A Molecular Link Between Sleep And Liver Fat
Scientists have discovered a molecular link between the body’s biological clock and fat production in the liver. The finding may help explain why disrupting daily cycles, such as rotating shift work, increases the risk of diseases like obesity and diabetes.
Mammals and many other organisms have natural daily rhythms. In people, the brain’s master clock sends out signals to other brain regions to make hormones that help keep you awake during the day. In the evening, when less light enters your eyes, the master clock triggers production of a hormone that makes you feel drowsy and helps you stay asleep. This daily cycle, called the circadian rhythm, affects various body functions, including body temperature, eating habits and blood pressure. Jetting across time zones or working the night shift causes disruptions in this rhythm.
As many as 1 in 4 Americans are estimated to have excess liver fat, which can lead to inflammation and damage that could eventually cause liver failure. Fat production in the liver is known to be affected by circadian rhythms. Past studies have shown that disrupting circadian rhythms in mice causes the animals to develop excess liver fat. They also suffer from obesity, diabetes and metabolic syndrome. A team led by Dr. Mitchell A. Lazar of the University of Pennsylvania set out to understand the molecular connections between circadian rhythm and fat production in the mouse liver.
by Amy Alabaster and Harrison Wein, Ph.D.
Effects Of Zolpidem On Sleep Parameters In Patients With Cirrhosis And Sleep Disturbances: A Randomized Placebo
1Department of Hepatology and Liver Transplantation, Institute of Liver and Biliary Sciences, New Delhi, India
2Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, India
3Department of Clinical Research, Institute of Liver and Biliary Sciences, New Delhi, India
4Department of Neurology, Institute of Liver and Biliary Sciences, New Delhi, India
5Department of Biostatistics, Institute of Liver and Biliary Sciences, New Delhi, India
Corresponding author :
*These authors contributed equally to this work as co-first authors.
How Does Your Liver Affect Your Sleep Patterns
Okay, its to be expected that if you suffer from a liver disease such as cirrhosis, you will experience a whole plethora of symptoms.;
However, your liver doesnt need to be that badly damaged for you to notice the impact on your sleep pattern. If youve read my blog, Not sure whats waking you up at night? youll be aware that, in Chinese Medicine, sleep disturbances between 1-3am are often linked to the liver but why? How does this organ affect your sleep?
Recommended Reading: How To Sleep When Stressed And Anxious
What Should Patients Do
The connection;between sleep apnea and fatty liver disease suggests that patients with NAFLD or its risk factors should be tested for sleep apnea. Since there is no specific treatment for NAFLD, testing patients known to have sleep apnea for liver disease is rather pointless. Patients who have been diagnosed with NAFLD but arent sure if they have sleep apnea may want to undergo a sleep study. If they do have sleep apnea, treating the condition may help reverse their liver disease.;
If youre interested in undergoing a sleep study, dont hesitate to;contact us;or:
Possible Causes Of Insomnia For Those With Liver Disease
For individuals with liver disease who are suffering from insomnia, the following are some possible causes:
- Cirrhosis of the liver; altered histamine levels in the brain caused by cirrhosis can cause an altered sleep-wake cycle from the onset of the chemical balance changes.
- Related illnesses; patients with liver disease often suffer from other conditions, including type-2 diabetes, obesity, and hypertension; however, all of these conditions can independently cause insomnia.
- Interferon Treatment; the preferential medical treatment for viral hepatitis B and C can cause insomnia in some individuals.
Recommended Reading: How To Win Sleep Apnea Va Claim
Fatty Liver Disease Symptoms
A healthy liver typically contains a small amount of fat. Fatty liver disease happens when theres excess fat in the liver.
A liver with too much fat will swell and become inflamed. This inflammation can lead to cirrhosis , which can permanently damage the liver.
- Alcoholic fatty liver disease develops as a result of long-term heavy drinking.
- Nonalcoholic fatty liver disease doesnt have a clear cause, though diet may play a role in some cases.
Alcoholic fatty liver disease usually doesnt cause symptoms in its early stages. However, some people experience pain in the right side of their abdomen.
As it progresses, it can also cause:
- nausea and vomiting
Many people with nonalcoholic fatty liver disease also have few or no symptoms in its earlier stages. But over time it may cause:
- general weakness and fatigue
- easy bruising
Keep in mind that many of these symptoms overlap with those of other, less serious conditions. Still, its a good idea to follow up with your healthcare provider if you have any of these symptoms.
Inflammation Underlies Allergic Reactions
When you have persisting allergy symptoms, this is a sign that your body is in a state of chronic inflammation. When your body is chronically inflamed, your immune system overreacts to the presence of allergens. Interestingly, the liver plays a vital role in modulating immune response. If the liver isnt operating at full capacity, as with fatty liver disease, this can disrupt normal immune function and cause inflammatory reactions that make seasonal allergies worse.
Systemic inflammation that plays a role in conditions like fatty liver disease and seasonal allergies may also cause psychiatric symptoms like insomnia, symptoms of depression, and anxiety.
Sleep Apnea Causes Fatty Liver Disease
Another study suggests the situation may be even more complicatedsleep apnea may be directly involved in the development of liver disease in the first place. In this;study, 226 patients suspected of having sleep apnea were examined. Despite the fact that the patients were not selected on the basis of being obese, an astonishing 61.5% had varying degrees of NAFLD.;
Analyses of these patients data identified an independent link between sleep apnea and the presence of NAFLD, which suggests that sleep apnea by itself might be able to directly cause NAFLD. In this same analysis, the severity of sleep apnea was linked to the severity of NAFLD in obese individuals.;
Effectiveness Of He Treatment On Sleep Disturbances
Lactulose and lactitol aim to decrease ammonia absorption from the gut and are effective for improving HE.,, Treatment improves neurocognition and QoL. A recent work from Singh et al, comparison of cirrhotic patients without HE and those with minimal HE who were given lactulose for 3 months, showed that HE treatment led to improvements in EDS , sleep quality , and QoL .
Rifaximin is a non-absorbable oral antibiotic currently recommended for the treatment of refractory HE and to maintain remission of these episodes. Its mechanism of action is complex and is thought to involve a decrease in the load of pathogenic microbial flora. Rifaximin improves neurocognitive function and QoL in HE., With regard to sleep, we have compared 15 recurrent HE patients before and after a rifaximin course. No changes in subjective nighttime sleep quality and daytime sleepiness were observed. REM sleep amounts were increased on PSG, but no changes were observed for EDS or the need for naps, despite improvements in HE scores.
Probiotics and l-ornithine l-aspartate
These medications have been proved to improve HE and QoL., However, no specific studies are currently focused on sleep disturbances.
You May Like: Can My Apple Watch Track My Sleep
Sleep And Cirrhosis How Can I Improve My Sleep
Fatigue and sleep problems are very common among cirrhosis patients. Some nights you cant go to sleep, other nights you wake up every two hours. We know it can be very frustrating. So here, we are going to look at some ways which may help you get a good nights sleep. It could be the key to improve your quality of life.
We all know that sleeping well is important, since a quality sleep can help our body to repair, strengthen our immune system, and improve our metabolism. Unfortunately, studies show that sleeping pattern changes with liver cirrhosis, and studies revealed that cirrhotic patients have disturbed sleep patterns, correlating with the degree of cirrhosis. This means the more advanced your cirrhosis, the less sleep you are going to get.
The cause of this is not entirely clear, at the moment we only know that cirrhosis can adversely affect brain function, and one possible explanation is that toxins build up in the blood when the liver is malfunctioning, possibly interfering with normal brain processes. Hepatic encephalopathy is the medical term for the disruption in brain function caused by liver disease.
Here are 8 tips that might help to improve your sleep:
Do not give up easilyPerseverance is the key! Making lifestyle changes can be challenging at first. But bear in mind that these are positive changes and allow some time for your body to get used to your new way of life. Carry on for some time and eventually youll see the difference!;
Why Is Sleep Important
You need a strong immune system to help your body work with the powerful drugs youâre taking to fight the virus. Sleep recharges your defense system.
Depression is also a problem for people with hep C. Itâs scary to have a serious disease. And some of the drugs you take can bring it on. Lack of sleep only makes these problems more likely. Treating depression can improve your sleep quality.
Good sleep at night may also help with daytime fatigue.
Don’t Miss: How To Get Rid Of A Sleep Deprivation Headache
What Are The Symptoms
Of the large cluster of possible symptoms, fatigue is obviously the predominant feature. This may be chronic and persisting, or relapsing, coming and going unpredictably. It is frequently overwhelming and may immobilize the patient. The fatigue is often exacerbated by even minor exertion, although sometimes the exhaustion will be delayed anything up to 24 hours after the exercise. Other possible symptoms include a feeling of weakness and heaviness of the limbs, poor memory and concentration, headaches, sleep disturbance, depression, mood swings, muscle and joint aches and pains, lymph gland swelling, recurrent viral infections, blurred vision, dizziness, nausea, bloating, constipation and diarrhea. All of these symptoms may fluctuate.
Sleep Deprivation Alters Liver Metabolism And Fat Content
- American Physiological Society
- Losing a single night’s sleep may affect the liver’s ability to produce glucose and process insulin, increasing the risk of metabolic diseases such as hepatic steatosis and type 2 diabetes.
Losing a single night’s sleep may affect the liver’s ability to produce glucose and process insulin, increasing the risk of metabolic diseases such as hepatic steatosis and type 2 diabetes. The findings of the mouse study are published ahead of print in the American Journal of Physiology — Endocrinology and Metabolism. The research was chosen as an APSselect article for September.
Sleep deprivation has been associated with eating more, moving less and having a higher risk of developing type 2 diabetes. However, a team of researchers from Toho University Graduate School of Medicine in Japan, explained, “It was not clear whether glucose intolerance was due to the changes in food intake or energy expenditure or to the sleep deprivation itself.”
The researchers studied two groups of mice: One group was kept awake for six hours each night , while the control group was allowed to sleep as desired. The research team offered unlimited high-fat food and sugar water — mimicking lifestyle-related food choices that people make — to both groups prior to the study. During the sleep/wake period, the animals had limited opportunity for physical activity.
Recommended Reading: Why Do Depressed People Sleep So Much
Insomnia And Fatty Liver
Insomnia is characterized by difficulty falling asleep or staying asleep. If you have insomnia, then you likely do not feel refreshed when you wake up in the morning. This is common among people with fatty liver disease. Insomnia can have many causes, from anxiety to poor sleeping habits, but fatty liver disease is also a possible cause.
It Might Be A Signal From Your Liver
Playing a vital role as the largest internal organ, liver is responsible for over 500 vital functions in our body. Poor dietary, environmental pollution and troubled emotions are detrimental to the liver and is almost impossible to avoid in todays lifestyle. As it is a silent organ, you are unlikely to feel any pain or discomfort even when it is 70% degraded due to limited nerves around it.
Think you look good? Dont flaunt it yet! Looking healthy doesnt necessarily vouch for a good health especially if youre battling for a peaceful sleep. Such case is a sign of your body indicating a deteriorating liver health. A few studies have reported that patients with chronic liver disease, such as liver cirrhosis, ;Hepatitis C and primary biliary cirrhosis have sleep disturbances.
The liver is the primary site for the clearance of circulating melatonin . Studies show that poor liver health may decrease the melatonin clearance rate causing increased daytime levels of this hormone and delay in the rise of plasma melatonin peak. As a result, sleep disturbance occurs! You will feel sleepy during the day and very alert at night.
Read Also: How To Get Better Deep Sleep
Your Liver Can Impact Your Digestion
As our Digestion Advisor Ali mentions in her blog, How healthy is your liver? if your liver is sluggish, it can have an impact on your digestive system. As Ali explains, your liver is responsible for breaking down fats and, if it isnt performing this role properly, it means that fat can enter your bowels, giving rise to symptoms such as diarrhoea or constipation.
I talk a bit more about how your digestion can affect your sleep patterns here, but generally, if your digestion is poor during the night you will definitely know about it. Unfortunately, sleep deprivation can also impact your digestion so a vicious cycle can form, with one symptom persistently agitating and encouraging the other.;
Impact Of Sleep Disturbances In Liver Cirrhosis
Sleep disturbances have been shown to negatively impact QoL in cirrhotic patients and have been measured in the majority of studies by the SF-36,,, or the Chronic Liver Disease Questionnaire., For example, QoL in patients with liver cirrhosis is worse than QoL in healthy controls, for both the Physical Component Summary and the Mental Component Summary. Samanta et al, in a study comparing 100 cirrhotic patients with minimal HE or no HE, showed that minimal HE was associated with poor sleep and EDS, but also that sleep disturbances aggravate neuropsychiatric impairment. Sleep disturbances have also been shown to negatively impact psychological distress and depression.
Don’t Miss: Does Apple Watch Series 4 Have Sleep Tracking
Sleep Disruption And Liver Cancer
The master clock in our brain regulates the circadian rhythms in tissues and organs around the body. This is important for sleep but also for normal metabolic function.
Shift work has already been linked to disruption of normal circadian function. A study reported by Medical News Today earlier this year, for example, linked simulated shift working patterns in mice with increased development of nonsmall cell lung cancer.
Now, researchers have associated sleep disruption with increased risk of liver cancer.
The American Cancer Society report that 700,000 people worldwide are diagnosed with liver cancer each year. Men are more likely to develop liver cancer than women. In the U.S., they estimate that over 18,000 men and nearly 9,000 women will die in 2016 from liver cancer.
Obesity is a major risk factor for hepatocellular carcinoma the most common type of liver cancer. Excess fat in the liver results in nonalcoholic fatty liver disease , which has a high incidence rate in obese individuals. NAFLD has been predicted to become the major cause of HCC in the 21st century.
Pathophysiological Mechanisms Of Sleep Disturbances In Liver Cirrhosis
Sleep disturbances have been associated with the presence of HE and also with disruptions of melatonin metabolism in cirrhotic patients. Some of the features of sleepwake regulation disturbances may be attributable to melatonin metabolism impairments because melatonin is metabolized by the liver. In patients with cirrhosis, the daytime melatonin level is high, the clearance of melatonin is lower at night, and melatonin secretion patterns are modified so that the peak of secretion is delayed., The delayed peak of melatonin secretion is associated with the degree of hepatic failure., The clinical consequence of these changes is delayed sleep onset.
Animal studies in rats with portacaval anastomosis have reported impairment of circadian loco-motor activity and also disturbances in the rhythm of pineal melatonin content. A dysfunction of the suprachiasmatic nuclei circadian clock has been also proposed to explain the alteration of melatonin secretion patterns.
However, EDS does not seem to be related to melatonin metabolism disturbances but rather to the degree of HE. Indeed, researchers have shown an association between HE severity and EDS,,, and the absence of EDS had a 92% negative predictive value for HE-triggered hospitalizations during an 8-month follow-up period in 58 cirrhotics.
Many lines of research remain to be explored in order to understand these complex pathophysiological mechanisms. A summary of current research in this area is shown in .
Read Also: Can Chiropractor Help With Insomnia
Morning Bright Light Treatment For Sleep
- 1Department of Medicine, University of Padova, Padova, Italy
- 2Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- 3Department of General Psychology, University of Padova, Padova, Italy
- 4Department of Biology, University of Padova, Padova, Italy
- 5Chronobiology, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom