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Pathophysiological mechanisms of sleep disturbances in liver cirrhosis
Sleep disturbances have been associated with the presence of HE and also with disruptions of melatonin metabolism in cirrhotic patients. Some of the features of sleep–wake regulation disturbances may be attributable to melatonin metabolism impairments because melatonin is metabolized by the liver. In patients with cirrhosis, the daytime melatonin level is high,4 the clearance of melatonin is lower at night,36 and melatonin secretion patterns are modified so that the peak of secretion is delayed.36,37 The delayed peak of melatonin secretion is associated with the degree of hepatic failure.29,36 The clinical consequence of these changes is delayed sleep onset.29

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC62204...