**5. Management of sleep problems in hemodialysis patients**

Proper management of sleep problems in ESRD patients requires in the first instance a proper identification of sleep abnormalities (extensively discussed above). Although significant research has been done to characterize sleep abnormalities in hemodialysis patients (Holey et al., 1992; De Santo et al., 2005; Merlino et al., 2006), little has been published regarding proper treatment. In the absence of guidelines, nephrologists rely largely on some published data and on opinion-based medicine. Sleep problems lower quality of life and contribute to physical and mental health problems. Sleep disorders and lack of sleep are an under treated threat to the public health. Sleep professionals have recognized the behavioral components of sleep disorders for decades, yet most patients never get a proper diagnosis and treatment (Mollaoglu & Mollaoğlu, 2009).

Periodic clinical assessment of sleep complaints should become routine for dialysis staff. Early identification of sleep problems and interventions to improve sleep quality is essential, because sleep disturbance that persists for a long period of time could decrease general health and functioning (Sabbatini et al., 2003; Tatomir et al., 2007). Increasing evidence supports the effectiveness of both pharmacologic and nonpharmacologic therapies for sleep problems (Edinger et al., 2001; Montgomery & Dennis, 2004; Smith et al., 2002). Pharmacologic therapy are discussed in the sleep disorders section.

The most effective nonpharmacologic interventions tested to date include all or most of the following components: *sleep hygiene instruction, sleep restriction, stimulus control, relaxation training, and cognitive modification* **(**Edinger et al., 2001; Montgomery & Dennis, 2004).
