Best timing for pred dose

[Cross-stitcher]

I am currently on 12.5mg uncoated pred for PMR, to be taken (according to my GP) in the morning with food, i.e. normally between 8.00 and 9.00 am (I am fully retired). Two problems - if I wake with morning stiffness, it can take up to 4 hours for the pred to have much effect, then the afternoons are good but I feel I am still "buzzing" somewhat when I go to bed. My sleeping is all over the place anyway, totally erratic and no two nights have the same pattern at present.

I understand the logic for taking the pred at 6.00 am or even at 2,00 am, so that it is already in the system before the cytokines "kick in" and morning stiffness can be reduced.

But how do you good folks manage this? Do you go to bed with an alarm set, then wake up to take your pred in the early hours (with or without food?), and then try to go back to sleep? How does your other half respond to this disturbance? My husband would be horribly cross to have an alarm clock ringing in the middle of his night's sleep - once he's awake he always finds it very difficult to drop off again. If I can't sleep, I have to take myself off to the spare room or the kitchen to read - even a small night-light disturbs him, let alone my tossing and turning. But he's 75 and is my rock and I totally depend on him on my "bad" days, so I feel he does deserve some consideration.

I would welcome some tips I may not have thought of yet.

[SheffieldJane]

It really does sound as if you would benefit from taking Prednisalone earlier, perhaps with a little plain yoghurt and then going back to sleep. Perhaps you could try an experiment whilst one of you sleeps in another room. We’ve done that for various reasons throughout this illness. Although my OH sleeps like a log and snores like a warthog. It’s all part of the give and take I guess.

[Soraya_PMR]

When I was on plain, I’d take it between 2am and 4am whenever I had to get up to spend a penny. My rheumi asked the typical ‘do you still have morning stiffness’ and when I said ‘No....because I take my pred early’ she was fine with that.

I take coated now, so take it as I go to bed. Never mentioned this to rheumi, but it’s the same-difference as far as I’m concerned, as the pred isn’t in my system til 2-4amish.

Could you convince your GP to prescribe you coated?

[Charlie1boy]

Hi,

I guess you'll have to experiment a bit. I had exactly the same problem of the four hour wait for pred to kick in. For a while I tried the 2 to 3 am method, but In the end I split my dose 50/50, with one half taken with breakfast and the other at bedtime.

This has worked for me all the time I've had PMR ( over four years). As you read this forum, you'll see that people have all kinds of different solutions, and it's a question of what works best for you.

Good luck

Paddy

[Cross-stitcher in reply to Charlie1boy]

Thanks, that's another good suggestion to get me through the next month, before I try to taper down to 10mg.

[PMRpro Ambassador]

One approach is to split the dose, often 2/3 in the morning, the other 1/3 later in the day, it may not need to be much later to allow the anti-inflammatory effect to carry over for the full 24 hours (it lasts for 12-36 hours depending on the person) and that means the mornings become better. Experiment ...

Alternatively, do you wake early for a pit stop? It doesn't really matter what time - just to take plain pred and settle down for another couple of hours to let it work. Yoghurt or just a glass of milk is enough according to pharmacists.

[Griggser]

I’ve just started taking my dose of 12mg at 5am as the morning stiffness has been particularly bad. I don’t set an alarm as I wake regularly during the night and can tell when it’s about 5am. I have a pit of yoghurt an then take the steroids before settling down again. To be fair I’ve only just done that this week whilst on holiday in menorca and being in an apartment makes it easier as everything is on one floor (no going downstairs to the fridge). The stiffness is certainly less doing this do I think I’ll continue.

[PMRpro Ambassador in reply to Griggser]

I wouldn't worry about keeping the yog in the fridge - they are live, they don't go off.

[Hidden in reply to Griggser]

It should be fine out of the fridge for a few hours. But if you are still worried invest in a lunch sized cool bag. I keep drinks etc in one.

[Roltuba]

I’ve been splitting my dose for a couple of years, half at 9am and half at 9pm (with a snack). But I have been getting very stiff in the morning recently and much better in the afternoon, so trying 2/3 near midnight and 1/3 about 8am and that seems to have improved things, possibly catching early hours inflammation before it sets in. Keeps me reasonably Ok throughout the day, never had trouble getting to sleep. I’ve had to go back up to 8 a day after a flare at 6. My diet has increased by 2x half a banana with the pred, as it’s not at mealtimes, but apparently that’s good for avoiding cramp. Yes, trial end error until something works! (Fingers crossed...)

[PMRCanada]

I have taken my uncoated pred (Canada) at a variety of times throughout the last year. I’ve settled on 2/3 dose (6mg) around 2am (I don’t set an alarm, but sometimes I sleep through a bit later), and 1/3 (3mg) around 2pm. No morning stiffness, no sleepless nights. I take my 2am dose with half a banana or I lay out a frozen tube of yoghurt at bedtime on my night stand with my dose and a glass of water.

Taking my dose at this time is quite a quick process...eat banana, take pred with water and lay right back down. Be careful however because in the dark, while sleepy, I’ve dropped a tablet before, so I put them in a shot glass now, and sweep it with my finger to ensure none are stuck in the bottom. One night I ate the banana and drank the water, but didn’t take the pred! Other than those few incidents, things have gone smoothly. But if I could get my hands on some Rayos (coated pred), I’d be thrilled to take my dose around 10pm before bedtime, and enjoy a less interrupted sleep.

It’s more my shifting of pillows to get comfortable that keeps OH up or disturbs him. That’s when a spare bedroom comes in handy.

[Legsy0714]

Hi. I invariably waje a couple of times in the night. I've started taking 5 mg of my 8 mg whenever that is -230 4:30 5:30 I find it very effective. As regards your dilemma I can only suggest putting your phone alarm on vibrate only and placing it somewhere it will wake you. With best wishes