**3. Factors contributing to sleep disturbances (Figure 1)**

No consistent relationship has been detected between subjective sleep complaints of poor sleep and Blood Urea Nitrogen (BUN), Creatinine, or Kt/V (see glossary) (1, 11, & 13). Anemia has been associated with complaints of poor sleep with improvement after treatment with recombinant erythropoietin (14). Mild hypercalecmia has also been associated with increased frequency of subjective insomnia (15). Frequent napping during day time dialysis may also be a factor which contributes to fragmented sleep at night.

Fig. 1. Factors associated with sleep disturbances.

Nocturia, one of the earliest symptoms of kidney disease may also lead to reduced sleep due to frequent awakening. Untreated sleep apnea has also been linked to nocturia. Most of the awakenings attributed to nocturia by patients are attributable to sleep disorders, particularly sleep apnea (63).
