Evaluation of an individual sleep intervention programme in people undergoing peritoneal dialysis treatment

Abstract

Aims and objectives This study aimed to evaluate effects of a non‐pharmacological intervention on sleep, activity and fatigue in patients receiving peritoneal dialysis by the use of both actigraphy registration and self‐assessed questionnaires. Background Insomnia is estimated to affect up to 60% of haemo‐ and peritoneal dialysis patients. It is associated with two common uremic symptoms, pruritus and restless legs syndrome. To our knowledge, no interventions have been evaluated by actigraphy. Design A prospective multiple baseline single‐case experimental design. Methods Two women and seven men with sleep problems, 48–77 years, treated with PD participated in a 17‐week study from January 2009 to February 2011. Two interventions were separately implemented. First, a pressure‐relieving mattress and second, a four week individual sleep hygiene and sleep scheduling intervention. The two interventions were evaluated both objectively by actigraphy and subjectively by questionnaires. Results A total of 315 sleep–wake cycles from nine individuals were evaluated. Three patients improved clinically significantly in five or more of the nine outcomes, i.e. sleep onset latency, nocturnal sleep duration, numbers and duration of napping, movement and fragmentation index, number of steps, metabolic equivalent unit, sleep efficiency and fatigue. The other six patients also showed improvements but to a lesser degree. Physical activity advice was the intervention that yielded most sleep improvements. Conclusions This study illuminates the need for regular assessment of sleep and tiredness. It also demonstrates how a non‐pharmacological treatment and self‐management can be applied with renal supportive care to improve sleep quality. Relevance to clinical practice This study is a clinical example of a non‐pharmacological intervention with supportive care and self‐management. This model can improve health and reduce the pharmacological burden because hypnotics can be replaced by sleep hygiene self‐care activities.

Fatigue in advanced kidney disease

“…Cognitive-behavioral therapy (CBT) for sleep disturbances in dialysis patients has shown promising effects on fatigue, with modest but significant reductions in fatigue scores after intervention. 118,119 A very small individual sleep intervention study by Yngman-Uhlin et al 66 also revealed similar results, with four out of nine patients reporting reductions in fatigue. Although these findings corroborate the association between sleep problems and fatigue, larger investigations are needed to support these data.…”

“…64 Joshwa et al 36 reported an association between daytime sleepiness, poor night-time sleep, and fatigue; results that were supported in both HD 50,65 and PD patients. 66,67 In addition, Sanner et al 15 found that the severity of sleep-related breathing disorders was associated with levels of vitality.…”

The role of sleep hygiene in promoting public health: A review of empirical evidence

“…Relatively few studies have investigated the efficacy of sleep hygiene interventions in nonclinical samples. 16-20 Overall, this work has provided some preliminary support for the use of sleep hygiene education in nonclinical populations, but the findings are inconsistent. Taken together with findings in clinical samples, these data raise an interesting question.…”

Prevalence and Severity of Itching in Patients with End-Stage Renal Disease: Treatment with Nalfurafine Hydrochloride

“…Although there was no significant difference in the severity or frequency of pruritus between the 3 study groups, itch-associated insomnia was significantly more common in patients on PD [1][2][3]. Although we have no clear explanation for this finding, there are many reports of insomnia in patients on dialysis, particularly those performing automated PD [4][5][6]. Moreover, the dialytic efficiency of PD is less than that of HD, so it is possible that patients on PD are more likely to become uremic and therefore are more prone to uremic pruritus.…”