Insomnia in ESRD

What is insomnia?

Insomnia is difficulty falling asleep or staying asleep, even when a person has the chance to do so. People with insomnia often feel dissatisfied with the quality or duration of their sleep, and usually experience one or more of the following symptoms: fatigue, low energy, difficulty concentrating, mood disturbances, and decreased performance in work or school. Chronic insomnia is disrupted sleep that occurs at least three nights per week and lasts at least three months.

Who is affected by insomnia?

The National Institute of Health estimates that approximately 10% of the general population has symptoms of functional impairment consistent with the diagnosis of insomnia. In a national study of ESRD patients on dialysis, 53% reported difficulty with falling asleep and/or staying asleep all or most of the time.

Hemodialysis and insomnia

Insomnia is a common and distressing symptom for patients on hemodialysis, and there is evidence for a much larger impact on the health of patients. Patients on hemodialysis might benefit if screening for insomnia was incorporated into their routine care. The Insomnia Severity Index is a self-report instrument that measures insomnia; both patient perceived severity of insomnia and its effect on daytime function.

While there are no studies on the treatment of insomnia among individuals undergoing hemodialysis, there is a large body of evidence that shows that CBT and medication are effective treatments for insomnia in the general population.

It is not known whether the effectiveness of these treatments translates to the HD population, as patients on HD have unique challenges with maintaining regular sleep/wake routines. This study seeks to show whether these treatments can be effective for the hemodialysis population despite these challenges.