What is your approach to managing insomnia in an ESKD patient?

I try to stay away from medication therapy. First, I recommend good sleep hygiene (i.e., avoiding coffee, watching TV while in bed, too much light, etc.). The next step would be recommending as much exercise (mainly walking) as possible. If I have to use medications, I would start with melatonin and...

I like mirtazapine. I usually start with 15 mg. Most do not have a hangover the next day, and I feel it is safer than Ambien-type drugs.

Start with good old Benadryl .