Avatar universal
insomnia
Does anyone have a problem with insomnia and are there any medications safe to use?  
Cancel
4 Answers
Page 1 of 1
446474 tn?1446351282
Sleeping issues are pretty much universal with advanced cirrhosis. I generally haven't slept more than 3-4 hours a day for at least the last 6 months. I have tired various treatments. Sleeping pills, Melatonin, etc. None work for me.

Sleep issues can be caused by unmanaged hepatic encephalopathy.
How you any signs of HE? Even minimal hepatic encephalopathy (MHE)?
HE can also cause day/night reversal. Where you can only sleep during the day and are wide awake at night.

'Introduction
Sleep disturbance and excessive daytime somnolence are common in patients with cirrhosis. In addition, a disturbance of sleep is recognized as one of the early signs of hepatic encephalopathy. Reversal of sleep rhythm, drowsiness and lethargy are classic signs of this disease, and their presence and entity are used to define the clinical stages of hepatic encephalopathy.  

The most common feature of the sleep pattern in patients with cirrhosis is fragmented nocturnal sleep caused by frequent nocturnal awakenings, and a daytime functioning affected by frequent episodes of undesired sleepiness and more prolonged napping time. The sleep-wake cycle was also shifted with activity toward the later hours of the day. This was ascribed to the displacement toward later hours in the 24-hour profile of plasma melatonin, common in cirrhosis. However, the existence of a phase delay in cirrhotic patients and its relation with the melatonin rhythm remains controversial. In addition, few data showed a
correlation between sleep impairment and the clinical parameters of liver disease. There are limited data on the true prevalence of sleep disturbance in cirrhotic patients compared with a control group.
For these reasons, we conducted a case control study to assess the prevalence and characteristics of sleep disturbance and excessive daytime sleepiness in patients with cirrhosis compared with a sex and age matched non-cirrhotic population, and to determine their correlation with clinical parameters.

Discussion

Our study confirms that patients with cirrhosis frequently have sleep disorders. We found a significantly higher prevalence of parameters of poor sleep quality, like difficulties falling asleep, nocturnal awakenings and complaints of sleeping badly in patients with cirrhosis than in healthy controls. In addition, daytime functioning of these patients was affected by
excessive sleepiness and more prolonged napping time. A higher prevalence of daytime sleepiness  disclosed by the BNSQ questionnaire was not accompanied by a significant different in the Epworth Sleepiness Scale (ESS). This may be because the ESS, validated in narcoleptics and OSAS patients, is not sufficiently accurate in estimating sleepiness in an
inactive population like patients with cirrhosis. As reported in previous studies, we found a poor correlation between clinical and laboratory  parameters and sleep disturbance or daytime somnolence. We did not find a phase delay in the sleep patterns of patients with cirrhosis, although the sleep questionnaire we used is not an accurate tool to identify circadian abnormalities.  
Another limitation of our study is the difficulty defining and estimating sleepiness on the basis of subjective patient evaluation. The first problem is to distinguish sleepiness from common symptoms in cirrhosis, like fatigue, tiredness and lack of energy. Sleepiness could also be linked to the limitations of a chronic disease forcing subjects to lead very sedentary lives, thereby increasing the risk of episodes of undesired sleepiness. In
addition, the frequent nocturnal awakenings could be related to more episodes of nicturia because of diuretic treatment. In this regard, another limitation in our study is the lack of a control group with another chronic disease (e.g. chronic renal failure). Sleep difficulty  in patients with cirrhosis could be related to a specific dysregulation of the histamine neurotrasmitter system, and a comparison with other chronic diseases could yield
information useful to estimate the real impact of hepatic failure on the sleep pattern and its pathogenesis.
Snoring and reported apnoeas did not significantly differ from healthy controls. However, the finding that snoring was more common in “sleepy” than in “post-prandial sleepy” and “not sleepy” patients with cirrhosis in our cohort could strengthen the hypothesis that somnolence in cirrhotic patients is favoured at least in part  by an obstructive apnoea syndrome during sleep.'

http://amsacta.unibo.it/2472/1/BaldiC.pdf  

Hector
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Comment
Post Comment
317787 tn?1473362051
Great information, thanks so much
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Comment
Post Comment
Avatar universal
Thank you once again for the great information Hector.  I really appreciate it!
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Comment
Post Comment
Avatar universal
Hi I am the wife of a man with cirrhosis and terrible sleep patterns, we've tried all kinds of remedies, is there really nothing that can be done?
Comment
Cancel
Comment
Avatar universal
Comment
Comment
Comment
Post Comment
Your Answer
Avatar universal
Answer
Do you know how to answer? Tap here to leave your answer...
Answer
Answer
Post Answer
A
A
Recent Activity
406584 tn?1399591666
Blank
10356 commented on stilltrying1965's status
Dec 01
Avatar universal
Blank
mikesimon Before you criticize someon... Comment
Nov 29
406584 tn?1399591666
Blank
10356 commented on MY cuz
Nov 27
Blank
Weight Tracker
Track your weight over time
Start Tracking Now
Top Hepatitis Answerers
Avatar universal
Blank
446474 tn?1446351282
Blank
San Francisco, CA
317787 tn?1473362051
Blank
DC
163305 tn?1333672171
Blank
Rural Mural, CA
683231 tn?1467326617
Blank
Auburn, WA
Avatar universal
Blank
Cirrhosis of the Liver Community Resources