Sleep problems

[Guest guest]

I know this problem has been discussed before and I'm not sure if

or anyone can answer it, but I, and I know some others have sleep

problems. I am worn out and fall right to sleep when I go to bed , but

then I wake up many many time during the night and have trouble getting

back to sleep and this is when I don't have pain or itching. What is

the cause of this, I never had this problem before I had PSC and

besides taking things that make you feel awful the next day what can we

do. Any suggestions???? Bettyann (SC)

[Guest guest]

One of the early signs of encephalopathy is sleeping disorders -

insomnia, inverted sleep patterns, etc. Treatment usually begins at a

later stage of encephalopathy, when mental confusion is evident, but

earlier treatment might relieve these sleep disorders too.

Tim R

> ... I am worn out and fall right to sleep when I go to bed , but

> then I wake up many many time during the night and have trouble getting

> back to sleep and this is when I don't have pain or itching. ...

>

[Guest guest]

Hi Bettyann;

The fatigue and sleep disturbances in liver disease and autoimmune

diseases are not well understood. One recent hypothesis is that the

fatigue may be due to reduced levels of dehydroepiandrosterone sulfate:

_________________

Neurochem Int. 2007 Jun 19; [Epub ahead of print]

Reduced plasma dehydroepiandrosterone sulfate levels are significantly

correlated with fatigue severity in patients with primary biliary

cirrhosis.

Ahboucha S, Pomier-Layrargues G, C, Hassoun Z, Tamaz R, Baker

G, Butterworth RF

Neuroscience Research Unit, CHUM—Hôpital Saint-Luc, 1058 St.-Denis,

Montreal, Quebec 2X 3J4, Canada.

Fatigue is a common debilitating complication of primary biliary

cirrhosis (PBC), the pathophysiologic mechanism of which is poorly

understood. Recently, the neuroactive steroid dehydroepinadrosterone

sulfate (DHEAS) was reported to be implicated in Chronic Fatigue

Syndrome in the absence of liver disease. The present study was

undertaken to analyse fatigue scores and their relationship with

disease severity and circulating levels of DHEAS as well as its

precursors DHEA and pregnenolone in PBC patients with (n=15) or without

fatigue (n=10) compared to control subjects (n=11). Fatigue was

assessed using the fatigue impact scale (FIS) including cognitive,

physical and psychosocial subclasses. Steroids were measured by

radioimmunoassay or gas chromatography/mass spectrometry. Plasma

concentrations of DHEAS were significantly reduced in PBC patients with

fatigue as compared to controls, while those of its precursors DHEA and

pregnenolone remained within the control range. Plasma levels of DHEAS

in PBC patients were significantly correlated with fatigue severity as

reflected by total FIS scores including total (rp=-0.42; p=0.018), as

well as the cognitive (rp=-0.37; p=0.03), physical (rp=-0.48; p=0.006)

and psychosocial (rp=-0.35; p=0.04) subclasses of fatigue scores. No

correlation of fatigue scores was observed with indices of liver

function. These findings suggest that reduced levels of the

neurosteroid DHEAS may contribute to fatigue in patients with PBC;

substitutive therapy using DHEAS or its precursor DHEA could be

beneficial in the management of fatigue in patients with low levels of

DHEAS. PMID: 17669554.

_________________

Another hypothesis is that tumor necrosis factor-alpha, whose

expression is generally increased in inflammatory and autoimmune

diseases, alters the expression of genes controlling the circadian

clock, resulting in sleep disurbances:

_________________

Proc Natl Acad Sci U S A. 2007 Jul 31;104(31):12843-8.

From the Cover: TNF-{alpha} suppresses the expression of clock genes by

interfering with E-box-mediated transcription.

Cavadini G, Petrzilka S, Kohler P, Jud C, Tobler I, Birchler T, Fontana

A

*Division of Clinical Immunology, University Hospital Zurich,

Haeldeliweg 4, CH-8044 Zurich, Switzerland.

Production of TNF-alpha and IL-1 in infectious and autoimmune diseases

is associated with fever, fatigue, and sleep disturbances, which are

collectively referred to as sickness behavior syndrome. In mice TNF-

alpha and IL-1 increase nonrapid eye movement sleep. Because clock

genes regulate the circadian rhythm and thereby locomotor activity and

may alter sleep architecture we assessed the influence of TNF-alpha on

the circadian timing system. TNF-alpha is shown here to suppress the

expression of the PAR bZip clock-controlled genes Dbp, Tef, and Hlf and

of the period genes Per1, Per2, and Per3 in fibroblasts in vitro and in

vivo in the liver of mice infused with the cytokine. The effect of TNF-

alpha on clock genes is shared by IL-1beta, but not by IFN-alpha, and

IL-6. Furthermore, TNF-alpha interferes with the expression of Dbp in

the suprachiasmatic nucleus and causes prolonged rest periods in the

dark when mice show spontaneous locomotor activity. Using clock

reporter genes TNF-alpha is found here to inhibit CLOCK-BMAL1-induced

activation of E-box regulatory elements-dependent clock gene promoters.

We suggest that the increase of TNF-alpha and IL-1beta, as seen in

infectious and autoimmune diseases, impairs clock gene functions and

causes fatigue. PMID: 17646651.

____________________

If the last mechanism is primarily involved, then one might expect that

treatment with tumor necrosis factor-alpha inhibitors (such as

remicade) may help. Does anyone have any experience with improved sleep

patterns after treatment with remicade?

Having said all this, I should add that I have major sleep disturbance

problems and I don't have PSC or IBD!

Best regards,

Dave

(father of (22); PSC 07/03; UC 08/03)

[Guest guest]

I have my days and nites mixed up...i haven't slept or napped since Monday and yes i have mental confusion and start to talk about something then stop and cant remember what i was saying...then there is times i can sleep so hard and deep for up to 3 days,, before i go to sleep i feel sometimes I'm not going to ever wake up..that is a weird feeling...I had my 6 month check up at the UofM today..and i was lucky to met a fellow PCS from MI...she came up and we had lunch together and talked it is PAT patriciamalmquist@... and she got to see me with my mental confusion...and forget-fullness..it is bad right now to listen to me i almost talk like I'm drunk...I HOPE I CAN SLEEP TONITE Jeanne Tim Romlein wrote: One of the early signs of encephalopathy is sleeping disorders -insomnia, inverted sleep patterns, etc. Treatment usually begins at alater stage of encephalopathy, when mental confusion is evident, butearlier treatment might relieve these sleep disorders too.Tim R> ... I am worn out and fall right to sleep when I go to bed , but > then I wake up many many time during the night and have trouble getting > back to sleep and this is when I don't have pain or itching. ...>

[Guest guest]

I don't know what causes this all as I'm new to the disease but I have

the same problem. Some days I'm fine with 2-3 hours of sleep but

others (most of the time) I need 10-15 hours of sleep and I'm still

tired. People always say " well that's because you have 3 month old

twins " but that's not true. I was like this before I got pregnant.

I used to take benedryl to help me sleep. 40mg would get me tired

enough to sleep all night and when I did wake up most of the time I

could go back to sleep soon.

from NE

psc dx 8/07