Q: My mother has diabetes and high blood pressure for more than 10 years. About 5 years ago, her condition got worse and was diagnosed with chronic renal failure. For the past year, her creatinine level has been at 600 plus. For the past 2 months, she is suffering from insomnia and her blood sugar and blood pressure is of out of control. She cannot sleep for 4-5 days and maybe only falls asleep for 1-2 hours per day. Is there anyway to help her to solve her insomnia problem? I am very worried that this problem will cause her kidney to stop functioning. She is complaining that her vision is very blur too. I am not sure if it is due to her cataract problem. She had done 2 laser treatments due to some red dots. I am not sure what it is called. Please help, I need some advice on how to help her insomnia problem?

A:1. Chronic renal failure represents the gradual, substantial, and irreversible reduction in the excretory and circulatory functions of the kidneys. Chronic renal failure is characterised by progressive destruction of kidney over a period of at least months to many years and in your mother's case most likely would be due to diabetes and hypertension. I assume creatinine value mentioned is micro mol/l (other unit could be mg/dl). Chronic renal failure can cause poor appetite, nausea, vomiting, fatigue, weakness, pruritus, lethargy, swelling and can result in collection of fluid around the heart and lung, oedema, dyspnoea, insomnia (lack of sleep), muscle cramps, headache, hiccups, fits etc. It is very important that your mother's blood pressure, sugar and other parameters like electrolytes should be regularly measured and monitored. You must take your mother to a diabetologist (endocrinologist) or nephrologist who can assess her status insomnia (lack of sleep) could be part of the symptoms of either kidney failure. Treating insomnia means diagnosing and treating the cause of the insomnia. Non-pharmacologic (not involving medication) and pharmacologic (involving medication) therapies may be recommended. Some of the non-medication treatment might help. Sleep only as much as is needed to feel rested. Do not force sleep Establish a regular bedtime and a regular wake-up time and stick to it, even on weekends. Use the bed only for sleeping. Avoid eating or drinking too much before bedtime, but do not go to bed hungry Avoid exercising vigorously. Avoid daytime napping, especially in the late afternoon or evening. Make the bedroom environment comfortable (consider light, noise). Medication can be given but it must be again under medical supervision. 2. Poor vision could be due to directly related to variable blood sugar or could be due to changes in diabetic retinopathy (part of the eye, which catches images and most commonly effected in Diabetes. You mother should also visit opthalmologist who must look her into the back of the eyes so that blindness can be prevented. Retinopathy is usually due to damage to the tiny blood vessels next to the retina. After several years, a high blood glucose (sugar) level can weaken and damage the tiny blood vessels next to the retina. This can result in various problems, which include: Small blowout swellings of blood vessels (microaneurysms). Small leaks of fluid from damaged blood vessels (exudates). Small bleeds from damaged blood vessels (haemorrhages). Blood vessels may just become blocked. This can cut off the blood and oxygen supply to small sections of the retina. New abnormal blood vessels may grow from damaged blood vessels. These new vessels are delicate and can bleed easily. This can also affect vision by blocking light rays going to the retina. Treatment can prevent loss of vision and blindness in most cases. Therefore, it is vital that you have regular eye checks to detect retinopathy before your vision becomes badly affected. Your mother should have at least 6 monthly check and if some changes than more frequent. Laser treatment is used mainly if you have new vessels growing (proliferative retinopathy), or if any type of retinopathy is affecting the macula. Treatment usually works well to prevent retinopathy from getting worse, and so often prevents loss of vision or blindness. However, laser treatment cannot restore vision that is already lost. Cataracts are more common in people with diabetes. A cataract is when the lens of an eye becomes cloudy. This affects vision as it blocks light getting to the back of the eye. Cataracts can usually be treated with a routine day case operation where the cloudy lens is removed and is replaced with an artificial plastic lens. Glaucoma may be more common in people with diabetes (although this is not certain as glaucoma is common anyway). Glaucoma can cause a painless rise in pressure in the eye. If left untreated, glaucoma can damage the eye and cause loss of vision. In summary lack of sleep and poor vision most likely related to Diabetes and chronic renal failure which need urgent medical attention