Stage 3 kidney disease, also known as moderate chronic kidney disease, can affect sleep in various ways. Many patients with stage 3 kidney disease experience excessive daytime sleepiness and have difficulties getting a good night’s rest. There are several reasons why kidney disease often leads to sleep problems.
What causes sleep problems in stage 3 kidney disease?
There are a few key factors that contribute to sleep disturbances in those with moderate chronic kidney disease:
Anemia
Anemia is a reduction in red blood cells or hemoglobin levels, resulting in less oxygen being circulated throughout the body. Anemia is common in stage 3 kidney disease due to the kidneys’ reduced ability to produce erythropoietin, the hormone that stimulates red blood cell production. With anemia, patients often experience severe fatigue and excessive need for sleep.
Uremia
As the kidneys fail, waste products and toxins build up in the bloodstream. This condition is known as uremia. The accumulation of urea and other urinary waste products can make patients feel washout and fatigued. Uremia-associated fatigue promotes daytime sleepiness.
Mineral imbalances
Kidney disease disrupts the balance of minerals in the body like calcium, phosphorus, and potassium. Abnormal mineral levels can impair nerve conductivity and muscle function. Electrolyte imbalances contribute to overall body fatigue, lethargy, and increase the desire to sleep.
Medications
Medications prescribed to manage complications of decreased kidney function like anemia, high blood pressure, and fluid retention can also cause drowsiness as a side effect. Common culprit medications include diuretics, anti-hypertensives, phosphate binders, and iron supplements.
Sleep disorders
Underlying sleep disorders like sleep apnea, restless legs syndrome (RLS), and insomnia are more prevalent among those with kidney disease. Sleep apnea and RLS promote sleep disruption, while insomnia makes it difficult to fall and stay asleep.
Dialysis
For those with stage 3 kidney disease undergoing dialysis treatments, the dialysis procedure itself can induce fatigue. Hemodialysis requires connecting to a machine 3-4 times per week, each treatment lasting 3-5 hours. This is physically taxing on the body and can cause excessive sleepiness.
Stress, anxiety and depression
Coping with chronic kidney disease can precipitate psychological conditions like stress, anxiety, and depression. These mental health issues make it harder to fall and stay asleep. Racing thoughts and worries disrupt sleep.
How much sleep do stage 3 kidney disease patients need?
Most adults need 7-9 hours of quality sleep per night for optimal health and wellbeing. However, many patients with stage 3 chronic kidney disease require even more sleep – up to 10 hours or more.
The excessive daytime sleepiness experienced by kidney disease patients signifies that their nighttime sleep is not sufficiently restorative. Although they may spend adequate time in bed and even sleep for prolonged periods, the quality of sleep is poor.
Frequent nighttime awakenings, difficulty falling back asleep, and spending excessive time in lighter stages of sleep rather than deeper, more restorative sleep stages means patients don’t feel refreshed and restored in the morning.
Therefore, spending additional time asleep allows for more opportunities to obtain rejuvenating deep sleep and overcome deficits from disrupted sleep. Those with moderate kidney disease should aim for a minimum of 8 hours in bed at night and try to incorporate daytime napping if able.
Tips to improve sleep with stage 3 kidney disease
Here are some helpful tips for those with stage 3 kidney disease to get better sleep:
Optimize the sleep environment
Ensure the bedroom is cool, quiet and comfortable. Use window curtains or an eye mask to block out early morning light. Consider using a fan or white noise machine to reduce disruptive noises. Invest in a new mattress or try a memory foam topper if your bed is uncomfortable.
Wind down before bedtime
Give yourself at least 1 hour before bed to relax, take a bath, listen to soothing music, do light stretches or read. Dim the lights at night to boost melatonin production. Turn off screens at least 30 minutes before bed, as the blue light inhibits sleepiness.
Follow a regular sleep-wake schedule
Going to bed and waking up at consistent times reinforces the body’s sleep-wake rhythm. Try to keep a similar schedule even on weekends. Exposure to outdoor early morning light helps signal wake time.
Avoid large meals, alcohol and caffeine before bed
Eating a heavy meal within 2-3 hours of bed or consuming alcohol or stimulants like coffee can negatively impact sleep. Caffeine’s effects can persist for up to 12 hours.
Exercise regularly but not before bed
Moderate activity during the day helps promote good sleep. However, vigorous exercise within 2 hours of bedtime may be too energizing.
Limit daytime napping
Daytime naps provide relief from drowsiness but can make it harder to fall asleep at night if taken too late in the day or lasting too long. Keep naps under 30 minutes and before 3pm.
Consider melatonin supplementation
Melatonin is a naturally produced sleep-regulating hormone often used as an over-the-counter sleep aid. Consult your doctor before starting on any new medications or supplements.
Seek treatment for underlying conditions
Get evaluated for sleep disorders like sleep apnea or restless legs syndrome which are common in kidney disease. Follow treatments plans to alleviate these conditions. Also discuss options to better manage chronic pain, anxiety, depression or other factors impairing sleep.
How does stage 3 kidney disease affect sleep architecture?
Sleep architecture refers to the cyclical pattern of distinct phases and stages of sleep. Research shows that stage 3 chronic kidney disease significantly alters normal sleep architecture.
Reduced deep NREM and REM sleep
Polysomnography and EEG recordings demonstrate that patients with moderate kidney disease spend less time in deep non-REM (NREM) slow wave sleep and REM (rapid eye movement) sleep. NREM and REM are critical for physical recovery and cognitive function.
Shortened sleep cycles
The typical sleep cycle of transitioning between NREM and REM sleep stages lasts about 90-120 minutes in healthy adults. Individuals with stage 3 kidney disease often have shortened cycles of only 60-90 minutes. This prevents patients from reaching optimal time in restorative slow wave and REM sleep per cycle.
Frequent sleep interruptions and fragmentation
Kidney patients exhibit increased sleep fragmentation due to amplified arousals, awakenings and stage shifts. Disrupted sleep impairs sleep continuity and quality.
Increased stage 1 and 2 NREM sleep
While deep NREM slow wave and REM sleep are reduced, those with kidney disease spend an increased proportion of sleep time in the lighter stages 1 and 2 NREM sleep. This means overall sleep is lighter and less refreshing.
Elevated daytime sleepiness
Due to the inadequate amount of deep, high quality nighttime sleep, patients with stage 3 kidney disease experience pronounced daytime sleepiness. However, napping does not fully compensate for the accumulated sleep debt.
Circadian rhythm disturbances
Kidney disease is associated with impaired regulation of the intrinsic circadian sleep-wake cycle. This results in delayed sleep onset, difficultly awakening in the morning and daytime sleepiness. Circadian disruptions can exacerbate sleep disturbances.
How does dialysis impact sleep in stage 3 kidney disease?
Many patients with stage 3 chronic kidney disease require hemodialysis treatments to filter waste products and excess fluid from their bloodstream. Undergoing frequent dialysis can significantly worsen sleep issues through a few mechanisms:
Time burden
Hemodialysis treatments are lengthy, ranging from 3-6 hours per session and occurring 3-4 times per week. This demanding time commitment can encroach upon time allotted for sleep, especially if treatment times are scheduled very early or late in the day.
Fatigue
The dialysis procedure itself is physically taxing on the body. Sessions can leave patients feeling exhausted. However, this dialysis-induced fatigue paradoxically makes it harder for patients to fall and stay asleep at night.
Dietary restrictions
Kidney patients on dialysis must closely restrict their fluid and nutritional intake, which can impair sleep. Thirst, hunger, and mineral imbalances caused by dietary limitations can wake patients during the night.
Stress and anxiety
Many dialysis patients experience emotional distress related to their reliance on this intensive, lifelong treatment for survival. Stress and anxiety related to dialysis care negatively affects the ability to fall asleep and decreases sleep quality.
Changes to sleep cycle and circadian rhythms
The thrice-weekly dialysis schedule forces patients into an unnatural sleep cycle aligned with treatment times rather than their innate circadian biology. This misalignment contributes to disturbed sleepwake patterns and daytime sleepiness.
Conclusion
In summary, the majority of patients with stage 3 chronic kidney disease suffer from problematic sleep issues like insomnia, fragmented sleep, and excessive daytime sleepiness. The uremic state of kidney failure combined with factors like anemia, dialysis treatments, and mineral imbalances alter normal sleep architecture. Those with moderate kidney dysfunction experience less restorative deep NREM and REM sleep leading to non-refreshing sleep. A multifaceted approach to optimizing the sleep environment, sleep habits, and management of underlying disorders may improve sleep disturbances related to stage 3 kidney disease. Most kidney patients require more total nightly sleep than the average adult. However, the critical focus should be on improving overall sleep quality given the constraints of living with chronic kidney disease.