Liver Disease and Sleep

What is liver disease?

Liver disease is the term given to any condition that primarily affects the function of the liver. There are many types of liver disease, each associated with a different cause:¹

• Alcoholic liver disease, which is caused by drinking too much alcohol
• Nonalcoholic fatty liver disease, which is caused by obesity and eating food that is high in fat
• Hepatitis, which is mainly caused by catching a virus
• Primary biliary cirrhosis, which is autoimmune, meaning the body attacks its own cells

Generally, the liver is able to regenerate its own cells, with some experts suggesting that even if up to 90% of it is damaged or removed, it can still return to its original size.² However, if liver disease is left untreated for a long time, it can progress to cirrhosis (scarring of the liver) and result in permanent, irreversible damage.

Does liver disease get better when you get enough sleep?

Sleep, undoubtedly, is important for all systems in the body. It improves long-term memory, increases the activity of the immune system, and affects metabolism.³ However, it is also important in healing injuries as, during sleep, there is increased blood flow to injured tissue and hormones (which act as messengers that can send signals from one place to another) that prevent inflammation.⁴

As a lot of the body’s healing work goes on during the time you spend asleep, the liver also uses this time to replace any of its cells that have been damaged by:⁵

• Processing alcohol
• Regulating hormones
• Neutralising toxins

Furthermore, research has suggested that sleeping for a shorter amount of time may increase the risk of developing nonalcoholic fatty liver disease.⁶

Liver disease and sleep disturbances

Sleep disturbances are reported by around 60 to 80 percent of people who suffer from liver disease.⁷ This may present in several ways including:

• Insomnia
• Poor sleep quality
• Excessive daytime sleepiness

Whilst the understanding of why patients with liver disease experience such sleep disturbances is limited, the current research suggests that there are a few explanations for this:⁸

• Hepatic encephalopathy, which is when toxic build-ups in the blood affect the brain’s function
• Impaired melatonin metabolism, which is when the hormone, melatonin, which is responsible for sleep, is not broken down properly because the liver is no longer able to process it properly

Insomnia

Insomnia is the inability to fall or stay asleep. Everybody experiences a sleepless night sometimes, but this is a regular occurrence for people with liver disease.

Usually, melatonin is released at night before a person goes to bed. It is then broken down in the daytime which is how our normal circadian rhythm (or, in other words, sleep schedule) arises.

However, in people with liver disease, the melatonin release is delayed, meaning it comes on later in the night, resulting in difficulty falling asleep in the earlier parts of the night 9. The amount of cortisol (the stress hormone) was also thought to be affected.

Another potential cause for insomnia is itching at nighttime and tense ascites (which is when the fluid build-up in the abdomen which is characteristic of liver disease becomes tense and uncomfortable).

Furthermore, the build-up of toxins can affect the number of receptors, which are molecules that can sense changes in the body and respond to them, in the brain, particularly the receptors associated with producing sleepiness (which are the adenosine A1 receptors). These receptor populations are lower in people with liver disease, so it is more difficult for them to feel sleepy at night.⁸

Excessive daytime sleepiness

Excessive daytime sleepiness is when a person experiences abnormal sleepiness in the day.

The blood concentration of melatonin is usually low during the day. In liver disease, the liver cannot process melatonin properly as it is damaged, and so the melatonin is broken down more slowly, contributing to the excessive daytime sleepiness experienced by people with liver disease.

Furthermore, studies have found that hyperammonemia (which is increased ammonia in the blood) can induce sleepiness in people, and people with liver disease cannot break down ammonia effectively due to their liver damage.⁸ meaning that they experience sleepiness in the day.

When to contact a doctor

Sleepiness is a very common problem in people with liver disease. It is important to monitor the severity of the insomnia and daytime sleepiness symptoms and reach out to a doctor if the severity seems to be increasing. This is because this can be associated with decreasing liver function.

If a person experiences the following symptoms, it may be worth contacting a doctor to assess liver function:¹

• Feeling tired and weak all the time
• Yellowing of the skin and whites of the eyes
• Loss of appetite
• Itchy skin
• Nausea and vomiting
• Ascites (fluid build-up in the abdomen which can may the stomach area look swollen)

Summary

Liver disease can result in sleep disturbances such as insomnia and excessive daytime sleepiness. Sleep is important for liver cell regeneration and insufficient sleep may increase the risk of non-alcoholic fatty liver disease. Contact a doctor if experiencing symptoms of liver disease such as fatigue, yellowing of the skin, and fluid build-up in the abdomen.