Somewhere, sometime ago I read in this group that it can be helpful to take preds at 2am - something about cyto shedding at 4am?
I would like ot understand this better.
What are the advantages of taking preds at 2AM, and how do others manage this and still get enough sleep? Thank you
Cytokines do shed around 4 am, and that’s when the inflammation from your illness begins to build up, if you take your Pred (plain uncoated tablets) they are in your system ready to fight that inflammation. Taking your pred at 2am is optimal for the improvement in morning stiffness.
If you are on enteric tablets which take longer to get into the system you may need to take them earlier.
PS- never altered timings from taking with breakfast - but had GCA only and always on high dose to last full 24hours….
How do people get enough sleep if they stay up to 2am? I just noticed that my new lot of 2.5mg tablets which are black, are coated.
Could taking my daily dose of 9.5mg (one 5mg, one 2.5mg coated and two 1mg) at 1am still work to calm the inflammation, yet still enable me to have much needed sleep hours?
You don’t have to stay up until 2am, some wake naturally for a comfort break, other put an alarm on….
Any reason why you’ve just got 2.5mg coated? Have you been on uncoated ones up until now?
We don’t usually suggest mixing and matching types of tablets unless it’s absolutely necessary- as they get into your system at different times…but if pharmacy didn’t have uncoated 2.5mg guess it’s only option.
Don’t see why 1am shouldn’t work, but only way you’ll know is to try….
Chemist didn't have uncoated - but will put in the request for only uncoated and ask if they will replace the black ones. Thank you
Easy. I’m retired and can get up whenever I want, but 9 am is still 7 hrs sleep.
I wouldn’t mix coated vs uncoated Pred because it’s possible the actual effectiveness of the coated may be less. Whatever they put you on stay with it, don’t mix.
It mimics the body’s natural rhythms. That said, if your pain is controlled and you are on the right dose, there is no reason you can’t take it first thing in the morning with breakfast. No need to disrupt sleep and have to eat in the middle of the night.
Hello Bennijax. I have had PMR and GCA since June 2018, and taken my Prednisolone as instructed by the medical lot, who we assume know best. Bit of a mistake there. About 6 months ago, I started taking my Prednisolone at 2am, as I had seen it mentioned on this amazing site a few times. Before my change of Prednisolone timing to 2am, I was no good for anything until the Prednisolone had worked it's magic by around 1pm. Now with the change in timing, I now HAVE MY MORNINGS BACK to do what I want to do, within the limitations of PMR. It works wonderfully for me, give it a try, nothing to loose, maybe a whole morning to gain for you, like it has for me. Wishing you well on your 2am trial. Trevor.
taking the preds at 2am has given me back my mornings too - and I feel so much better physically and so much more energy. The BUT is that I'm a late bird, getting to sleep, normally, between 12:30-1am. So staying up that extra 90 minutes is not allowing me to have enough sleep and so I remain a mess in the morning although a different kind of mess.
Then take it at 12,30-1am - it will still have the same effect in minimising morning stiffness. As you get to lower doses and are looking for adrenal function to ramp up again, taking the pred after midnight is advisable - it is the low level of corticosteroid in the blood at that time that triggers the HPA axis to produce cortisol. If the level is too high that won't happen.
Strangely I was just reading this:
rmdopen.bmj.com/content/2/1...
which discusses the role of night dosing of pred in RA - and mentions polymyalgia as a parallel condition which also benefits from the concept. It also mentions why mornings are worse - and why we shouldn't take melatonin.
If your pred effect doesn't last the full 24 hours and symptoms reappear before you are ready for the next daily dose, then splitting the dose may deal with that, and then WHEN you take the dose becomes less important. You can take the bulk of the dose in the morning and the rest late enough to extend the effect to 24 hours.
I do it the easy way - I get Lodotra here in Italy, It is a delayed release formulation, you take it at 10pm, it releases at 2am - without you having to wake up 
Unfortunately it is no longer funded by the NHS and is a tad pricey (about £25 for 30 tablets so up to £100 per months if you need 4 tablets to make up your dose, it comes in 5mg, 2mg and 1mg pills). Mind you - even that is peanuts compared with the price they charge in the USA!
I started taking my pred in the early hours to reduce the morning stiffness, and I certainly am less stiff. However, it is more tricky if pred keeps you awake. I take sleeping tablets for that reason, and so, rather than waking myself up to take them, which seems a bit silly, I just take them whenever I happen to wake up in the small hours, usually between 2.30 and 4.00am. Seems to work ok. but you have to watch out that you do not end up taking them within 2 hours of indigestion remedies.
Diagnosed with PMR Nov 2019, GCA December 2019. 60mg down to 5mg now. I take the dose (uncoated) at around midnight. Because I start my day at about 6 .30am and am working by 7 a.m. (online) it is wonderful to feel almost functional in the mornings. Early morning means bed at about 10 (sometimes much earlier). have alarm for midnight ...take tabs with yogurt...go back to sleep. My days completely exhaust me so I don't have a problem falling asleep (sometimes listening to radio 4 or the world service helps).I saw on here that at low doses, when you are hoping for the adrenals to creep back into action, it helps to take it in the morning, so I changed. Ruined my mornings, now back to the midnight dose.
You need to experiment to see what works for you. Pain free is all that matters.
We are so lucky to be able to zap the pain with pred.
best wishes for your PMR/pred journey
Hi Bennijax, I am another who has benefitted from taking the pred in the early hours of the morning. As has already been said by the more experienced people here, it doesn’t have to be at 2am. I was a stickler at first, but then found if I awoke a bit earlier, it didn’t really matter. Up for a pee, take the pred with half a small carton of yoghurt and back to bed. Because I intentionally avoid any distractions and get the deed done as quickly as possible, I find that I doze back off almost immediately. I’m glad it’s working for you too!
I recently started taking my pred at 2am as I was very stiff and going down the stairs was painful. I have definitely noticed a difference. I set the alarm on my smart watch and have it on vibrate so not to disturb my wife. I eat half a banana to protect my stomach. I’ve never had any problems with my stomach but eat the banana just in case. Give it a go and hopefully like me you’ll fall back to sleep quickly.
I had assumed the 2am preds was mainly for enteric coated version and the yoghurt or banana to protect the stomach. Do you take coated preds, Griggser?
No - 2am is for plain pred. If you take enteric coated pred you can get away with taking it before bed as it takes at least 4 hours to get through the stomach for absorption in the duodenum and lower down the gut.
I don’t, I just take between 8-9 am each morning. Now at 2.25 mg/d. Had blood drawn this morning to determine basal cortisol level. Be interesting how one could get this test if taking their daily Pred dose at 2 am unless can find someone to do the blood draw at 1 am!😂
You would delay the pred until the morning because the pred may interfer with the lab test. The basal cortisol is the level early morning in response to a very low corticosteroid level at midnight so technically taking pred at 2am wouldn't affect that,
Morning Bennijax, I've taken mine around 02:00 for any months now, with some Greek Yogurt and a banana and it has happily lasted me throughout the day. I take uncoated Pred and as already mentioned if you are on coated then things are different.
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