Effectiveness of Pranayama on Fatigue and Insomnia among Patients with Hemodialysis

Chronic renal failure or chronic kidney disease is a slowly progressive loss of kidney work over a time of quite a while. As kidney disappointment propels and the organ’s capacity is truly weakened, hazardous degrees of waste and liquid can quickly develop in the body. On the off chance that persistent kidney disappointment closes At end-stage kidney infection, the patientwon’t get by without dialysis or a kidney transplant. Dialysis is adopted for cleaning the blood, is one of themostwidely recognized treatment alternatives for patients with the end-stage renal illness. The study aims are to assess the effectiveness of Pranayama on fatigue and insomnia among patients with Hemodialysis. An evaluate approach was used for this study with one group pretest and posttest design. Nonprobability purposive sampling method was used to select the 60 samples of the study. The tool used for this studywas fatigue and insomnia severity index was to assess the level of insomnia among patients with Hemodialysis. Pranayama was given to the patients for 15 mins twice a day, one hour after Hemodialysis for 15 days. The collected data were analyzedusing descriptive and inferential statistics. The results depicts thatmean posttest score of fatigue and insomnia were 19.09 (SD + 8.44), 15.17 (SD+ 4.85) and the mean pretest score were 59.38(SD +8.18), 25.55 (SD+ 3.37) respectively. The mean difference was 40.29 and 10.38, respectively. The paired ’t’ valuewere 33.77 and 22.8 and (’t’ value= 0.0001) respectively, which was signi icant at P< 0.05. The above indings showed that Pranayamawas an effective intervention in reducing fatigue and insomnia among patients with Hemodialysis.


INTRODUCTION
Chronic renal failure depicts the continuous loss of kidney work. The kidneys ilters squander and overabundance liquids from the blood, which are then discharged in the urine (Pandey et al., 2017). When chronic kidney disease arrives at a serious stage, hazardous degree of liquid, electrolytes and squanders can develop in our body (Roth et al., 2010). The signs and manifestations of constant kidney sickness create over the long run if kidney harm progress gradually, queasiness and heaving, exhaustion and shortcoming, rest issues, changes in pee yield, growing of feet and lower legs, muscle jerks and spasms, signs and side effects may not show up until irreversible harm has occurred (Singh et al., 2009). Patients, as a rule, require Hemodialysis when the byproducts in their body become so high that they begin to get debilitated from them (Anupama and Uma, 2014). The degree of the side effects generally develops gradually. Hemodialysis is a treatment for those patients whose kidney can't work any longer. It is a method of purging the blood of poisons, additional salts and liquids through a dialysis machine called "Arti icial Kidney" (Okonta, 2012). It keeps up appropriate compound equilibrium, for example, potassium, sodium and chloride and keeps pulse under control (Kashinath et al., 2014). According to National kidney foundation (2018), the duration of Hemodialysis procedure in usual schedule treatment is three times a week. Patients likely have the same morning or afternoon time for each treatment. The length of treatment depends on patient conditions. During Hemodialysis procedure three to four is common (Shende and Parekh, 2011). Fatigue is an abstract inclination of sleepiness which is unmistakable from shortcoming and has a steady beginning. Weakness likewise alluded to as sleepiness, weariness, laziness, and eagerness portrays a physical or mental condition drained and feeble. Exhaustion is regularly brought about by a blend of components. Progressed illness is the normal reason for weakness. Serious heart and lung sickness, kidney disappointment and liver illness just as malignancy and its therapy are additionally connected with fatigue (Awuah et al., 2013).
The exhaustion goes from 60% to as high as 97% in patients on Hemodialysis substitution treatment. The signi icance of patients with kidney infection is underlined by the perception that 94% of Hemodialysis patients embraced an eagerness to go through more incessant dialysis if there would be a related expansion in energy level (Anu et al., 2014). Insomnia is very basic among Hemodialysis patients.
Abstract rest grievances are accounted for in up to 80% of patients issues with eagerness, twitching legs, gagging sensations and persistent exhaustion. The Integration of reciprocal and elective clinical treatments, for example, needle therapy, customary oriental medication, chiropractic, homegrown medication, rub treatment, yoga and brain, body treatment as traditional treatment guidance may collaborate with patient's exertion towards self consideration in Hemodialysis patients (Ali et al., 2012). Tamilnadu incidence of insomnia in chronic maintenance of Hemodialysis patients. There was a high prevalence of depression (47.8%) insomnia (60.9%) increased risk of sleep apnea (24.6) and depression in caregivers (31.9%) (Colgrove et al., 2015).
Al-Jahdali (2016) had conducted the study to assess the prevalence of insomnia in patients with renal failure admitted to the dialysis unit in the Marjan Teaching Hospital. The sample composed of 88 cases (51 males and 37 females) referred for Hemodialysis. Sleep disorders are common among patients with renal failure undergoing Hemodialysis (Bantornwan et al., 2014). The overall mean of age patients who sit for renal dialysis was 53.14 + 13.92years. Out of 88 patients, 47 patients (53.4%) were complaining of insomnia, 57.9% of the sample were males and 42.1% were females. Insomnia was reported by 53.4% among 88 patients undergoing Hemodialysis (Rohini and Ezhilarasu, 2015). The researcher observed during the clinical experience in SMCH hospital. That the patients with Hemodialysis, the majority of the patients with Hemodialysis suffered from pain, fatigue, insomnia, muscle cramp, and swelling in the face and legs. Hence, the researcher felt to help the patient with Hemodialysis by using Pranayama to reduce fatigue and insomnia. The study aims are to assess the effectiveness of Pranayama on fatigue and insomnia among patients with Hemodialysis.

MATERIALS AND METHODS
An evaluate approach was used for this study with one group pretest and posttest design. Nonprobability purposive sampling method was used to select the 60 samples of the study in the Dialysis Unit of Saveetha Medical College and Hospital and formal permission was obtained from the hospital authority. The patients were given explained about the purposes of the study and written informed consent was taken from each participant. On 1 st day, the demographic variables were collected by interview then the pretest was conducted to the participants by using fatigue severity scale to assess the level of fatigue and insomnia severity index to assess the level of insomnia and Pranayama was given to the participants individually for 15 days one hour after Hemodialysis, by using the demon-stration method. Each session lasts for 30 minutes per day, and each day observes the patients up to 15 days. On the 16 th day posttest was conducted by using the same tool. The same procedure has been followed for the remaining 40 samples of the patients with Hemodialysis. The data were collected and analyzed and tabulated.

Distribution of demographic variables of patients with Hemodialysis
Regarding     Figure 2.
Comparison between the effectiveness of Pranayama pretest and posttest level of fatigue among patients with Hemodialysis Data analysis shows that the mean pretest score level of fatigue is 59.38 (SD + 8.18) and the posttest mean score 19.09 (SD + 8.44) and mean difference is 40.29. The posttest mean score (19.09) was lower than the pretest score is (59.38). The paired 't' value 33.77 which was signi icant at P < 0.0001. Therefore, the research hypothesis H 1 the mean posttest level of fatigue score is signi icantly lower the mean pretest level of fatigue score was accepted.
Comparison between the effectiveness of Pranayama pretest and posttest level of insomnia among patients with Hemodialysis Data analysis shows that the mean pretest score of level of insomnia is 25.55 (SD + 3.37) and the posttest mean score is 15.17 (SD + 4.85) and the mean difference is 10.38. The post mean score (15.17) was lower than the pretest mean score (25.55). The paired 't' value was 22.8, signi icantly P=0.001.(P< 0.05) Table 3. Therefore the research hypothesis H 2 that is the mean posttest level of insomnia score is signi icantly lower than the mean pretest level of insomnia score was accepted.
The current investigation is upheld by (Rohini and Ezhilarasu, 2015). Directed blended technique research on rest, weariness, and personal satisfaction among patients going through Hemodialysis. Gathering CBT was managed for around 40 to an hour to subjects in exploratory gathering for about a month (twice week by week). Post evaluation was done at about fourteen days, a month and a half, and 10 weeks after the eighth meeting. Rehashed measure ANOVA exhibited the mean distinction for rest, weariness, and QOL as critical between the groups (Yurtkuran et al., 2007).
Comparison between the effectiveness of Pranayama pretest and posttest level of insomnia among patients with Hemodialysis Chi-Square values were calculated to ind out the association between posttest level of fatigue score among patients with Hemodialysis with their demographic variables Table 4. The indings revealed that there was a signi icant association with demographic variables P < 0.05. Therefore the research hypothesis H 3 there was a signi icant association between posttest level of fatigue among patients with Hemodialysis with their selected demographic variables. (Yurtkuran et al., 2007) conducted study to evaluate the adequacy of an altered yoga-based exercise program in hemodialysis patients: a randomized controlled examination. The discoveries say Comparison of the gatherings based on rate changes showed measurable noteworthiness for abstract and target factors: torment power (P = 0.03), weakness (P = 0.008), rest unsettling in luence (P = 0.04) (Gordon et al., 2013).
Association between the effectiveness of Pranayama posttest level of insomnia among patients with Hemodialysis and their selected demographic variables The indings revealed that there signi icant association with demographic variables P< 0.05. Therefore the research hypothesis H 4 there was a signi icant association between the posttest level of insomnia among patients with Hemodialysis with their demographic variables.

CONCLUSIONS
Pranayama reduces the fatigue and insomnia among patients with Hemodialysis. From the result of this study, it was concluded patients with Hemodialysis had a reduction of the score on fatigue and insomnia after the intervention of Pranayama. So, in addition to treatment, Pranayama can be used for managing.