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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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End Stage Liver Disease, Have Inverted Sleep Pattern. How Can I Get Back On Track?

I have end stage liver disease and am doing remarkably well considering 2 life threatning bleeds , coma and temporary insanity!! Have been worked up for liver transplant at Northwestern, however my MELD scores are around 14 and do not require that route as of yet. My main problem is my inverted sleep pattern, which poses a problem as I have an 11 year old with autism and severe hemophilia A. Its like I am a baby,eat fall asleep wake up after 2 hrs etc. Any advice to help get back on track? I do have hepatic encepalophy (1 oz laculose 2x daily) UUKKK.
Thu, 11 Jul 2013
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Psychiatrist,  's  Response
hi,
for your inverted sleep pattern you can use lorazepam-2mg as it is metabolized and excreted by renal route and is safe in liver disease.
also sleep hygiene is also needed,

1-Arise at the same time daily.
2-Limit daily in-bed time to the usual amount present before the sleep disturbance.
3-Discontinue central nervous system (CNS)-acting drugs (caffeine, nicotine, alcohol, stimulants).
4-Avoid daytime naps (except when sleep chart shows they induce better night sleep).
5-Establish physical fitness by means of a graded program of vigorous exercise early in the day.
6-Avoid evening stimulation; substitute radio or relaxed reading for television.
7-Try very hot, 20-minute, body-temperature-raising bath soaks near bedtime.
8-Eat at regular times daily; avoid large meals near bedtime.
9-Practice evening relaxation routines, such as progressive muscle relaxation or meditation.
10-Maintain comfortable sleeping conditions.
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End Stage Liver Disease, Have Inverted Sleep Pattern. How Can I Get Back On Track?

hi, for your inverted sleep pattern you can use lorazepam-2mg as it is metabolized and excreted by renal route and is safe in liver disease. also sleep hygiene is also needed, 1-Arise at the same time daily. 2-Limit daily in-bed time to the usual amount present before the sleep disturbance. 3-Discontinue central nervous system (CNS)-acting drugs (caffeine, nicotine, alcohol, stimulants). 4-Avoid daytime naps (except when sleep chart shows they induce better night sleep). 5-Establish physical fitness by means of a graded program of vigorous exercise early in the day. 6-Avoid evening stimulation; substitute radio or relaxed reading for television. 7-Try very hot, 20-minute, body-temperature-raising bath soaks near bedtime. 8-Eat at regular times daily; avoid large meals near bedtime. 9-Practice evening relaxation routines, such as progressive muscle relaxation or meditation. 10-Maintain comfortable sleeping conditions.