The pathogenesis of insomnia in liver cirrhosis and research progress in traditional Chinese and Western medicine

As one of the common symptoms of liver cirrhosis, the high incidence of insomnia may be associated with clinical symptoms, complications, medication, poor sleep hygiene habits, environmental and psychological factors, etc. Nevertheless, the underlying pathogenic mechanisms remain unclear, may be related to hormonal dysregulation, including melatonin, thyroid hormones, growth hormones, etc.; metabolic disturbances induced by sugar metabolism, bilirubin metabolism, trace element metabolism, intestinal flora metabolism, ammonia metabolism, etc.; changes in body temperature; specific factors related to the different primary etiology; drug effects such as diuretics and β-blockers; and psychology factors, as well as. In Western medicine, pharmacological interventions primarily include ammonia-lowering agents, sedatives, and melatonin, while non-pharmacological approaches involve morning light therapy and cognitive behavioral therapy that incorporate mindfulness. Based on the characteristics of syndrome differentiation, seeking the cause through syndrome analysis, and treating the root cause of the disease, combining the understanding of the etiology and pathogenesis of both liver cirrhosis and insomnia, respectively. Further, it summarizes the pathogenesis and clinical characteristics of insomnia in patients with liver cirrhosis. Aiming to alleviate the insomnia symptoms of patients with liver cirrhosis and enhance their quality of life, traditional Chinese medicine (TCM) rooted in "liver-oriented", treats and diagnoses through oral herbal formulations and external therapies such as acupuncture and massage. This paper reviews recent advances in the pathogenesis of insomnia in liver cirrhosis, progress in Western medical treatments, and systematic TCM perspectives and therapeutic developments for this condition, aiming to provide references for further basic research on pathophysiological mechanisms and real-world clinical practice research.