Why Hepatitis C Makes You Feel Tired (and What to Do About It)

by Martin Reed Patient Advocate

There are many symptoms of Hepatitis C, including pain, anxiety, digestive issues and, of course, extreme fatigue. Unfortunately (and perhaps surprisingly), although we know that fatigue is a common Hep C symptom, we don't really know why.

One theory is that when the liver is damaged from the Hep C virus, an additional burden is placed on the body as a whole, resulting in exhaustion.

Another theory argues that the depression often associated with the virus is the culprit behind the fatigue.

Research into Hep C and fatigue

When researchers in Canada set out to identify whether there is a link between specific sleep disorders and levels of fatigue in those with Hep C, they studied 115 patients undergoing treatment in a liver center. The mean age of the participants was 56, and 36 percent were female.

Each participant completed a questionnaire about his or her fatigue, sleep, depression, and anxiety.

The study revealed that:

  • Almost 60 percent of participants experienced severe fatigue.

  • 71 perecent of participants had a high likelihood (70 perecent - 86 percent) of obstructive sleep apnea.

  • More than a third of participants demonstrated moderate or severe clinical insomnia.

Those with clinical insomnia, or clinical insomnia combined with likely obstructive sleep apnea, were far more likely than others to report higher levels of fatigue.** Thus, rather than Hep C being solely to blame for the extreme fatigue, so often associated with the disease, some patients might also have a clinical sleep disorder, as well.** Can cognitive behavioral therapy help?

Of particular interest in the Canadian study was the fact that although a large percentage of participants demonstrated a high likelihood of suffering from obstructive sleep apnea, only 7 percent had actually been diagnosed with the condition.

Researchers also determined that insomnia had the strongest effect on those who were the most concerned about their fatigue and their perceived lack of control over it. This suggests (and studies back up the idea) that an approach like cognitive behavioral therapy might be beneficial for individuals with Hep C.

The bottom line? You're likely to experience fatigue if you live with Hepatitis C -- but the reason might not be Hep C alone. You may additionally be suffering from a sleep disorder such as insomnia or obstructive sleep apnea. Speak with your doctor to diagnose (or rule out) any sleep disorders that could be contributing to your fatigue, and consider cognitive behavioral therapy as a method for dealing with the anxiety and other unproductive thought patterns that can often accompany a serious medical condition.


Zalai, D., K. Mcshane, M. Sherman, K. Fornadi, C. Shapiro, and C. Carney. "Are you concerned about your fatigue? Fatigue perceptions mediate the relationship between insomnia and fatigue related functional impairment in chronic hepatitis C infection." Sleep Medicine 14 (2013): e312-e313. Accessed May 12, 2016.

Zalai, D., K. Mcshane, M. Sherman, K. Fornadi, C. Shapiro, and C. Carney. "The silence of sleep disorders. High prevalence of insomnia and obstructive sleep apnea symptoms in chronic hepatitis C infection." Sleep Medicine 14 (2013). Accessed May 12, 2016.

Martin Reed
Meet Our Writer
Martin Reed

Martin is the creator of Insomnia Coach, an eight-week course that combines online sleep education with individual sleep coaching. His course helps clients improve their sleep so they can enjoy a better life with more energy and start each day feeling happy, healthy, rested, and refreshed. Martin also runs a free sleep training course that has helped over 5,000 insomniacs. He holds a master’s degree in health and wellness education and studied clinical sleep health at the University of Delaware.