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Importantly, this relationship is bidirectional: progressive MASLD and MASH impair circadian regulation through hyperammonemia, astrocyte dysfunction, altered glutamatergic signaling within the SCN, neuroinflammation, endocrine dysregulation, and HE, thereby reinforcing sleepwake fragmentation and chronobiologic instability

Practical strategies to manage thirst include: Carrying a water bottle throughout the day as a visual reminder to drink regularly Setting hydration goals and tracking fluid intake using smartphone apps or journals Drinking small amounts frequently rather than large volumes at once, which may worsen nausea Consuming hydrating foods such as watermelon, cucumbers, and broths Limiting caffeine and alcohol, which can have diuretic effects Using appropriate oral rehydration solutions if experiencing significant gastrointestinal fluid losses (consult your healthcare provider for specific recommendations, especially with kidney disease or heart failure) Timing fluid intake strategically can help minimize discomfort

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