Daytime Sleepiness/Insomnia
Insomnia is a common problem that is seen in cirrhotic patients, mainly related to Hepatic encephalopathy (HE). It is characterized by daytime sleepiness and/or waking up several times during the night, and also having difficulty initiating sleep. The association of sleep disorders with fatigue suggests that a treatment aimed at improving daytime sleepiness may produce an improvement in fatigue.
Poor sleep affects patients’ cognitive functions and life quality. Obstructive sleep apnea, which is common in patients with fatty liver disease (steatosis), is correlated with steatohepatitis and fibrosis, and sleep apnea can sometimes be extreme and life-threatening. It may be caused by decreased melatonin clearance, altered circadian variation of core body temperature and delayed melatonin peak.
These sleep disorders has some connection to the hepatic melatonin metabolism. Treatment for this condition include medication and non-medication approach. Despite its relationship with HE, the HE treatment has some influence on these sleep disorders. And there are some non-specific approaches has been tried; modafinil and hydroxyzine has made encouraging results.