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.
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.
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.'
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