Sleep-related complaints affect 50-80% of patients on dialysis. Sleep disorders impair quality of life significantly. Increasing evidence suggests that sleep disruption has a profound impact both on an individual and on a societal level. The etiology of sleep disorders is often multifactorial: biologicsocialand psychological factors play a role. This is especially true for insomniawhich is the most common sleep disorder in different populationsincluding patients on dialysis. Biochemical and metabolic changeslifestyle factorsdepressionanxietyand other underlying sleep disorders can all have an effect on the development and persistence of sleep disruptionleading to chronic insomnia. Insomnia is defined as difficulty initiating or maintaining sleepor having nonrestorative sleep. It is also associated with daytime consequencessuch as sleepiness and fatigueand impaired daytime functioning. In most casesthe diagnosis of insomnia is based on the patient's historybut in some patients objective assessment of sleep pattern may be necessary. Optimally the treatment of insomnia involves the combination of both pharmacologic and nonpharmacologic approaches. In some cases acute insomnia resolves spontaneouslybut if left untreatedit may lead to chronic sleep problems. The treatment of chronic insomnia is often challenging. There are only a few studies specifically addressing the management of this sleep disorder in patients with chronic renal disease. Considering the polypharmacy and altered metabolism in this patient populationtreatment trials are clearly needed. This article reviews the diagnosis of sleep disorders with a focus on insomnia in patients on dialysis.
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