Fatigue and sleep issues in liver disease

Last updated Feb. 6, 2024, by Susie Strachan
Fact-checked by Patricia Silva, PhD

While everyone has moments of more than usual tiredness, fatigue is a similar but very debilitating symptom that affects people with all types of liver disease, from nonalcoholic fatty liver disease (NAFLD) to viral hepatitis to primary biliary cholangitis. It’s a persistent weariness that doesn’t get better with rest or sleep.

Fatigue is one of the most common reasons people with chronic liver disease see their doctor. It’s estimated between 50% and 85% of people with chronic liver disease report symptoms of fatigue.

Other symptoms of liver disease related to fatigue include a lack of energy, difficulty concentrating, and an inability to sleep. But there are ways of managing fatigue with liver disease.

Why does liver disease make you tired?

Fatigue can affect your physical, mental, and emotional well-being. It can eventually interfere with daily activities and cause brain fog. It may even play a role in developing mental health issues such as depression and anxiety.

Your liver normally functions by metabolizing nutrients from the food you eat. It also helps regulate blood sugar levels and remove toxins such as medications and alcohol from your blood.

Liver disease can cause your liver to become inflamed. There is evidence that inflammation can disrupt communication pathways in your central nervous system, leading to fatigue.

How liver disease affects sleep

Between 60% and 80% of people with a chronic liver disease experience poor sleep. This may include issues such as:

• difficulty falling asleep
• insomnia
• waking up frequently
• reduced time in rapid eye movement (REM) sleep
• restless leg syndrome
• excessive daytime sleepiness.

There are a number of potential reasons why chronic liver disease may cause sleeplessness, which can exacerbate the feeling of fatigue. In fact, poor sleep is believed to be caused by multiple factors in patients with chronic liver disease, but these are not yet well understood.

One potential cause is related to the fact that chronic liver disease can affect the body’s ability to produce melatonin, the hormone that affects your sleep-wake cycle. For example, people with liver cirrhosis (severe scarring of liver tissue) have been shown to have elevated levels of melatonin during the daytime and less at night, which causes their body’s sleep-wake patterns to shift.

Liver disease also may reduce your body’s ability to cool its core body temperature, which normally happens while you are falling asleep. A malfunctioning liver can interfere with this thermoregulation, stopping you from reaching the deeper, more restorative phases of sleep.

Another potential cause is that liver disease can disrupt the normal circadian regulation of glucose. This may lead to inconsistent blood sugar levels throughout the day and night. This inconsistency can affect your body’s ability to maintain a stable sleep-wake cycle.

A disrupted sleep pattern also may be triggered by side effects from medications. People with chronic hepatitis C infection, for example, may experience sleep disturbances from immunotherapy treatment.

Practicing good sleep hygiene

Establishing good sleep habits can help you improve your overall quality of life while managing liver disease and fatigue.

Good sleep is essential for restoring your energy levels and potentially helping to reduce liver disease-associated fatigue. Sufficient rest can contribute to better concentration, memory, and overall mental clarity.

Good sleep hygiene involves:

• following a consistent bedtime, even on weekends
• creating a relaxing bedtime routine, including reading a book or doing relaxation techniques such as meditation or deep breathing
• keeping your bedroom cool and dark
• reducing screen use before bedtime by turning off the TV, phones, tablets, and computers an hour before going to sleep
• avoiding heavy meals, caffeine, and nicotine close to bedtime
• decreasing or not drinking alcohol
• reducing fluid intake in the evening to avoid middle of the night trips to the bathroom
• limiting naps.

It has been found that certain sleep behaviors — such as snoring, taking naps longer than 30 minutes, and a late bedtime — along with a sedentary lifestyle, is associated with a higher risk of developing metabolic dysfunction-associated fatty liver disease in middle-aged and older people.

If your sleep problems persist, consult a healthcare professional — such as a sleep specialist — for evaluation and guidance. They can work with you on strategies to improve your quality of sleep. They also can help figure out if your fatigue is being caused by your liver disease or another condition like chronic fatigue syndrome.

Managing fatigue with liver disease

If you need help managing your fatigue, talk to your doctor. They may recommend making lifestyle changes, such as:

• eating a nutritious diet
• doing moderate exercise
• drinking more fluids to help flush toxins from your liver
• resting when feeling fatigued.

Your doctor also may want to review your medications. Some medications, such as antihypertensives or beta blockers, may cause fatigue.

Moderate physical activity

People with chronic liver disease may be told to do moderate physical activity as a way to increase energy levels and reduce feelings of fatigue.

Exercise can help control weight gain, especially for people with specific types of fatty liver disease.

Before starting or changing your exercise routine, talk to your doctor.

Sleep apnea

While many people have sleep apnea, it is a common symptom of nonalcoholic fatty liver disease. It causes a lack of oxygen that can disturb your sleep and cause fatigue during the day.

Some sleep apnea can be treated by losing excess weight and sleeping on your side instead of your back. Your doctor may recommend a bi-level positive airway pressure or a continuous positive airway pressure machine to help you breathe better at night.

Therapy for fatigue

For some people, cognitive behavioral therapy can lessen fatigue by helping you learn techniques to:

• reduce stress
• improve sleep
• set realistic goals to avoid overexertion
• break large tasks into smaller steps to make it easier to navigate daily activities.

Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.