Colchicine for CKD!
In a multi-center, nested, case-control study in three Korean hospitals, patients with CKD stage 3 and 4 who are using drugs including colchicine, allopurinol, and febuxostat for high uric acid or chronic gout were studied over a period of 10 years. The progression of CKD was compared between 3085 compared to 11715 control patients.
Colchicine use was associated with a lower risk of adverse kidney outcomes in CKD patients with hyperuricemia, or chronic gout.
Unlike a study published two years ago in NEJM which excluded patients with advanced CKD, this study included patients with kidney function as low as 15 ml/min. Colchicine is known to anti-inflammatory. It also protects against kidney fibrosis.
There are concerns about myopathy and neuropathy with the intake of colchicine. It is, therefore, important to adjust the dose with advanced kidney disease and to be cautious when using it with patients who are on other myopathy-inducing drugs such as statin drugs.
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Long sleep duration is associated with decline in kidney function
This study is retrospective, longitudinal cohort study included 82,001 participants who visited a primary care center in Japan. Patients were categorized into CKD risk groups and sleep duration categories according to their self-reported average nightly sleep duration. The relationship between average nightly sleep duration and the incidence of composite renal outcome was studied.
Researchers found that an average sleep durations ≥8 h/night were associated with an increased risk of kidney function decline over time.
There are many reasons that connect sleep problems with poor kidney function. We summarized these in this blog.
Risk of environmental heavy metal toxicity is higher in CKD
In a study of 5,638 NHANES participants, lead and cadmium levels were higher in patients with CKD than those without it. This was also associated with decreased urinary lead excretion. Each decrease in estimated GFR by 10 ml/min/1.73m2 was associated with 0.05 mcg/dL increase in lead levels and 0.02 mcg/dL of cadmium levels. This association was even stronger among black participants.
The study concluded that CKD increases the susceptibility to heavy metal environmental exposure by reducing its elimination.
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There are practical steps that you can take to improve your sleep. These include creating a relaxing sleep environment, lowering the temperature in the bedroom, making sure it is dark, and having a comfortable mattress, etc. Yet, many people don’t realize that a good sleep is more about what we do away from the bed than what we do in bed.
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In the era of social media, technology, and 24-hour news that are always available in the palm of our hands, our minds are going a million miles per hour. Many of us are juggling so many things and have even more worries. We worry about work, about the kids, emails, social media reactions, finances and many other things. Some of us get to bed with exhausted bodies but minds that are still going at full speed.
So, what do you need to do to help the brain shut down? Here are the five steps to help you unwind your brain and get a better sleep.
Step 1: Don’t carry today’s problems into bed
Your mind is not going to stop thinking about today’s problems and worries unless you help it clean up. You must tie up all the loose ends from the day. The best way to do that is by allowing your mind to settle down two hours before bedtime. Simply, write down ALL your thoughts and worries on a paper or in a notebook. It does not matter how or what. Think of it as a thought download or a brain dump.
Do this process outside the bedroom and leave the notebook or paper there. This will train your brain to leave the worrying thoughts outside the bedroom. It allows space for positive thoughts. Positive thoughts are calming and will help you to go to sleep.
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Step 2: Plan your tomorrow
After you downloaded your thoughts, look at your plan for the next day. Look at your calendar and prepare for that early meeting, pick workout clothes, prepare and pack for lunch. Your attention to details will help your mind avoid the worry about tomorrow. This will set you up for success and give you control. The control that will help you settle your mind.
Step 3: Keep your phone outside of the bedroom
In fact, keep all electronics out of the bedroom. The bedroom is for two things, sleep and intimacy. I actually recommend that you stop looking at your phone, social media, emails or any other projects for two hours before going to bed. Trust me, I know it is hard and I am guilty of this too.
I also get that some of you may be in a profession like me where you take calls at night and may need a phone nearby. But in the era of smartphones, it is easy for the mind to wander at night. These types of phones bring your worries and the whole world with you to the bedroom. Do you want the world to be in your bedroom when you’re trying to sleep?
So, if your profession requires it, get a landline or cheap flip phone to be by your bed for emergencies. No texting, no social media, and no news in the bedroom. Research found that one third of people wake up at night and check their smartphones.
Step 4: Create a bedtime restorative ritual
A restorative ritual signals your brain that you’re going into a relaxed state. These rituals include things like taking a bath or a hot shower, drinking hot green tea, lighting up candles, dimming the lights, praying or meditating. You can also read a fiction book to take your mind out of your own story into the story of the book.
Step 5: Think happy thoughts
Pick a location of your dreams. If you love to be on the beach in Hawaii or on top of mount Everest immerse yourself in the experience. Feel it, smell it, see it and dream it. Visualize it as if you are living in it. This powerful way will calm your mind and set it up for dreaming. The goal is to feel calm, safe, quiet and “tucked in.”
Bonus: what if you wake up in the middle of the night
Waking up in the middle of the night is not unusual. Researchers found that 31% of people wake up in the middle of the night at least 3 times a week. So, if you wake and you can’t go back to sleep, use the 15 minute rule. If you wake up in the middle of the night and after 15 minutes you don’t drift back into sleep, you should get out of bed. Do not lay there and start thinking about going to sleep. Do not look at the time, do not check your phone, and do not make a cup of coffee.
Get up and go to another room. Sit in a comfortable chair, read that novel, light up a candle. If your mind is racing again. Go back to that piece of paper or notebook and write down your thoughts and worries again. Do not do these things in bed because that will train your mind to associate your bed with wakefulness instead of sleep. When you feel drowsy again, go back to your bed and go to sleep.
The Bottom Line
Here is the trick though, you have to do these steps every night. You may feel like you want to stay up watching a movie on your favorite app or stay on your phone or catch up on a project instead of your bedtime ritual. But your health and your mind deserve a good sleep. So, this simple promise to yourself will help you establish the good habit of sleep and set you up for better health and success.
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The root causes of my sleep problems go far back, with mild symptoms of pregnancy insomnia in my third trimester. After giving birth, I became an extremely light sleeper who could be awakened by hearing anyone tiptoeing nearby. I became hyper-vigilant. I thought it was driven by me being a new mom. I was getting up multiple times through the night to heed to my newborn baby, and then staying wide awake the rest of the night. However, that chronotype of light sleeping continued throughout the following years.
My journey with suboptimal sleep.
In 2016, when I was a victim of a chronic job, I was drained by a huge workload and long hours. I was assailed with onerous functional, technical, and humanitarian ethical commitments. My job required crossing several time zones. My social life was badly affected and my social circle narrowed significantly. I was severely sleep deprived, barely getting 2-3 hours a night for days in a row and occasionally getting 5 hours once in a blue moon.
In the beginning, I didn’t feel the negative effects of poor sleep. I was getting up early in the morning feeling energetic, motivated, and looking forward to my day as if I had good sleep the night before. That made me wrongly think that I might be blessed; my body doesn’t need long hours of sleep for me to be able to fully function. Having the extra hours in my day seemed to help me perform at a high level, deliver more, and enjoy my time.
Consequently, I stopped obsessing about getting enough sleep and started to adjust to my insomnia, telling myself I’m lucky that I’m unfettered and not wasting my time with unnecessary sleep. When I was in bed trying to sleep every night, my brain was hyper alert; I was not able to stop the thoughts circulating in my mind, and when I awoke in the morning, I felt like my brain had been racing while I was sleeping.
The fatigue began to catch up, causing my mental and emotional state to shake. I was gradually running out of energy. Any energy I did have to socialize or practice my hobbies was diminishing day by day. The fatigue also stirred my vitality and my mood disorder was on the rise.
I started to look for remedies to beat my sleep disorder. I tried melatonin supplements, sought advice from sleep therapists, heard about acupuncture, listened to alpha waves tones, drank herbal tea and had amber/rose aromatic baths pre- bedtime. The last thing I tried was based on advice from a colleague of mine, who recommended that I wipe my eyes with the water of soaked jasmine petals so that I could fall asleep.
Unfortunately, none of these worked for me.
Deep dive into our brain circuits.
As a science-oriented person, I was interested in decoding the chemistry of the brain and the Cognitive Neuroscience of Sleep to understand how to use neuroscience to improve my sleep and how stress and worrying affect sleep. I learned that my daily routine, along with managing my reaction to stress, can change the activity of the neurotransmitter systems in my brain, and can therefore positively impact my insomnia. I read the article published on InKidney titled “Sleep and Kidney Health”, in addition to the book The Upward Spiral by Alex Korb, PhD which helped me understand the biological basis of sleep disorders and adopt practical tips to improve my sleep cycle. One caveat of the aforementioned book is that it focuses more on how to get out of the downward spiral of depression; thankfully, I was not suffering from any course of depression. The book also illustrated how the circuits inside our brains are connected to each other (for example, the changes to my daily routine that reduced stress levels, improved mood, and provided me more energy to exercise, significantly contributed to the improvement of my sleep circuit by releasing more norepinephrine, oxytocin, endocannabinoids, dopamine, and melatonin).
The magic of sleep.
To improve sleep, we must first understand what I call “the magic of sleep.” I became familiar with the sleep architecture of our brains. That was key to understanding the stages of sleep and the governance the brain has on hormones/neurotransmitters and quality of sleep cycle. The circadian rhythm, controlled by the hypothalamus, also plays a role . The hypothalamus governs a large number of our daily activities including hunger, alertness, and body temperature. It also made me aware of the fact that circadian rhythms cause a variety of daily neuro-hormone fluctuations, including melatonin which helps with falling asleep. This biological system can be restored and maintained by sticking to a sleep schedule and making small changes like minimizing light exposure at night.
Figure 1: The Cycle of Melatonin- (Matthew Walker, 2017)
Figure 2: Sleep Architecture- when experts chart sleep on a hypnogram, the different levels resemble a drawing of a city skyline. This pattern is known as sleep architecture. The hypnogram above shows a typical night’s sleep of a healthy young adult.
(the editors of Harvard Health Publishing in consultation with Lawrence Epstein & Program Director, 2019)
Optimizing my sleep hygiene.
Because habits are triggered by stress, I have come to understand the fundamental importance of controlling stress and anxiety. Additionally, I’ve followed a number of tips and strategies that made me feel an immediate lift in the quality and duration of my sleep. The tips to improve sleep are summarized as follows:
Day-time activities:
- Exercise, which is a great part of my daily life, gives me an enormous sense of well-being, and makes me more energetic and positive throughout the day. This translates to more productivity, happiness, and relaxation when I go to bed at night.
- Consume high prana foods (green, organic, whole and unprocessed food) that are energy giving, and necessary to function with the highest levels of productivity.
- Practice mediation for 10 minutes on a daily basis.
- Avoid naps during the daytime.
- Accomplish harder tasks during the daytime only, and keep easier or funnier tasks to the evening time.
- Caring for the people I love which is a powerful pathway to my personal growth, long lasting happiness, and stress relief.
- Self-care, maintain work-life balance, and make time for friends and people I care about.
Pre-bedtime routine:
- Go to sleep and wake up at the same time all days of the week (including weekends). It’s okay to deviate a little occasionally, but there should be a defined target for your sleep and wake up times.
- Refrain from caffeine intake (coffee or tea) 6-8 hours before bedtime.
- No eating after 8:00 PM.
- Lower all lights by a certain time at night.
- Set phone and PC on night-mode, and reduce the brightness on my devices’ screens.
- Stop the use of electronic devices at least 30 minutes before going to sleep.
- Turn off the TV in my bedroom as well as all electronics that might illuminate the room.
- Maintain self-care, healthy diet, and proper hydration.
Bedtime setting:
- Adjust LST (no light, no sound, low temperature).
- Wear light and comfortable sleepwear; sleep on breathable fresh bedding .
- Make my bed my haven; avoid reading or working in bed to associate the bed only with sleep.
- Charge phone away from bed
Wake up routine to stay energized:
- Start the morning with proper hydration and stretching exercises.
- After a warm shower, shower with cold water for up to 5 minutes.
- Journaling and setting the daily highlights.
The Bottom Line
One of the key pillars for building a healthy foundation for good sleep is implementing daytime habits that support a solid nighttime routine. By controlling stress and following the tips above, I have managed to improve my sleep from an average of 3 interrupted hours of sleep into continuous 6 hours of sleep. I’m waking up happier, more put together, more productive, and, most importantly, healthier. I continue to strive for 8 hours of quality sleep. I would like to end with a quote from Dr. Mathew Walker in his book Why We Sleep: “the best bridge between despair and hope is a good night’s sleep”.
Read the bio of Rania M. AlQenneh here.
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