an adjustable bed or lofty pillow can keep your head elevated during the night so your throat muscles don’t relax and collapse.

Insomnia

Currently, insomnia is the number one sleep disorder in the United States. Its onset can occur with life changes, traumatic events, stress, or other diseases. Insomnia is defined as inadequate sleep duration or poor sleep quality— insomniacs don’t just have trouble falling asleep, but they usually suffer from frequent sleep interruptions during the night, resulting in less time spent in the most restorative sleep stages.

The symptoms of insomnia are fairly easy to spot: daytime sleepiness, decreased mental acuity, difficulty falling or staying asleep, irritability, anxiety, depression, and difficulty focusing.

Insomnia can be temporary or chronic; chronic insomnia is characterized by long-term interruptions to the sleep-wake cycle. In the general population, 4-29% of adults deal with insomnia— among ERSD patients, 50-75% deal with insomnia. The connection between the two is not definitive, but researchers hypothesize that insomnia occurs more frequently among CKD patients because of the stress of their condition and consistent pain.

Treatment

While treating insomnia won’t cure CKD patients of their kidney disease, it can certainly improve their quality of life. The most effective treatments for insomnia focus on better sleep hygiene, including establishing a consistent bedtime routine.

One study discovered patients on dialysis in the early morning or late at night had higher rates of insomnia compared to patients who had dialysis treatment in the afternoon. This could be because the process of dialysis affects the release of melatonin, which regulates the circadian rhythm. Like other strenuous activities, dialysis should be done a few hours before bedtime to avoid any melatonin disruption.

Another study learned that 73% of study participants undergoing hemodialysis had no identifiable circadian rhythm at all. Irregular circadian rhythms lead to excessive daytime sleepiness, longer naps, and the perpetuation of insomnia. The best treatment for insomnia is better sleep hygiene, which we will go over in the next section.

Establishing Better Sleep Hygiene

While some sleep disorders require more than just a healthy bedtime routine, following these lifestyle changes leads to an overall higher quality of life— a plus for CKD patients or anyone dealing with other health issues linked to sleep deprivation. Most of us don’t have time to take part in a polysomnography test (sleep study), but cultivating a healthier sleep schedule is accessible for anyone.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral treatment might sound complicated, but it’s one of the simplest and most effective insomnia treatments. It involves setting strict “rules” for yourself surrounding bedtime, such as only using your bedroom for sleep, sleeping only in your bed (not on the couch), avoiding naps completely, and waking up and going to bed at the exact same time every day— no matter what.

Establish a bedtime routine

Many insomnia-sufferers are caught up in bad bedtime habits, such as taking long naps during the day, drinking caffeine too close to bedtime, or engaging in stressful or strenuous activities too close to bedtime. To encourage your body to fall asleep at normal times, choose a bedtime and wake time and stick to it— even on the weekends. Limit your naps to no more than 30 minutes, and try not to take any naps after 3 pm. Help your body prepare for sleep by dimming the lights in your home, taking a warm bath, or meditating.

Avoid electronics close to bedtime

Many studies have shown devices emitting blue light delay the release of melatonin, keeping the user awake past their bedtime. Exposure to blue light during the day is relatively healthy, but when the sun goes down, the body needs warmer light. Avoid looking at any screens at least 2-3 hours before bedtime— this includes TVs, e-readers, smartphones, or computer screens.

Avoid certain foods

CKD patients will already be watching out for overly salty, processed foods, which can decrease their risk of intestinal discomfort before bed. In addition to avoiding heavy foods, CKD patients should abstain from spicy foods, since this can cause acid reflux.

It is believed that consuming spicy foods too close to bedtime results in less time spent in slow-wave sleep since it can compromise the body’s temperature. Your body cools down every night to prepare for sleep— spicy foods will slow or prevent this process, keeping you up.

One study published in the Journal of Clinical Sleep Medicine tested the effects of caffeine 0, 3, and 6 hours before bedtime. They concluded that participants who drank caffeine 6 hours before bedtime experienced the least amount of adverse effects on their sleep. If you like having a drink before bed, make it an herbal tea like lavender or chamomile instead of something with caffeine. Lavender, in particular, has been found to stabilize mood and relax the muscles.

Eat sleep-promoting foods

Certain foods lead to the release of sleep-promoting hormones and receptors in the body, such as serotonin, melatonin, and tryptophan. However, some sleep-promoting foods like bananas are high in potassium, which CKD patients should avoid. Keeping this in mind, CKD patients can safely enjoy cherries, low-fat milk (in moderation), kiwis, or white rice before bed.

Create a Healthy Sleep Environment

Your sleep environment may be to blame if you’re not getting enough sleep— besides avoiding blue or bright lights before bed, you should be sleeping in a relatively cool room with minimal noise. Some people like to use white noise machines or apps which block out any distracting noises, like a ticking clock, with more calming sounds like running water or a slight breeze.

Your body sleeps best in a room that’s 60-67 degrees Fahrenheit. If that seems too chilly for you, use light blankets or sheets to regulate your body’s temperature. Sleeping on a comfortable mattress helps tremendously; if your bed is more than 7 years old, it might be time to replace it with a newer, more comfortable model. A mattress that sags, squeaks, or causes you to sleep hot isn’t worth the lost sleep. Above all, your mattress should keep your spine aligned so you don’t wake up with more pain.

An adjustable bed is another option— many chronic disease sufferers use adjustable beds for more comfortable, customized sleep. An adjustable frame allows you to elevate your head, legs, or feet for improved circulation, reduced risk of snoring, and better sleep posture.

Living Comfortably with CKD

If you’ve 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 won’t cure CKD, it can dampen the symptoms and even slow the progression of the disease if it’s 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.

Additional Resources and Information

A chronic kidney disease diagnosis can feel overwhelming. There’s plenty of resources available to you so you can get all the help you need:

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