Maybe Just a Little One

IMAG0269 (1)I love my dog, and because she’s recently had three surgeries for cancer, I’ve had some sleepless nights.  It looks like she’s going to be all right, but I’m tired.  So I thought about taking naps. Well, I really thought about napping after Nima sent me a chart of the value of different length naps and asked me if that information were true.

As Chronic Kidney Disease patients, most of us have sleep problems.  For a while, I experienced interrupted sleep.  That seems to have magically disappeared.  Not so, the sleep apnea which will be my constant companion for life…and why I wear the mandibular advancement device every night. Then there’s insomnia and let’s not forget restless leg syndrome.

I know, I’m rushing again.  I think I’ll start to slow down by explaining the difference between insomnia and interrupted sleep.

{As I wrote last week} According to Wikipedia – which is open to the general public for editing – this is the definition

Segmented sleep, also known as divided sleepbimodal sleep patternbifurcated sleep, or interrupted sleep, is a polyphasic or biphasic sleep pattern where two or more periods of sleep are punctuated by periods of wakefulness.

Insomnia, on the other hand, according to the Mayo Clinic at http://www.mayoclinic.org/diseases-conditions/insomnia/basics/definition/con-20024293 is

… a persistent disorder that can make it hard to fall asleep, hard to stay asleep or both, despite the opportunity for adequate sleep. With insomnia, you usually awaken feeling unrefreshed, which takes a toll on your ability to function during the day. Insomnia can sap not only your energy level and mood but also your health {which is already compromised by Chronic Kidney Disease}, work performance and quality of life

I’ve never discussed restless leg syndrome so we’ll need a definition of this, too.  MedicineNet at http://www.medicinenet.com/script/main/art.asp?articlekey=16440 tells us this is

An uncomfortable (creeping, crawling, tingling, pulling, twitching, tearing, aching, throbbing, prickling, or grabbing) sensation in the calves that occurs while sitting or while lying down. The result is an uncontrollable urge to relieve the uncomfortable sensation by moving the legs. Restless leg syndrome is a common cause of painful legs. The leg pain typically eases with motion of the legs and becomes more noticeable at rest, worsens during the early evening or later at night, and may cause insomnia.

Whoa, there’s a lot keeping us up at night!

Well, what about napping?  I found this wonderfully explanatory chart on the web. What I truly liked about it is all the attributions at the bottom.  I didn’t know much of this and found it too enticing not to share the entire chart with you.  The source is Positive Med at http://positivemed.com/2012/09/17/napping/napping

As to the best way to nap, HPRC {Human Performance Resource Center, a Department of Defense initiative under the Force Health and Protection Readiness Program} at http://hprc-online.org/mind-tactics/sleep-optimization-1/sleep-optimization-strategies/nap-to-be-at-your-best-mentally  has the simplest, most direct answer:

The bottom line? Your brain requires sleep to function optimally. If you do not get the recommended seven to eight hours of sleep each night, then napping will reduce your sleep debt. Nap when you can and as long as you can to get the seven to eight hours of sleep you need every 24 hours.

No fuss, no bother, just do it.  This common sense approach to napping has me reconsidering.  If my body needs it, tells me so, and makes it difficult to function without sleep, why not nap?

Something else that’s been keeping me awake is converting The Book of Blogs: Moderate Stage Chronic Kidney Disease from digital to print. I don’t mind this at all.  My brain is bursting with ideas about this and I’m eager to get to the editing.  I’m laughing at myself for ever thinking this was going to be a piece of cake.  It’s a print book, for goodness’ sake!  That means all the click throughs and web addresses need to go.  Yet, the sources of whatever I use that someone else wrote must remain clear.41DsvandphL._BO2,204,203,200_PIsitb-stThe Book of Blogs

Thank you, thank you, thank you to all the readers who have dropped me notes that they’re already enjoying the digital copy of the book.  I hope you were all able to make use of the two day discount price of $ .99 to celebrate the publication of my second Chronic Kidney Disease Book.

While Amazon is terrific at coming up with ways to keep the book affordable, I won’t be able to do another low price or free day until April according to the contract I signed. Keep in mind that you can lend it for free for 14 days if you are a member of Kindle Unlimited.

Once I finish editing The Book of Blogs: Moderate Stage Chronic Kidney Disease for print – Book Coverand you know I’ll be sure to let you know when the print version is available – be on the lookout for a box set of this second book and my first about our disease What Is It and How Did I Get It? Early Stage Chronic Kidney Disease.

And this is where I start asking you for reviews.  I realize it’s early days {to borrow a phrase from Downton Abby} yet, but I would appreciate a review on Amazon when you finish the book. Amazon.com will be my only distributor for this book.

Until next week,

Keep living your life!

 

 

Sleepus Interruptus

I just started – and trashed – three different versions of what I thought today’s blog would be about because I didn’t understand the research.  That’s the trouble with not being a doctor, and why I always remind you to speak with your nephrologist before you take anyone’s advice about your Chronic Kidney Disease, even mine.

I finally decided to write about my first choice.  This is yet another indication that our hunches are right.  My hunch after a night of waking up just about every hour was to write about CKD and interrupted sleep.  I should have listened to myself and saved all that time.baby-shots-5

DaVita.com at http://www.davita.com/kidney-disease/overview/living-with-ckd/sleep-issues-and-chronic-kidney-disease/e/4896 tells us there are several reasons CKD patients have sleep problems:

  • restless leg syndrome
  • sleep apnea
  • inadequate dialysis clearance
  • emotions
  • changes in sleep patterns
  • caffeine

We share most of these reasons with those who do not have CKD except for those dealing with dialysis.  This includes the inadequate dialysis clearance.  It also includes restless leg syndrome which is usually associated with hemodialysis session. Since I only write about early stage, I won’t be discussing these causes.

Let’s talk about sleep apnea.  I wrote a blog about on August 12, 2012 that refers to this.  The most important information from that blog is:

“I found a study at http://www.medscape.com/viewarticle/538872which clearly links

sleep apnea and hypertension. Dr. John J. Sim makes the connection very clear:

‘We think there may be a causative factor here; that sleep apnea may be causing directGlomerulus-Nephron 300 dpi jpg

 glomerular injury,’ Dr. John J. Sim (Kaiser Permanente, Los Angeles, CA) told renalwire .

‘We already know that sleep apnea causes hypertension and that hypertension causes

kidney disease.’ If some degree of causality can be shown, it’s possible that treating sleep

 apnea may slow the progression of kidney disease, the authors speculate.”

This particular study was conducted in 2005.

Obstructive sleep apnea (OSA) was also the subject of January 13, 2014’s blog.  That’s where the following information is from:

“Have I ever told you I have sleep apnea?  And that this affects CKD patients? I do and it

does. According to http://www.ncbi.nlm.nih.gov/pubmed/20676805, one of the National

Institutes of Health’s sites, sleep apnea can raise blood pressure, which in itself is one of

the problems of CKD.  It can also result in glomerular hyperfiltration.”

This is from a 2010 study.

madOkay, so I have sleep apnea, had a sleep study and started wearing a Mandibular Advancement Device (MAD) at night to correct the problem, yet I still experience interrupted sleep.

Hmmmm, what is this ‘changes in sleep patterns’? Oh, of course.  Because I have CKD, I become more tired and even drowsy during the day.  Maybe I’ll sit on the couch in the family room to read for a bit; maybe I’ll even lay down there; and maybe – just maybe – I’ll fall asleep during the day.  Nothing wrong with naps, but if they’re long naps they could interfere with your sleep pattern.

So can going to bed earlier.  I tried that on really tired days and ended up waking up repeatedly.  I do go right back to sleep, but it just didn’t seem restful. Keep in mind that as you age, your sleep cycles are lighter and shorter.  So I may think I’m getting all the sleep I need, but the waking up interrupts the cycling of the different stages of sleep and then I start the cycles all over again.

WebMD at http://www.webmd.com/sleep-disorders/guide/sleep-101 tells us,

Victorian clock“During the deep stages of NREM sleep, the body repairs and regenerates tissues, builds

bone and muscle, and appears to strengthen the immune system. As you get older, you

sleep more lightly and get less deep sleep. Aging is also associated with shorter time spans

of sleep, although studies show the amount of sleep needed doesn’t appear to diminish

   with age.”

Uh-oh, the deep stages of NREM (non-rapid eye movement) sleep are stages 3 and 4 which I may be missing by constantly waking up.  These are also the stages during which the body restores itself.

Emotions?  I can see that.  I dwell on the family’s medical problems, or someone I know and love who is out of work, or even my sweet Bella’s brush with cancer and I can get myself truly worked up.  So I don’t.  I mean I don’t think about these things at bedtime.  If I can’t seem to get them out of my head, I write a list of things to think about tomorrow.  As simplistic as it sounds, it works for me.  This is one piece of advice you don’t need to check with your nephrologist.

Wait a minute!  Who included my beloved caffeine on this list?????? This is where I get emotional.  Those two cups of caffeine a day are the only item on my renal diet that help me not feel deprived.  Okay, maybe we do need to be a bit rational about this (Don’t you just hate to be a grown up sometimes?).

This is what The National Sleep Foundation at http://sleepfoundation.org/sleep-topics/caffeine-and-sleep has to offer us about caffeine and sleep:

“Caffeine enters the bloodstream through the stomach and small intestine and can

have a stimulating effect as soon as 15 minutes after it is consumed. Once in the body,CoffeeCupPopCatalinStock

caffeine will persist for several hours: it takes about 6 hours for one half of the caffeine

to be eliminated.”

Six hours for only half to be eliminated?  You mean, twelve hours for all of it to be eliminated?  I have got to stop drinking caffeine after noon. Okay, I can learn to live with that.  Heck, it’s better than no coffee at all.

Hopefully these suggestions will take care of my interrupted sleep problems.  Now what about yours?  Remember to speak with your nephrologist if you want to explore any of my suggestions.  As far as the emotions causing sleep problems, if my trick doesn’t work for you and you feel you need professional help with your emotions, please get it.

Here’s my last suggestion: buy a copy of What Is It and How Did I Get It? Early Stage Chronic Kidney Disease before Moderate Stage Chronic Kidney Disease: The Book of Blogs is published. Then you’ll have the set of two.Book signing

Until next week,

Keep living your life!