Sleep problems on nocturnal hd

Hi! So happy I found this site. I recently switched to NHD after 10 years on PD. Started training in August using short daily. Switched to nocturnal in December. Since then I have increasing sleep problems. I go to sleep, sleep 3-4 hours, wake up and can’t get back to sleep. The most nights I can run in a row is two, and then I have to take a night off to get some rest. I have Ativan I take on my off nights so I can sleep but I’m afraid to take it when I’m on the machine in case I don’t hear an alarm and I don’t want to take it every night anyway as it is habit forming. Does anyone else have this problem? Will it eventually go away after I’ve done nocturnal a while? Any tricks for solving the problem. Would appreciate any help you can give. Thanks!

Annette

It sounds like the problem is staying asleep? I sometimes take a Valium to help fall asleep; it doesn’t knock you out so bad that you can’t wake up if you need to. Staying asleep is a new one to me. Do have any suspicions? On an off night if you don’t take Ativan do you wake up after a few hours?

Hi, Bill. I haven’t tried not taking an Ativan on an off night but plan to do so. Today my doctor prescribed trazodone (longer acting than Ativan) which I will try tonite. He says I can use the Ativan for breakthrough. I don’t like taking such strong drugs but I have got to get some sleep. I’m hoping I can take the drugs for a short time and break the pattern.

Is there something in particular that disturbs your sleep? I’m not on dialysis, but notice that in the winter, some nights each time the furnace kicks in, it wakes me up. Earplugs that DON’T work so well that they keep you from hearing alarms might help you ignore softer noises that would otherwise disturb your sleep.

Also, what sort (if any) of sleep ritual do you have for helping yourself to fall asleep in the first place? If you establish one, it may help you to get back to sleep if you wake up. I used to just lay there and eventually go to sleep, or read until I was tired, but found that actually having a sleep routine helped a LOT. Here’s what I do (sounds strange, but works like a charm. Really.):
– 1. Choose a slow song that you like.
– 2. Thinking of the tune of the song, breathe in deeply and count 1,000 (in your head, of course, not out loud).
– 3. Breathe OUT and count 999 (keeping in rhythm with the song)
– 4. Breathe IN and count 998
– 5. Breathe OUT and count 997
– 6. Etc.

This is a sort of meditation, but I find that it basically occupies my entire brain so I bore myself to sleep. :wink: Usually, I can’t get down past about 800, even on a bad night. If it isn’t working, switch songs. Give it a try–it’s free and kind of fun to do…

[QUOTE=Dori Schatell;19297]Is there something in particular that disturbs your sleep? I’m not on dialysis, but notice that in the winter, some nights each time the furnace kicks in, it wakes me up. Earplugs that DON’T work so well that they keep you from hearing alarms might help you ignore softer noises that would otherwise disturb your sleep.

Also, what sort (if any) of sleep ritual do you have for helping yourself to fall asleep in the first place? If you establish one, it may help you to get back to sleep if you wake up. I used to just lay there and eventually go to sleep, or read until I was tired, but found that actually having a sleep routine helped a LOT. Here’s what I do (sounds strange, but works like a charm. Really.):
– 1. Choose a slow song that you like.
– 2. Thinking of the tune of the song, breathe in deeply and count 1,000 (in your head, of course, not out loud).
– 3. Breathe OUT and count 999 (keeping in rhythm with the song)
– 4. Breathe IN and count 998
– 5. Breathe OUT and count 997
– 6. Etc.

This is a sort of meditation, but I find that it basically occupies my entire brain so I bore myself to sleep. :wink: Usually, I can’t get down past about 800, even on a bad night. If it isn’t working, switch songs. Give it a try–it’s free and kind of fun to do…[/QUOTE]

Thanks for the input. I use earplugs to block out the machine noise. I don’t have a sleep ritual and will give yours a try. I don’t have any trouble falling asleep, it’s the staying asleep part. If I can’t get back to sleep after an hour, I usually give up and watch a little television. Probably not the best choice. Will try meditating instead.

If this process works for you to fall asleep, you can use it to fall BACK asleep, too.

One other thought is to tough it out and just be tired for afew days while your body/mind gets use to sleeping while dialyzing. I did a study a few years ago of every other night dialysis and that made it hard to sleep while dialyzing. I knew I would get a good night sleep the next night so no big deal.

When I first started home nocturnal on the NxStage I went back to bed after treatment the first two nights then I stayed up and was sleepy after a couple of treatments - after three days I was so tired I slept through the night.

Sleeping is a big issue with Kidneys that do not work. I am a nite person and stay up most of the nite.I get my best sleep between 4 and 8 am, otherwise I am jumping off ceilings if i try to go to sleep before this time.
I know everyone is different. I take an ativan before my treatment which is usually 7or 8 am and sleep for about 2 hours out of a 4.5 hour treatment. It helps relax me.
I think that its just all the medications we take and then put something else into the equation and it all equals to messing up our sleep patterns.

///MM

Have you ever had a sleep study? This could probably identify the cause of your waking midway through the night. If so, a treatment designed to address that diagnosis could be prescribed and attempted. Since you’ve only been on nocturnal HD at home since December, it’s possible that you’ve not been on nocturnal long enough for it to reach it’s maximum benefit. Most reports of nocturnal HD done 4 or more times a week say that patients have fewer problems with sleep apnea and restless leg syndome, either of which can cause sleep problems.

I have been doing nocturnal now for about 6 months maybe? I continue to have the same pattern of sleep where I fall asleep for 4 hours and wake up for the next 4 usually tossing and turning. I can see this is not uncommon for people on nocturnal - unless they take a prescription sleep aid. I’ve tried the over-the-counter pm medicines with 50 mg diphenhydramine HCI (normal 2 tab dosage). I can fall asleep but I wake up 4 hours later. The package says not to take more than 2 tabs in 24 hours but I have taken another 2 in order to fall back asleep which isn’t always successful.

My nephrologists group has this resistance to prescribing medications for patients. I suspect they’ve had problems with patient addition in the past so have adopted a general rule to resist prescribing drugs. I personally would rather avoid prescription meds as well but continued lack of sound sleep takes its toll. I dialyze 5 or 6 nights a week and I can’t tell you how much I look forward the my night off so I can sleep soundly 8 or 10 hours to catch up.

My neph also made the statement that I am past the ‘adjustment’ phase insinuating that my sleep disturbance is not dialysis related and suggested referring me to a sleep specialist…ugh. One more unecessary appointment. I declined knowing the sleep doc wouldn’t tell me anything I didn’t already know.

If there is a poll feature on this site, I will be sending out a poll to find out how many nocturnal dialysors have sleep problems and if and what medication they take to help.

Have you tried exercise during the day? It should be enough to make you feel exhausted then you should sleep better. Good luck. Let us know if you find what works please.

I do exercise at the gym regularly. My neph wrote a prescription for Ambien as a sleep aid. However, after taking it a few times I know that I always feel irritable and slightly hungover the next day. I have found that taking Xanax before I go to sleep helps a lot plus I feel normal the next day. I originally used Xanax for episodes of restless legs which thankfully are rare today. I’ll talk to him about Xanax on a continued basis. If I (and he) feel its ok then I’ll continue with that.