**6. Conclusion**

420 Progress in Hemodialysis – From Emergent Biotechnology to Clinical Practice

until an optimal sleep duration is achieved. Typically, it is best to alter the bedtime and to keep the rising time constant in order to maintain a regular sleep-wake rhythm. By creating a mild state of sleep deprivation, this therapy promotes more rapid sleep onset and more efficient sleep (Hauri, 2000). To minimize daytime sleepiness, time in bed should not be reduced to less than five hours per night. Sleep restriction therapy is modified in older

Lichstein and Reidel (1994) concluded that sleep restriction therapy is actually the preferred technique for insomnia in older patients. In a later study they combined sleep restriction with sleep education for older insomnia patients, comparing a self-help technique (a guiding video) with therapist guidance (Riedel et al., 1995). While the self-help technique alone showed improvement on some sleep variables, therapist guidance was superior in that it

Implementation of this technique requires a high level of motivation and compliance on the patient's part, and close follow up by the clinician. Below are listed the rules for sleep

 Patient is only allowed to stay in bed for the amount of time they think they sleep each night, plus 15 minutes. For example, if patient reports sleeping only 5.75 hours, they are

Patient must get up at the same time each day. If normal waking time is 6:30, patient is

Upper-body obesity is a risk factor for OSA, and it is well documented that weight loss has a notable ameliorative impact on the occurrence of OSA (Ancoli-Israel et al., 1996; Smith et al., 1985). Since OSA results from closure of the airway, excess fatty tissue in theneck area may be a contributing factor. This supports the notion that weight plays a significant role in the presence and severity of sleep disordered breathing although no conclusive treatment trials

The most influential treatment for circadian rhythm disturbances is increased exposure to bright light. This form of therapy, which directly targets the circadian system, is much preferred over hypnotics and other sedative medications. Since light is the most important synchronizer in our circadian system, increasing bright light exposure during certain times of the day can shift circadian rhythm phase and increase its amplitude. Specifically, bright light exposure in the evening causes a phase delay, while morning bright light exposure causes a phase advance in circadian rhythms, including rhythms of melatonin, core body

Many behavioral sleep medicine interventions are based on cognitive-behavioral therapies (CBT). The focus is on systematically introducing behavioral changes that have been proven

 When sleep efficiency has reached 85%, the patient can go to bed 15 minutes earlier. This procedure is repeated until the patient can sleep for the desired amount of time.

improved sleep latency, wake time after sleep onset and sleep satisfaction.

adults by allowing a short afternoon nap.

*Instructions for Sleep Restriction Therapy* 

allowed to go to bed at 12:30.

Napping is not allowed.

have been published at this time.

temperature and sleepiness (Martin et al., 2000).

**5.7 Cognitive-behavioral therapies** 

allowed to stayin bed for 6 hours.

restriction therapy.

**5.5 Weight loss** 

**5.6 Light therapy** 

Considering that the most frequent sleep complaints, such as insomnia, OSAS and RLS, are related to a significant negative impact on functional health status in uraemic patients, the nephrologists should improve their recognition and treatment of these conditions to restore the quality of life of their patients. A good sleep history and, when indicated, a sleep recording, will help the clinician to make an accurate diagnosis and thus identify the best treatment. Nonpharmacologic methods such as behavioral techniques and cognitive therapyas well as pharmacologic approaches and combinations of these methods should be used for the treatment of sleep problems in hemodialysis patients.
