Ramelteon for Treatment of Insomnia in Cirrhosis

This study will be a prospective study of patients with compensated cirrhosis This study will be divided into screening and post-ramelteon visits. For this study, subjects with cirrhosis will be recruited from the hepatology clinic. Screening: All subjects will come for an initial screening visit to the CRSU at which point the following procedures will be performed: 1. Vitals, including BMI 2. Neck circumference 3. Skinfold thickness and waist-hip ratio 4. Beck Depression Inventory (BDI) 5. Sickness impact profile for overall HRQOL Questionnaires regarding sleep: 1. Berlin questionnaire 2. STOP Bang questionnaire 3. Epworth sleepiness scale (ESS) and 4. Pittsburgh sleep quality index (PQSI) Cirrhotic patients with either of the criteria below (a) neck circumference \>17 inches for men and \>16 inches for women (b) Positive Berlin questionnaire will be excluded because these are highly suggestive of sleep disturbances and OSA. The investigators will also exclude patients who have evidence of moderate to severe depression on Beck Depression Inventory (score ≥20) without the suicide question. All enrolled study participants will perform 5 paper-pencil and two computerized tests of intelligence which will last approximately 35 minutes total. RAMELTEON THERAPY: The subjects' study chart, current medications, medical history and pregnancy testing will be assessed by sleep physicians at VCU, who will then decide if this patient would benefit from ramelteon. The criteria used will be insomnia along with the absence of OSA by the questionnaires. Ramelteon is an FDA-approved selective melatonin receptor 1 and 2 analog indicated for use in insomnia. The dose used will be 8 mg, the lowest possible dose. If the sleep specialists believe that a particular cirrhotic patient is a candidate for this therapy, they will be clinically prescribed ramelteon after a detailed face to face visit explaining the risks and benefits. Ramelteon is not indicated in patients with severe hepatic impairment (defined as Child Class C), therefore, these patients will not be included in this study. If the patient agrees to take the medicine, it will be dispensed through the investigational pharmacy, where it will be stored for this study. Patients will be asked to complete a medication and sleep diary for the duration of the drug therapy which will be a maximum of 15 days. Within 15 days of drug initiation, the patients will be asked to complete the sleep questionnaires again and cognitive testing similar to that described in visit 1.