Sleep and HCV

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Sleep and HCV

Sleep Disorders in People with Hepatitis C

SUMMARY: Nearly two-thirds of people with chronic hepatitis C virus (HCV) infection may experience sleep disturbances, and those treated with interferon-based therapy may develop insomnia and other sleep-related problems as side effects, according to a review article published in the January 2009 Journal of Clinical Gastroenterology.

By Liz Highleyman

Sanjeev Sockalingam from the University of Toronto and colleagues noted that sleep disturbances occur in up to 60% of patients with chronic hepatitis C, and are often related to co-existing psychiatric conditions such as depression.

Moreover, they added, neuropsychiatric complications of interferon alfa -- which can cause depression, anxiety, and other symptoms -- may manifest as sleep problems.

Newly diagnosed sleep disturbances occur in up to 30% of interferon-treated patients, the authors estimated. Since insomnia in people with chronic hepatitis C may be influenced by a variety of comorbidities -- both psychiatric (such as depression) and medical (such as anemia or hypothyroidism) -- it is important to screen patients for other conditions that might be contributing to the problem.

Given the lack of specific sleep studies in this population, treatment recommendations for people with HCV are derived from general sleep disorder treatment guidelines. Thus, Sockalingam and colleagues concluded, "Further research is needed to elucidate the efficacy of pharmacological and non-pharmacological treatments of sleep disorders in chronic hepatitis C patients."Department of Psychiatry, University of Toronto; Division of Medical, Illness and Mental Health, University Health Network; Head, Multi-Organ Transplantation Psychosocial Program, University Health Network; University of Toronto, Toronto, Ontario, Canada; King Saud University, Saudi Arabia; Institute of Behavioral Sciences and 1st Department of Internal Medicine, Semmelweis University, Budapest, Hungary.

1/08/10

http://www.hivandhepatitis.com/hep_c/news/2010/010810_c.htmlReferenceS Sockalingam, SE Abbey, F Alosaimi, and others. A Review of Sleep Disturbance in Hepatitis C. Journal of Clinical Gastroenterology 44(1): 38-45

(Abstract).

Sleep Apnea Linked To The Progression Of Liver DiseaseJan 2009

Researchers from s Hopkins Bayview Medical Center Bariatric Surgery Clinic have found that the chronic intermittent hypoxia that often characterizes Obstructive Sleep Apnea, a common form of SDB, is independently linked to the progression of liver disease.In this study, researchers recruited 90 severely obese patients presenting for bariatric surgery at without known diagnoses of obstructive sleep apnea.

Each patient underwent a sleep study and blood tests for markers of liver function, insulin resistance, and systemic inflammation. And, because standard practice for patients undergoing bariatric surgery is to biopsy the liver, the researchers were able to analyze liver tissue for signs of disease and link it to the severity and type of sleep disordered breathing they observed during the sleep study.

The results validated the link between Obstructive Sleep Apnea and insulin resistance, and further linked it to the level of hypoxemia experienced during the night versus simply the number of apneic events. Strikingly, of the patients whose liver tissue was analyzed, those who were observed to have severe nocturnal hypoxemia also exhibited "ballooning" of their hepatocytes and a pericellular fibrosis of the liver, indicating liver injury.

"We demonstrated that the severity of nocturnal oxyhemoglobin desaturation predicted the severity of insulin resistance and might be implicated in the development of liver disease. In contrast, severe obesity was associated with high levels of serum c-reactive protein (CRP), indicating systemic inflammation," said lead researcher, Vsevolod Y. Polotsky, M.D., Ph.D., of s Hopkins' Asthma and Allergy Center.

"Interestingly, there was no relationship between the severity of nocturnal hypoxemia and serum CRP. This suggests that that obesity and Obstructive Sleep Apnea have distinct metabolic, inflammatory and hepatic profiles, which act in different detrimental ways on the liver.""We hypothesize that severe obesity per se acts as a 'first hit' in the progression of liver disease, inducing hepatic steatosis, whereas the presence of the chronic intermittent hypoxemia that often characterizes Obstructive Sleep Apnea acts as a 'second hit'.

The hypoxic stress of Obstructive Sleep Apnea may induce oxidative stress in the livers of patients with severe obesity, leading to further inflammation."The clinical implications of the findings are clear: obesity and obstructive sleep apnea exert separate and perhaps additive negative effects on insulin resistance and the liver, and each disorder must be treated concomitantly in order to address the secondary complications."Our data suggest that patients with Obstructive Sleep Apnea and severe nocturnal hypoxemia should be screened for liver disease and, conversely, patients with liver disease should be screened for Obstructive Sleep Apnea," said Dr. Polotsky.

"We have developed a mouse model of intermittent hypoxia and have demonstrated that a combination of a high-fat diet and intermittent hypoxia leads to liver disease in those mice. We plan on continuing to use the model in future research. We plan to examine whether treatment of Obstructive Sleep Apnea with continuous positive airway pressure can improve or reverse liver disease."

This news briefing is based on an article published in the American Thoracic Society's peer-reviewed journal, the American Journal of Respiratory and Critical Care Medicine. About the ATS

http://janis7hepc.com/related_conditions4.htm#sleep

Combatting HCV Fatigue

Franciscus, Editor-in-Chief and Fran Carey

http://www.hcvadvocate.org/news/newsLetter/2005/advocate0405.html#2

One of the most vivid memories I have from running a support group is of a woman who came to one of our support group meetings complaining of fatigue and depression. When we started our check-in, she expressed her frustration with the increased bouts of fatigue and the effect they were having on her life. This person's story is not that much different from others who suffer from fatigue, but I think that she was able to verbalize what many of us go through when we are fatigued. She is a single parent of two children. In order to put food on the table for her family and a roof over their heads, she is required to work long days and devote all of her precious energy to work. In the evening when she came home from work she would basically collapse in front of the TV and would be unable to perform many of the functions needed to care for herself and her children. She became isolated and started to become depressed. In addition, she was

unable to spend the necessary time to cook nutritious meals for herself and her children. The thought of exercise never occurred to her because she was so tired all of the time. For this person, life became a downward spiral and she saw no way out. Luckily, she came to a support group.Throughout the evening we were able to give her words of encouragement - she was not alone. We were also able to help her develop strategies to combat her fatigue. It was one of those incredible support group moments when you can start to see a ray of hope in someone's eye.One of the most common symptoms that people with hepatitis C experience is fatigue. In fact, in one study 67% of people living with hepatitis C reported fatigue as a symptom. Fatigue can range from mild to severe and can affect every area of life. Fatigue is a difficult symptom to quantify since it affects everyone differently. Some people with hepatitis C have constant fatigue while others

may have fatigue cycles - sometimes they feel energetic and at other times they may feel so tired that they might not be able to perform basic daily functions, such as going to work, cleaning the house or joining in on social events. It is important to keep in mind that when living with a chronic illness such as hepatitis C, energy management should be a top priority. When we push ourselves beyond our physical capacity, good judgment declines and accidents occur more frequently. In addition, when fatigue sets in, it is easy to become depressed or anxious about the future. One of the most important strategies HCV positive people can adopt is to pace themselves and focus on techniques that may decrease the time spent doing certain activities and increase the amount of rest. As well, activities should be prioritized according to their importance. If the house needs to be cleaned but you have a dinner date that evening, think about saving your energy for the evening and doing the house cleaning later in the week. You don't want to sacrifice needless energy at the expense of more important areas that will provide more of a balance in your life.Causes of FatigueFatigue can be caused by many factors including depression, anemia, poor diet, and lack of exercise, or by more serious ailments. It is important to talk with your medical provider if you are constantly fatigued. If you feel too tired to get out of bed for more than 24 hours or if you feel confused, dizzy, or have a problem waking up you

should notify your health care provider as soon as possible. Medical Treatment for Fatigue There are no approved medications to treat HCV-related fatigue, but some physicians are experimenting with a variety of drugs including Ritalin and Provigil. However, there is concern about the potential for abuse of these drugs - especially Ritalin since it is known to exacerbate substance use disorders. Studies are needed to determine the safety and effectiveness of these drugs in HCV positive individuals before they are used to treat HCV-related fatigue.

Rest When TiredIt is important to rest when you get tired or when you have time. Taking short naps or rest periods during the day helps most people. Try not to sleep too much during the day because this could affect how well you sleep at night. Also, too much rest may make you even more tired so try to find a balance. Many people report that even just taking a few minutes to close down, mediate, pray, listen to music, reading or thinking about a happy or positive experience revitalizes them within a very short period of time. If you are having trouble sleeping or experience insomnia for more than a few days, talk to your medical provider about medicines to help you sleep.

Plan Activity and RestMake a plan for the day, week, and month. Try to alternate activities so that you can balance the more difficult activities with the lighter activities. People normally have certain times during the day or night when they have more energy. Save the more difficult tasks for when you are more likely to have the energy to perform them. Alternate the difficult with the easy tasks. Many people with hepatitis C and other chronic illnesses report that they have more energy in the evening. However, be careful that you don't overdo it or stay up too late since this can affect how well you sleep in the evening and how you will feel the next day.

BreatheIncorrect breathing can lead to fatigue. When people are stressed out or fatigued they have a tendency to hold their breath. Try deep breathing exercises and concentrate on how the air goes in and out of your body.

Massage People report that massage helps to improve their energy and general wellbeing. Try massage that uses techniques to encourage lymphatic flow and regain energy. AcupunctureAcupuncture is based on the idea that "qi" flows through the body in channels called meridians; each organ system has a set of channels. Acupuncture has been found to be helpful in relieving pain, overcoming addictions and in decreasing fatigue.ExerciseIt may seem counterintuitive, but regular exercise is one of the best strategies for combating fatigue. Try to stay as active as possible but don't overdo it. Exercise comes in many forms and walking is one of the best exercises for relieving fatigue. Other forms of exercise include Pilates, yoga, swimming, light weight resistance or any other activity that will re-energize, but do not exercise to the point of becoming overly fatigued. Listen to your body and let it guide you. Start slowly

with a 2- or 3-minute walk and work your way up to 30 minutes of activity 5 days a week. It is also recommended that you check-in with your healthcare provider or an exercise physiologist to determine what level of activity is right for you.Diet A healthy and nutritious diet based on the recommendations from health experts includes finding a balance between the quantities of food you eat with the amount of energy expended. Try to stay away from foods that are high in fat, sugar and sodium. Eat larger portions of fruits and vegetables and drink plenty of water. If possible, consult with a registered dietician or nutritionist.

Vitamins & Nutritional Supplement A well-balanced diet should contain all the essential vitamins and minerals you need, but some people also take vitamin supplements. Taking a megavitamin supplement may be harmful to the liver. Instead choose a multi-vitamin supplement without iron that meets the daily requirements.

Is It Important?Ask yourself -is this task really necessary? Will the benefit outweigh the chance that you will become overly fatigued? There are many alternatives to common chores, such as to allow dishes to drip dry, to buy permanent press or fabrics that need little attention beyond laundering, and to use frozen or pre-cut vegetables instead of peeling and cutting.Ask for HelpDon't be afraid to ask for help from family members or friends. Many times people are willing to help but may not want to interfere with your life. It never hurts to ask for help and you might be surprised to find that your family and friends will be more than happy to help you out. However, you may need to set limits so that it doesn't turn into a social exercise that could deplete your energy even more. If you have the resources available, it might be worth considering using a laundry or house cleaning service. The key is to simplify when

possible.

Educate Family and FriendsTalk to your friends about what it means for you to be fatigued. Tell them that at times you may not be able to participate in social functions or that you may need to leave early because of fatigue. Learn to say "no" to family and friends who have unrealistic expectations of your energy level.Organize Staying organized is sometimes difficult, but it is the key for putting to use the limited energy one has. Have organized work centers, with all supplies for each task stored together: Keep all of the dry ingredients together including the mixing bowls; keep measuring tools together. Put all of the cleaning supplies in a pail. Store the can opener in the cupboard with the canned goods. Store pots & pans near the stove. Keep items within easy reach. Avoid bending & reaching. Eliminate unnecessary clutter. Utilize organizing equipment such as revolving shelves, stacking bins, lazy-susans,

etc.Use wheels to transport: laundry cart, grocery basket, kitchen cart - to convey equipment & supplies in one trip. Load the cart with all the goods needed to set the table in one trip rather than several. Use a wagon to transport groceries from car to the house, a cart to transport the laundry, foods from the fridge to the counter, etc. There are a lot of strategies that can help conserve energy and reduce the likelihood of fatigue induced injuries.

Try some of these simple tips:Sit whenever possible. Use a tall stool at the sink to wash & prepare food, use an adjustable ironing board as a work surface to sit at, wipe down the bathtub while still sitting in it, or use a shower stool and hand held shower for bathing. Bathe before going to bed rather than in the morning. It takes less energy to put on nightwear since there is much less of it and you will have less to attend to in the morning. Always sit down while dressing and undressing. Use good posture and comfortable work heights. While standing, the working surface should be between waist & hips, while sitting, the surface should be no more than 3 inches below your elbows. Don't work at a low counter that causes you to bend over it. If the kitchen sink is low, place a pan under the dishpan to raise it closer to you. Stand & sit with spine erect.

While you are working avoid stretching & bending. Keep most commonly used items within easy reach. Have long handles on the dustpan, bath brush, and use tongs to reach for something on the floor. Work in a well-lighted environment that is at a comfortable temperature and has good ventilation. Wear supportive and comfortable shoes. Use both hands for activities: setting the table, dusting, holding pots. Avoid stress and rushing. Frustration and irritation increase fatigue. Pace yourself; rushing leads to mistakes and accidents which then require extra energy to clean up or resolve, not to mention the potential for injury. Flare-ups of symptoms including fatigue are a common experience for people with HCV, which can drastically reduce your energy level and quality of life. Prepare for these times by storing dried, canned and frozen foods/meals available for the times when you are not able to get to the store. Keep healthy snacks around the house and remember to eat small frequent healthy meals. Skip unimportant tasks until a better time. One of the most important strategies is to listen to your body. It is important that you

allow yourself to rest - pushing yourself unnecessarily could prolong your "flare-up" and make you feel worse. We all know that fatigue can cause depression and anxiety. Be prepared to indulge yourself in enjoyable activities that require little energy, such as meditating, reading, watching a video, knitting, etc. It is 'ok' to recognize that you are depressed. It is not healthy to put a positive spin on everything. Talk to family and friends - a friendly ear can help with anxiety and depression. Talk to professionals and seek guidance. Consider antidepressants - they can help with depression and energy. One of the most important strategies people living with hepatitis C can adopt for themselves is to join a support group. Everyone experiences physical, mental and emotional changes throughout their lives and must adapt accordingly in order to safely maintain their ability to function. By practicing some of the above techniques you will reduce your risk for injuries and conserve your energy for the things in life that are most important to you.

Sources:Arthritis Foundation website:http://www.arthritis.org/

http://Hepatitis Cnewdrugs.blogspot.com/2010/01/sleep-and-hcv.html