You might wonder why kidney disease causes sleep problems if you’re living with the condition. Many people with chronic kidney disease (CKD) struggle to sleep well because different factors can affect their quality of sleep. In fact, a systematic review — a study that looks at many studies on a topic — found that as many as 80 percent of people with CKD who are on dialysis have poor sleep quality. People with kidney disease often have complications that are risk factors for sleep disturbances. These complications can affect quality of life and increase the risk of worsening kidney function and progression of CKD. They can also lead to comorbidities — two or more conditions at the same time — like cardiovascular issues and depression.

Fortunately, there are steps to help you rest better. Sleep is very important for your health and kidneys. Talk to your doctor to learn what might be causing your sleep issues. Here are a few factors you can discuss.

1. You May Have Restless Leg Syndrome

People with CKD are two to three times more likely to develop restless leg syndrome (RLS). RLS is considered a sleep disorder. In RLS, people may feel itchy, painful, or crawling sensations in their legs, along with a strong urge to move them. These sensations often happen while resting or sitting, especially in the evening or when trying to sleep.

RLS can be linked to anemia (low red blood cells), not enough iron, high calcium in the blood, and issues with dopamine (a chemical made in the brain and adrenal gland) receptors. People undergoing hemodialysis may experience RLS more often, particularly during or after dialysis sessions.

2. Sleep Apnea Is Common in People With Kidney Disease

Sleep apnea happens when a person’s sleep is often interrupted by short moments of not breathing, followed by gasps. Sleep apnea often occurs alongside other comorbidities such as diabetes or living with obesity.

Two types of sleep apnea can develop in people with CKD — obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA is more common and occurs when airways are blocked because the throat muscles are abnormally relaxed during sleep. Central sleep apnea is caused by problems with brain signals to the muscles that regulate breathing during sleep.

Kidney disease symptoms like fluid buildup can cause fluid to move up toward the upper body and neck when lying down, which can narrow the windpipe. Also, metabolic acidosis (a buildup of acid in the blood) and uremia (a buildup of toxins in the blood) seen in CKD can affect breathing patterns and cause sleep apnea. In people with sleep apnea, blood oxygen levels decrease, which causes hypertension (high blood pressure), increases the risk of life-threatening cardiovascular events, and makes kidney function worse.

3. Insomnia Often Affects People With Kidney Disease

Sleeplessness — or insomnia — is a sleep disorder where a person has trouble falling asleep, staying asleep, or waking up too early and not being able to go back to sleep, leading to feeling tired during the day. Many factors can cause trouble sleeping, like RLS, periodic limb movement (PLM), comorbidities, sleep apnea, or problems in the body like uremia (waste buildup), anemia, high calcium, bone pain, and itching. Problems with the circadian rhythm or sleep-wake cycle and bad sleep habits, like napping during dialysis, can also make it worse.

4. Over-the-Counter Sleep Medication Should Be Discussed With Your Doctor

If you have kidney disease, you should always talk to your nephrologist (kidney doctor) before taking any over-the-counter (OTC) sleep medications or supplements, such as melatonin, that are supposed to help with better sleeping. Some OTC medications and supplements can interfere with other medications. There is also the risk that an OTC medication or supplement might negatively affect your renal (kidney) function or have ingredients or additives such as sodium or potassium that can be harmful to your kidneys.

If your doctor believes an OTC product may be good for you, it’s also important to get medical advice on proper dosage.

5. Cognitive Behavioral Therapy May Help You Sleep Better

Many doctors recommend trying cognitive behavioral therapy (CBT) before prescribing sleeping medication. CBT aims at changing negative thought patterns and behaviors that may be interfering with your overall quality of sleep. By identifying factors that are affecting your sleep, CBT can help you make positive changes in your daily routines, sleep habits, and lifestyle that may be contributing to sleep disorders.

CBT often involves interventions that can help improve sleep, such as:

• Quitting smoking
• Avoiding caffeine in the afternoon
• Stopping alcohol consumption
• Getting regular exercise and staying physically active
• Maintaining consistent sleep patterns

CBT can provide you with relaxation techniques to help clear your mind of negative thoughts. It can also address sleep disturbances and create a routine to improve the overall quality of sleep.

6. Treatment Options May Help With Sleep

Depending on the cause of your sleep problems, there are treatment options that may help improve the quality of your sleep. If you often have trouble sleeping, keep track of your sleep patterns so you can share them with your doctor. You may want to use a sleep diary that tracks your sleep duration and when you wake up. The sooner you get evaluated and treated, the better. Your doctor may recommend a sleep test such as polysomnography, which records brain activity, breathing, and movement while you sleep.

Treatment Options for Restless Leg Syndrome

If you’re experiencing RLS, your doctor may suggest medications such as:

• Iron supplementation — May be either oral iron supplements or intravenous (through a vein) iron supplements, if your doctor determines you have an iron deficiency
• Drugs that raise the dopamine level in the brain — For example, pramipexole (Mirapex ER), rotigotine (Neupro), and ropinirole (ReQuip)
• Drugs that affect calcium channels — Gabapentin enacarbil (Horizant), gabapentin (Gabarone, Neurontin, Gralise), and pregabalin (Lyrica)
• Muscle relaxants
• Prescription sleep medicine
• Opioids — Codeine, tramadol (ConZip, Qdolo), hydrocodone (Hysingla ER), and oxycodone (Oxycontin, Roxicodone)
• For people on dialysis, doing it more often or using cooler dialysis fluid might help.

All medications have a risk of side effects, some of which can be serious. Always discuss potential side effects thoroughly with your doctor before starting a new medication.

Sleep Apnea and Kidney Disease Treatment Options

Obstructive sleep apnea is generally treated with a continuous positive airway pressure device (CPAP), which is a machine that pushes air into the windpipe to keep it open. In some cases, a mouthpiece can be worn to keep airways open.

For people with kidney disease, doctors may suggest additional steps for treating obstructive or central sleep apnea, such as:

• Adjusting dialysis treatment schedules such as nighttime dialysis, can help by reducing fluid buildup and improving airflow.
• Reducing fluid overload with dialysis has also been shown to improve sleep apnea in people with kidney disease
• Kidney transplantation, in severe cases

Insomnia

If insomnia isn’t caused by restless leg syndrome or sleep apnea, talk to your doctor about the benefits of cognitive behavioral therapy. If CBT and lifestyle changes aren’t effective, your doctor may recommend different treatment options. If this is the case, you’ll need to talk about potential side effects first.

Talk to Your Doctor

Getting good sleep is important for your overall health, especially if you have kidney disease. Sleep problems like restless leg syndrome, sleep apnea, and insomnia are common, but there are ways to manage them. Talking to your doctor about your sleep issues can help you find the right treatments, whether that means adjusting your dialysis, trying therapy, or using medication. Small changes in your daily habits may also make a big difference. The key is to take steps early and find what works best for you.

Find Your Team

On MyKidneyDiseaseTeam, the social network for people living with rare kidney disease and their loved ones, members come together to ask questions, give advice, and share their stories with others who understand life with kidney disease.

Have you had trouble sleeping with kidney disease? Has your doctor evaluated you for your treatment options? Share your tips in the comments below, or post a question on your Activities page.