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Treatment of Insomnia and Other Sleep Disturbances
Melissa Palmer, MD posted:
The average person requires between 7-8 hours of sleep per night. However, some people require as much as10 hours of sleep per night and others require only 4 hours of sleep per night. No matter what your personal requirement is, the main objective is to feel rejuvenated upon awakening. People with liver disease often suffer from sleep disturbances. In fact, approximately 35 to 50 percent of people with cirrhosis report having sleep-related difficulties. Some people have trouble falling asleep and others have difficulty staying asleep. Many people complain of being tired all day and awake all night. Others complain of erratic sleeping habits characterized by days of excessive sleep (a condition known as hypersomnia) alternating with days of lack of sleep (a condition known as insomnia). Still others state that they experience delays of their usual bedtimes and wake-up times. For most people suffering from these sleep disorders, the sleep they do get is not refreshing. Sleep disturbances may cause decreased concentration, poor coordination, excessive fatigue, anxiety and depression. It may affect personal relationships, work performance, and physical appearance. These symptoms and consequences of sleep disorders are magnified in people with liver disease as they may already be suffering from one or more of the aforementioned symptoms.
The cause of sleeping disorders in people with liver disease is unclear, but most likely it relates to alterations in the body's production of melatonin—a hormone that is produced by the pineal gland and is involved in the sleep cycle. Sometimes, sleep disturbances stem from medications used for the treatment of liver disease. For example, interferon, ribavirin, prednisone, and propanolol all may cause insomnia. Pruritus (itching) can sometimes cause a sleeping disorder. People suffering from intense itching (discussed on page xx) may find themselves awake half the night scratching. People on interferon therapy for chronic hepatitis may be drinking up to a gallon a day of water to diminish the side effect of dehydration. Therefore, they may be awakening throughout the night to go to the bathroom. Discontinuation of water or fluid intake 2-3 hours prior to retiring, along with urinating before bedtime, may alleviate this problem. Caffeine, nicotine, and alcohol consumption may disturb sleep habits. Abstaining from these substances will likely assist in the quest for a good night's sleep. Note that sleep disturbances may also be a sign of impending encephalopathy
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