Common Sleep Problems Caused by Kidney Disease

People with chronic kidney disease (CKD) or end-stage kidney disease (ESKD) often have trouble sleeping. A small 2022 study comparing sleep problems between those with CKD and ESKD found that 66 percent of people with CKD and ESKD said their sleep was “poor.” And those with ESKD, also called kidney failure, had worse sleep than those with CKD. So, as kidney disease worsens, sleep quality may worsen as well.¹

Along with CKD itself, treatment for CKD and ESKD affects sleep. Dialysis can lower sleep quality, while having a kidney transplant can improve sleep quality.^2,3

Many sleep problems can develop in those with CKD or ESKD. They include:²

• Insomnia
• Sleep hypoventilation
• Sleep apnea
• Sleep-wake disorders
• Hypersomnolence
• Parasomnias
• Restless legs syndrome

Insomnia

Insomnia is a sleep condition in which it is hard to go to sleep and stay asleep. A 2022 review found that about 48 percent of people with CKD who are not on dialysis have insomnia. It also found that the risk of insomnia increases with age. Insomnia risk was lowest in those who had a kidney transplant.^2,3

Sleep hypoventilation

The lungs and kidneys usually work together to regulate acid-base and carbon dioxide levels in the blood. If the kidneys do not work well, it is hard to maintain healthy levels of both.²

Sleep hypoventilation occurs when you are not able to get rid of carbon dioxide in your blood. In people with kidney disease, this can cause acid level to build up in the body.²

Obstructive sleep apnea and central sleep apnea

Obstructive sleep apnea (OSA) occurs when your throat muscles relax too much while you sleep. This narrows the airway. A narrow airway can stop your breathing. Central sleep apnea (CSA) occurs when your brain does not signal to your body to breathe. Both conditions are linked to kidney disease.^2,4-6

Doctors have found a link between OSA and low glomerular filtration rate (GFR). GFR measures how well your kidneys filter fluid. Having a lower GFR raises your risk of having OSA, and having OSA can lower your GFR.^4-7

CKD is considered an independent risk factor for CSA. Several issues may cause CSA in those with CKD, including:^2,4

• A buildup of fluid in the lungs (interstitial pulmonary edema)
• Long-term buildup of acid in the body (chronic metabolic acidosis)
• High amounts of toxins that the body cannot get rid of (uremic toxins)

Circadian rhythm sleep-wake disorders

The 24-hour sleep-wake cycle that your body follows is called your circadian rhythm. CKD can upset the circadian rhythm and cause abnormal sleep patterns. It can affect your memory and decision-making. An abnormal circadian rhythm can also worsen kidney problems.^2,8,9

Central disorders of hypersomnolence

Hypersomnolence means consistently being tired even after a full night’s sleep. Disorders of hypersomnolence include:²

• Narcolepsy
• Idiopathic hypersomnia
• Klein Levin syndrome

More studies are needed to understand the link between these disorders and CKD. But 1 study showed that the number of people with CKD who have narcolepsy is higher compared to those with healthy kidneys.²

Excessive daytime sleepiness (EDS) is common for people with CKD. A 2018 study found that 44 to 67 percent of people with CKD who were on dialysis or who had received a kidney transplant had EDS.²

Parasomnias

Parasomnias are behaviors that interrupt sleep. These include:^2,10

• Sleepwalking
• Nightmare disorder
• Sleep terrors
• Sleep paralysis
• Sleep-related eating disorders

Parasomnias can be simple or complex. Complex parasomnias are more extreme. In 1 study, more people with CKD and ESKD had parasomnias compared to those with healthy kidneys.^2,10

Restless legs syndrome

Restless legs syndrome (RLS) causes an uncomfortable, uncontrollable desire to move your legs. Doctors think CKD and ESKD are linked to RLS by low iron. If you are on dialysis, your iron may be low from the treatment. This can cause RLS.^2,11

Why are sleep disorders linked to CKD?

This is a complicated question with several possible answers. The kidneys help your body regulate internal processes like blood pressure and blood sugar. When the kidneys fail, several internal processes are affected. It is likely that sleep disorders occur in response to several effects of CKD on the body.^2,12

When the kidneys cannot filter properly, waste and other products build up. This is called uremia. Some experts think that uremia, which can cause chronic inflammation, can lead to sleep issues. Others think that if CKD affects the hormones orexin or melatonin, this can cause poor sleep. More research is needed to understand the relationship between kidney disease and sleep.^2,3

Regardless of its cause, poor sleep makes it harder for your body to handle your kidney disease. If you are on maintenance dialysis, poor sleep raises your risk of death. If you have kidney disease and trouble sleeping, talk to your doctor. You may need to see a sleep specialist. Addressing your sleep issues can improve your overall health.^1,3