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Depression is characterized by feelings of helplessness, hopelessness, inadequacy and sadness. It can also cause loss of interest or pleasure in life, changes in appetite and sleep pattern, decreased energy, fatigue, and an impaired ability to concentrate and made decisions. Depression is responsible for both behavioral and physiological processes that influences early mortality and therefore is considered a mortality risk factor in people with end-stage renal disease. The prevalence of depression is thought to be 20-30% among dialysis patients.

Living on dialysis is a perpetual challenge requiring a demanding treatment schedule, dietary restrictions, and changes in function and daily routine. While it may be difficult to discern the symptoms of depression from those of uremia, it is important to consider the possibility of depression since appropriate treatment can significantly improve the quality of life of the person with end-stage renal disease.

Difficulty sleeping is a problem identified by up to 73% of persons with end-stage renal disease. Complaints include trouble falling asleep, numerous awakenings during the night, and awakening after a few hours of sleep with inability to fall back to sleep. Underlying reasons may include issues such as restless legs syndrome (RLS) or periodic leg movements during sleep (PLMS), sleep apnea, or depression.

Helpful interventions may include avoiding caffeine, alcohol and tobacco; a warm bath or massage before bedtime, and ensuring an appropriate sleep surface and position for comfort. If these techniques are not helpful, speak with your health care provider for other suggestions, which may include medication, if necessary.