Is there a relationship between steatosis (fatty liver disease) and insomnia (sleep disorder)?

From the Guidelines

Steatosis (fatty liver disease) and insomnia are not directly related, but they can coexist and potentially exacerbate each other, and the most recent evidence suggests that lifestyle modifications can help manage both conditions. To address both conditions, focus on improving overall lifestyle habits. Reduce alcohol consumption, as it contributes to fatty liver and can disrupt sleep, as recommended by the 2024 guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD) 1. Adopt a balanced diet rich in fruits, vegetables, and whole grains, while limiting saturated fats and processed foods, which can help manage steatosis and promote better sleep, as suggested by the 2021 clinical care pathway for the risk stratification and management of patients with nonalcoholic fatty liver disease 1. Regular exercise, at least 30 minutes most days of the week, can improve liver health and sleep quality, with a recent meta-analysis finding a close dose–response relationship between weight loss and resolution of nonalcoholic steatohepatitis (NASH) 1. Manage stress through relaxation techniques like meditation or deep breathing exercises. For insomnia, practice good sleep hygiene: maintain a consistent sleep schedule, create a relaxing bedtime routine, and avoid screens before bed. If insomnia persists, consult a doctor about short-term use of sleep aids. For steatosis, weight loss (if overweight) is crucial, and the 2024 comprehensive medical evaluation and assessment of comorbidities standards of care in diabetes recommend therapeutic lifestyle interventions for patients with low risk of advanced fibrosis 1. In some cases, your doctor may recommend vitamin E supplements or medications like pioglitazone for non-alcoholic fatty liver disease. Regular medical check-ups are important to monitor both conditions and adjust treatment as needed.

Some key points to consider:

• Lifestyle modifications, including weight loss, dietary changes, and physical exercise, are essential for managing steatosis and promoting better sleep.
• Reducing alcohol consumption is crucial, as it can contribute to fatty liver and disrupt sleep.
• Managing stress through relaxation techniques and practicing good sleep hygiene can help alleviate insomnia.
• Regular medical check-ups are necessary to monitor both conditions and adjust treatment as needed.
• The 2024 guidelines on the management of MASLD recommend a stepwise approach using blood-based scores and imaging techniques to rule out advanced fibrosis, which is predictive of liver-related outcomes 1.

It is essential to prioritize lifestyle modifications and manage comorbidities to improve outcomes for patients with steatosis and insomnia, as recommended by the most recent and highest quality studies 1.

From the Research

Relationship Between Steatosis and Insomnia

• There is evidence suggesting a relationship between steatosis (fatty liver disease) and insomnia (sleep disorder) 2.
• A study on rats found that insomnia promotes hepatic steatosis possibly by mediating sympathetic overactivation 2.
• However, the relationship between steatosis and insomnia in humans is not directly addressed in the provided studies, except for a study that found genetic factors and sleep duration to be associated with cardiovascular events, which can be related to steatosis 3.

Mechanisms and Interactions

• Sympathetic overactivation is thought to be a mechanism by which insomnia may cause hepatic steatosis 2.
• Genetic factors, such as the PNPLA3-rs738409 variant, can interact with lifestyle factors, including sleep duration, to influence liver fat content and steatosis risk 3.
• Lifestyle interventions, including healthy lifestyle patterns and physical activity, may be more impactful in individuals with higher genetic risk for steatosis 3.

Diagnosis and Treatment

• Insomnia disorder is commonly comorbid with psychiatric, medical, and neurologic disorders, and diagnosis should be based on patient interview, assessment with tools, and use of criteria 4.
• Cognitive-behavioral therapy for insomnia is a first-line recommendation by guidelines, but some patients may not respond to it or may require alternative treatments 4.
• The treatment of insomnia with estazolam has been shown to inhibit sympathetic activation and reduce hepatic steatosis in rats 2.