How does your sleep quality impact your liver health and metabolic balance?

Often sleep is an afterthought among the other pillars of health, but growing evidence is showing how instrumental sleep is to your metabolic health and immune systems, as well as organ function including the liver. As a hepatologist or another type of doctor, I often remind patients that sleep isn't just lack of sleep, fatigue, or impaired productivity – poor sleep may also affect liver health directly, particularly when individuals are already compromised (e.g., liver disease, non-alcoholic fatty liver disease (NAFLD), hepatitis).

Your liver helps detoxify, store glycogen, produce bile, and regulate hormones and metabolism while you sleep. According to a study in the Journal of Hepatology, your liver is different than you think because it runs on biological clocks called circadian rhythms. Each circadian rhythm tells the liver when to turn on or off a gene that controls metabolism. If your sleep is disturbed, these natural circadian rhythms will be disrupted, leading to a disconnection between your body’s need to detoxify and effective detoxification.

Increased insulin resistance & fat accumulation
Bad or less than adequate sleep leads to an increased incidence of insulin resistance, and is the main contributing factor to NAFLD. Increased incidence of insulin resistance means higher blood sugar as well as free fatty acids, and we know from the above that both of these will end up in the liver cells to produce hepatic steatosis (fatty liver).

Dysregulation of circadian genes
The liver function is controlled by circadian genes (BMAL1 and CLOCK), which are at the core of metabolic balance. Altered or disturbed sleep patterns can lead to dysregulation of these genes and impair liver detoxification, glucose metabolism and lipid handling.

Increased inflammatory markers
Decreased hours of sleep results in increased levels and production of pro inflammatory cytokines (TNF-α and IL-6). Chronic inflammation is a well-described hallmark of progressive liver disease (non-alcoholic steatohepatitis [NASH] and liver fibrosis).

Exacerbation of pre-existing liver conditions
In patients with viral hepatitis and alcohol-related liver disease when sleep is impaired it adds an additional stressor when their immune surveillance is diminished. Chronic sleep patients may not be sufficient to reduce viral replication, viral-induced inflammation and it might worsen the progression of virus-mediated liver disease.

In clinical practice, we notice that when patients experience sleep disruption, especially conditions such as obstructive sleep apnea, shift work sleep disorder, or chronic insomnia, there are higher rates of increased liver enzymes, ultrasound evidence

Tips to protect liver health via better sleep, for patients
Have a regular sleep schedule (7–8 hours/night).
Avoid heavy meals or alcohol before bedtime.
Treat any underlying sleep disorders, such as sleep apnea.
Exercise regularly to improve sleep and metabolic health.
If you have ongoing insomnia, seek help. Don't ignore it.