Non-alcoholic fatty liver disease: How the condition may appear in your sleeping habits

NHS Choices: Liver Disease

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Non-alcoholic fatty liver disease (NAFLD) can result in different types of sleep disturbance, and the treatment of these conditions can often also lead to sleep disturbance. What is the link?

The liver plays a crucial role to a person’s hormones.

Once the hormones circulating in a person’s system have accomplished their task, whether it be triggering a stress reaction or getting ready for ovulation, they report to the liver, where they are broken down and deactivated.

This system prevents a hormonal imbalance from occurring.

When it comes to your sleep pattern, many different hormones can have a great effect.

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When it comes to a person’s sleep-wake cycle, there are two hormones which govern this action, namely cortisol and melatonin.

Cortisol is a stress hormone that is usually secreted just before you wake up in the morning, so one feels refreshed and energised for the day ahead.

Melatonin, on the other hand, is produced as natural light fades, helping one to feel relaxed and sleepy in preparation for bedtime. 

Your liver can influence these hormones in a couple of ways.

Firstly, if you’re prone to stress or anxiety, it may mean that your blood levels of cortisol become elevated, thereby increasing your liver’s workload when it comes to deactivating this particular hormone.

In cases of chronic stress, your liver may become overwhelmed, meaning that excess cortisol may remain in your system for longer.

When the liver is not in a healthy state, it is possible that your liver may struggle to breakdown melatonin.

This may result in increased bouts of daytime fatigue followed by night-time alertness when your liver finally gets around to deactivating the melatonin still circulating in your system.

Therefore, sleep disturbances between 1am and 3am are often linked to an unhealthy liver.

In a study published in the National Library of Medicine, sleep disturbances in patients with liver cirrhosis was analysed. 

The study noted: “The main causes of cirrhosis are related to harmful alcohol consumption, viral hepatitis B and C, metabolic disorders, and non-alcoholic fatty liver disease.

“Sleep–wake disturbances are common in liver cirrhosis and associated with impaired quality of life.

“The most common abnormalities are insomnia (difficulties falling asleep and maintaining sleep, or unrefreshing sleep), excessive daytime sleepiness, and sleep–wake inversion (disturbances of circadian rhythmicity).

“A few non-specific treatments for sleep–wake abnormalities have been tried, with encouraging results for hydroxyzine and modafinil.

“However, due to the increased potential for medication toxicity in these disabled patients, further studies are needed to address the potential role of non-drug therapies in this population (eg, cognitive behavioural therapy, mindfulness, yoga) that have demonstrated usefulness in insomnia disorders.”

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