Less Sleep, Less Healthy Kidney

Sleep is often underestimated by most people. Some people prefer to reduce hours of sleep, rather than having to skip a good movie, play social media, and other unfinished work. Although it is often taken for granted, it is undeniable that sleep has a very vital function for all organ systems in the body, including the kidneys. Research shows that sleep disorders influence the development of kidney disease. The suspected cause is an inflammatory process and sympathetic nerve activation that damages the glomerular basement membrane and the renal tubular apparatus. Several sleep disorders, such as obstructive sleep apnea, circadian rhythm disorders, hypersomnia, and insomnia have been associated with metabolic disorders which ultimately lead to kidney involvement, either because of decreased kidney function in dealing with increased metabolic waste or because the shorter duration of rest causes susceptibility to decreased quality of life of renal cells themselves. One of these decreases is the ability of the glomerular filtration function which tends to be ineffective so that it is not optimal in maintaining homeostasis associated with the escape of various metabolic wastes, including important substrates and protein, through the urine. In this condition, the kidneys are dysregulated which eventually worsen the already existing sleep disorder.

Sleep disorders are commonly found in patients with chronic renal failure with end-stage renal disease (ESRD). As many as 80% of ESRD patients who receive hemodialysis complain of feeling sleepy in the morning. This is due to increased sleep disorders at night. The presence of sleep disorders may reduce a person's quality of life, and can even increase the morbidity and mortality of patients with chronic kidney failure.

The underlying mechanism of sleep disorder in patients with chronic renal failure is the imbalance of sympathetic and parasympathetic nervous activity, which is similar to that of the general population, but is much more severe. This imbalance is due to hyperactivity of the sympathetic nervous system, thereby reducing vagal tone. In healthy individuals, there is a decrease in sympathetic nerve activity and an increase in parasympathetic nerve activity during sleep, so that blood pressure during sleep tends to be lower. On the other hand, in individuals with sleep disorders, the disorder itself will cause hypoxemia which may increase sympathetic nerve activity. High blood pressure is one of the risk factors that can aggravate the condition of previously disturbed organs, including, in this context, kidney disorders.

The duration and quality of sleep is an important component for general health, including the health of the kidneys. Individuals with sleep duration of less than 5 hours and more than 8 hours a day have a high risk of developing chronic kidney disease. Short sleep duration can also increase the risk of proteinuria and renal hyperfiltration. A large epidemiological study involving 200,000 patients, stated that too short and too long sleep duration, and poor sleep quality were associated with an increased incidence of chronic kidney failure. Asian populations, well- educated, and non-smokers, expressed a positive relationship between sleep and the development of chronic kidney failure. Some of the researches above should be enough to make us aware of how important sleep is for kidney's health.

To improve the quality of sleep at night, we should implement sleep hygiene that includes:

  1. Setting up sleep time and regular wake-up time.
  2. All activities other than sleeping should not be done in bed. For example, watching television, playing, and eating.
  3. Not doing exercise too close to bedtime.
  4. Setting up a time of relaxation before bed, for example with yoga.
  5. Not consuming alcohol, coffee, and smoking before bed.
  6. Sleep ingin a dark, quiet, and comfortable atmosphere.
  7. Using the habit of sleeping during the day to a minimum.

If by implementing sleep hygiene the optimal duration and quality of sleep have not been achieved, then one should immediately seek help from professionals.

Benjamin Franklin wrote, “a prevention is worth more than many cures.” This states that preventing the onset of a disease is better than curing the disease. Therefore, let us maintain the habit of getting enough restful sleep with optimal sleep duration and good quality sleep to prevent diseases, especially kidney disease.


Prof. Djoko Santoso, dr., Ph.D, Sp.PD-KGH, FINASIM
Professor, Faculty of Medicine, Universitas Airlangga
Chairman of Health Department, Indonesian Council of Ulama, East Java