Advice needed re timing of split doses please

[Jackie_boy]

I’ve been reading various posts over the last weeks and have found excellent advice on how to manage the tapering process and split doses which has transformed my experience of tapering. Started last winter with PMR ( on top of another blood related auto immune condition) and had to leap up to 15mg daily to control it. Since then I have successfully come down to 7.5 mg without any adverse effects apart from a few days of feeling a bit ‘odd ‘, and stabilised on that dose finally with very good energy levels. Now I am aiming to work slowly towards 7mg and have had first two ‘new’ doses on the DSNS plan. I split my steroid dose taking 5mg in the morning after breakfast and the balance in the evening but these last two or three nights I’ve been waking about 2-3am feeling very restless and with what I recognise as general discomfort associated with steroids. Can’t put it any more clearly than that but maybe others on this site will recognise it too. By the morning when I have managed to sleep some more I am ok and once I’ve taken my morning steroid dose things improve all day. Any advice on how to manage the night time would be appreciated!

[DorsetLady PMRGCAuk volunteer]

Hi,

As you’re aware the usual recommendation is 2/3rds am, 1/3rd evening - which my you have obviously been following - successfully.

Your feelings around 2-3am may just be steroid withdrawal - although a DSNS taper is designed to stop that.

A few choices really -

Keep going with the taper and see if it resolves (that may confirm SW),

Decrease morning dose by 0,5mg or 1mg - increasing evening dose according, or

As you’re awake take the morning dose at 2-3am.

My preference would be first option - and see what happens, if it doesn’t resolve then try one of the others.

But whatever you do, you need to give it a few days to settle.

[Jackie_boy in reply to DorsetLady]

Thank you, useful options and I will follow your advice!

[PMRpro Ambassador]

Think you just have to experiment a bit. I sometimes wake then - but no idea why and it isn't pred withdrawal. If anything it is pred being there as I use Lodotra and it is released at about 2am.

[nickm001]

One option is to take your evening dose as late as possible, just before you go to sleep to minimize steroid impact on your sleep pattern. BTW, when I was tapering with split dose I always reduced morning dose. I find that evening dose (for me) is much more important and effective. But as PMRpro said, you need to experiment to find out what works best for you.

[Jackie_boy in reply to nickm001]

Thanks, I was wondering about the timing of the evening dose and as I’d was initially told that steroids stop you sleeping, I was taking it earlier in the evening. Will now try the later timing and if necessary combine with a rebalancing of the two doses. Hey ho, trial and error as always!

[sampete]

I was waking every morning with very stiff shoulders and aching arms which would last for a couple of hours but for the last couple of weeks I have altered my regime I used to take my 2/3 in the morning and the other around teatime. I am on 12mg at the moment and now take 10mg at around midnight and 2mg after my tea. Still a bit uncomfortable when I wake but by the time I have been to the bathroom I'm fine. My husband thinks the improvement is great