Miya Pearson
Sleep disturbances are common in patients with liver disease, particularly daytime sleepiness and insomnia. These can negatively impact patients' quality of life, mental well-being, and cognitive functions. While there are some over-the-counter and prescription sleep aids available, it is important to exercise caution when taking any sleeping pills, especially if you have a liver condition. This is because some medications can be harmful if you have advanced liver disease or cirrhosis, and certain underlying medical conditions can make them unsafe.
| Characteristics | Values |
|---|---|
| Safety of classical sleeping pills for patients with liver disease | Dangerous, can lead to serious side effects such as coma |
| Safety of hydroxyzine for patients with liver disease | Relatively safer alternative to classical sleeping pills, but must be used with caution and under medical supervision |
| Safety of over-the-counter sleep medication | Generally safer than prescription sleeping pills, but still carry risks and must be taken as directed |
| Safety of prescription sleeping pills | Must be taken with caution, as prescribed by a doctor |
| Conditions that can cause sleep disturbances in patients with liver disease | Hepatic encephalopathy (HE), restless leg syndrome, obstructive sleep apnea (OSA) |
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What You'll Learn
Antihistamines as an alternative to sleeping pills
While having a liver condition can affect your sleeping patterns, it is important to note that some sleep aids and medications may have unwanted side effects and could be unsafe for long-term use. Antihistamines are one such alternative to sleeping pills that people sometimes use to combat insomnia. However, it is not recommended to take them for sleep as there is little research to support their effectiveness for this purpose, and they may lead to harmful side effects with long-term use.
Antihistamines such as diphenhydramine and doxylamine succinate cross the blood-brain barrier, mimicking the natural decrease in histamine levels in the brain that induces non-rapid eye movement sleep (NREM). This is why you may feel sleepy when taking medications that contain antihistamines. These over-the-counter medications are generally safe for occasional use. However, long-term use may increase the risk of dementia and Alzheimer's disease, especially in older adults.
Instead of antihistamines or sleeping pills, the American Academy of Sleep Medicine recommends cognitive behavioural therapy (CBT) as a first-line treatment for insomnia. CBT focuses on sleep hygiene and strengthening the connection between bed and sleep. It helps adjust your circadian rhythm and reduces anxiety about insomnia. Other alternatives to sleeping pills include melatonin and good sleep hygiene practices.
To improve your sleep hygiene, you can create a positive and calming bedtime routine. This includes avoiding caffeine, alcohol, and smoking in the early evening and refraining from using electronic devices at least 30 minutes before bed. Instead, try incorporating relaxing activities such as reading, colouring, knitting, listening to soft music, or drinking a warm, milky drink to help your body wind down. Keeping a sleep diary can also help you identify patterns in your sleeping habits and make any necessary adjustments.
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The dangers of combining sleeping pills with alcohol
Having a liver condition can affect your sleeping patterns. While it is common to think that combining sleeping pills and alcohol may help you sleep better, it can actually have several negative consequences and should be avoided. Mixing sleeping pills with alcohol can increase the sedating effects of both substances, thereby increasing the risk of overdose. Drinking even a single alcoholic beverage along with a sleeping pill can be dangerous.
The side effects of mixing alcohol and sleeping pills include drowsiness, impaired motor control, increased risk of overdose, lowered blood pressure, memory problems, slowed heart rate, and slowed or difficulty breathing. Some sleeping pills have adverse and/or unusual effects such as memory loss and sleepwalking, even when taken on their own. People have reported engaging in behaviours such as eating, talking on the phone, and sometimes even driving with no recollection after taking a sleeping pill. When combined with alcohol, the risk of such side effects increases.
Older patients may experience greater side effects from sleep medications. Some over-the-counter medications such as diphenhydramine (Benadryl, Nytol QuickCaps, Tylenol PM, Aleve PM) and doxylamine (Unisom, Nytol Maximum Strength) can interact directly with alcohol as they contain sedating antihistamines. Anticholinergic drugs have also been linked to a higher risk of dementia in the elderly. Barbiturates, which were used more frequently in the past to help with insomnia, can be especially toxic or even deadly when mixed with alcohol due to the drastic slowing down or stopping of breathing.
Mixing sleeping pills and alcohol can also negatively impact sleep quality. While this combination may make a person feel more tired and fall asleep more quickly, the rest they will get will be of poor quality. The changes in the chemicals in the brain that occur with alcohol use, especially when combined with sleeping pills, will decrease the sleep-related brain waves and cause the person to feel unrested when they wake up.
If you or someone you know is struggling with the combined use of alcohol and sleeping pills, professional treatment can help address both substance use and any underlying mental health conditions. Treatment for alcohol and sleeping pill addiction typically consists of medical detox, co-occurring disorder treatment, rebound insomnia treatment, individual and group therapy, relapse prevention skills training, and behavioural interventions.
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The importance of taking prescription sleeping pills as directed
Sleep plays a crucial role in our overall health and wellbeing. However, sleep difficulties become more common as we age, and disorders like insomnia are prevalent, with approximately 1 in 7 people in the US suffering from long-term insomnia. While prescription sleeping pills can be an effective short-term solution, it is important to recognize that they are not intended for long-term use and should be taken exactly as directed by a healthcare provider.
Prescription sleeping pills are potent medications that can have significant side effects. These may include excessive drowsiness, dizziness, balance issues, muddled thinking, allergic reactions, and even a hangover effect the next day. Additionally, they can worsen snoring and sleep apnea, a potentially life-threatening condition. Mixing sleeping pills with alcohol or other sedatives can lead to dangerous overdoses, excessive drowsiness, and impaired breathing, which can result in death.
It is imperative to follow the directions on your prescription and never take more than the recommended dosage. Always consult your healthcare provider before taking sleeping pills, as they will monitor your reaction and may suggest starting with a lower dose or short-term usage to assess the effects. Never mix sleeping pills with alcohol or other sedatives, and refrain from driving or operating machinery after taking them.
Taking prescription sleeping pills as directed is crucial to minimize side effects and ensure your safety. It is also important to be aware that your body may become dependent on these medications, and stopping them may result in rebound insomnia, where your insomnia returns worse than before. Therefore, always consult a healthcare professional before starting or stopping these medications to ensure your sleep management is safe and effective.
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The side effects of prescription sleeping pills
While this answer will focus on the side effects of prescription sleeping pills, it is important to note that liver disease can affect your sleeping patterns. Sleep plays a vital role in managing your mood, boosting your immune system, and improving your memory. If you have a liver condition, there are some things you can do to help manage your sleep patterns, such as creating a bedtime routine, keeping a sleep diary, and using relaxation techniques.
Prescription sleep medications work in different ways. Benzodiazepines, for example, stimulate a chemical in the brain called GABA, leading to sedation, muscle relaxation, and reduced anxiety. Z-drugs work by slowing down brain activity. Sleeping pills can cause a range of side effects, including:
- Constipation or diarrhea
- Muscle weakness
- Digestive problems, including gas, heartburn, and nausea
- Worsening snoring and sleep apnea
- Rebound insomnia when trying to stop taking the medication
- Parasomnia, a disruptive sleep disorder that can cause dangerous behaviors, such as sleepwalking, eating, or driving while unaware
- Dizziness and balance problems
- Memory issues and confusion, which can be particularly dangerous for older adults, increasing the risk of falls and hip fractures
- Fatigue, irritability, and depression, especially in patients with liver and kidney disease
- Drug tolerance and dependency, with approximately 8 out of 10 people experiencing a hangover effect the day after taking sleep medicine, feeling drowsy and having muddled thinking
- Brain degeneration and increased risk of Alzheimer's disease
- Respiratory depression during sleep, which may lead to death
If you are experiencing side effects from prescription sleeping pills, it is important to talk to your healthcare provider about how to stop taking them safely, as it may take months to stop taking the pills.
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Non-drug treatments for liver disease patients with sleep disturbances
Sleep disturbances are common in people with liver disease, and they can negatively impact a patient's quality of life, cognitive functions, and increase mortality. While the pathophysiology of these disturbances is not fully understood, it is believed to be linked to impaired melatonin metabolism.
Bedtime Routine
Creating a calming bedtime routine can help relax the body and promote better sleep. This includes avoiding caffeinated drinks in the early evening, as well as alcohol and smoking, which can negatively impact sleep. Instead, try incorporating relaxing activities such as taking a warm bath, reading a book, colouring, knitting, drawing, listening to soft music, prayer, meditation, or drinking a warm, milky drink.
Use of Bed for Sleeping Only
Try to associate your bed with sleep only. Avoid watching TV, using electronic devices, eating, or working while in bed, as these activities can keep you awake longer.
Relaxation Techniques
If you find yourself lying in bed unable to sleep, try a distraction technique such as going through the alphabet and naming a flower or any other item starting with each letter. This helps take your focus away from anxious thoughts and can aid in falling asleep. Keeping a sleep diary or journal can also help identify patterns of sleep disturbances and their possible triggers.
Light Therapy
Light therapy is an underutilized, non-drug approach to sleep disturbances. While there are inadequate studies on its effectiveness in cirrhosis, it is a promising treatment.
Cognitive and Psychological Therapies
Mindfulness, cognitive behavioural therapy, and yoga have demonstrated usefulness in insomnia disorders and can be considered as potential non-drug treatments for sleep disturbances in liver disease patients.
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Frequently asked questions
Sleeping pills should be taken with caution and only under a doctor's supervision, as they can be unsafe with some underlying medical conditions. Classical sleeping pills are forbidden for cirrhosis patients, as they can lead to serious side effects such as a coma. Antihistamines, such as hydroxyzine, are a safer alternative.
Common side effects of sleeping pills include headaches, prolonged drowsiness, memory problems, and dizziness. More severe risks include sleepwalking and next-day grogginess that impacts your ability to function.
Creating a positive and calming bedtime routine can help promote better sleep. This includes avoiding caffeine and back-lit devices in the evening, and relaxing activities such as reading a book, taking a bath, or listening to soft music. Other alternatives include keeping a sleep diary, distraction techniques, and cognitive behavioral therapy (CBT).
Sleep disturbances, such as daytime sleepiness and insomnia, are common in patients with liver disease or cirrhosis. This can be due to impaired hepatic melatonin metabolism or comorbid conditions such as obstructive sleep apnea and restless leg syndrome.
Avoid late-night snacking, as this can increase the risk of acid reflux and worsen sleep disturbances. Instead, have a bedtime snack 1-2 hours before lying down to prevent complications.
