Sleep Issues and Hepatitis C

Having hepatitis C can negatively impact one’s quality and quantity of sleep. But why? There are several causes of sleep disturbances with hepatitis C which can occur alone or concurrently with one another.

Hepatitis C can lead to fatigue

Daytime fatigue is a common symptom of hepatitis C and one of the major causes of nighttime sleep disturbances. In a research study of 1,614 patients with hepatitis C, 53% of the participants reported having severe fatigue that impaired their activity.¹ Out of all of the symptoms reported that occur outside of the liver, fatigue was the most frequently reported. But what causes this fatigue?

What causes hep C fatigue?

One cause of fatigue can be medication side effects. Hepatitis C medications like Harvoni and Epclusa can disrupt a person’s sleep cycle by causing daytime fatigue, which may tempt a person to take naps, which can interfere with being able to sleep well at night.²

Another possible cause behind daytime fatigue with hepatitis C is liver cirrhosis that has led to hepatic encephalopathy.³Hepatic encephalopathy, which is a condition where toxins that can’t be filtered in the liver travel to the brain, can cause “sleep-wake reversal” which is where a person’s circadian rhythm reverses. People with this condition sleep during the day and stay awake throughout the night.

For those with hepatitis C who have liver cirrhosis, obstructive sleep apnea is often another cause behind their daytime fatigue and sleepiness. Research has found that people with obstructive sleep apnea have over a 4 times higher prevalence of liver cirrhosis than the general population.⁴

Depression, which can be a symptom of hepatitis C, a side effect of some hepatitis C medications, or just as a separate co-occurring condition, can also lead to sleep disturbances. Itching, a common symptom of liver disease, can also interfere with restful sleep.⁴

But sometimes, issues with sleep are a result of someone having a separate clinical sleep disorder that just happens to occur alongside their hepatitis C infection. Having a sleep study can rule out or diagnose a clinical sleep disorder, including sleep apnea.

Tips for better sleep

Here are some general sleep hygiene tips that may help alleviate sleep issues. Your doctor may recommend:

1. Cutting down on caffeine intake (including chocolate!), and not ingesting anything with caffeine after 3pm.
2. Not taking daytime naps that last longer than 20 minutes.
3. Not looking at your phone, television, or other screens up to 2 hours before bed. Or at the very least, turning on the blue light blocker setting on your phone if you’re going to use your phone near bedtime.
4. Going to bed at the same time every night.
5. Only using your bed for sleeping and sex.
6. Keeping your bedroom cool and dark.
7. Getting out of bed if you can’t fall asleep within 20 minutes. Engage in a quiet activity such as reading, taking a slow walk, or taking a warm bath/shower and then try going back to bed when you start to feel tired.

Alert your physician if none of the above tips alleviate your sleep issues, if you snore or wake up gasping for air, or if you have new sleep difficulties after starting your hepatitis C medication.