pred timing

[winfong]

Recently had to double my pred (to 10 mg) because of elevated blood markers. I noticed that I am now waking fairly early - either 4:00 or 5:00.

That's pretty early for me. Before the increase, I was typically up at 8:00 and could easily sleep past that as well.

If I have a chance (after eating a little something), I might then go back to bed or lay on the couch. I might fall asleep for a little bit or not.

Most times, though, I'm fairly awake and then have a good morning. After that, I then tend to be droopy throughout the rest of the day.

Could this possible have something to do with when I take the pred? It's always been in the morning.

[piglette]

Did you have pain because of the increased level of your inflammation markers or did they just go up?

[winfong in reply to piglette]

The latter. I think I had a separate post about that maybe a week or two ago.

[SheffieldJane]

Has your doctor advised you to double your dose with raised inflammatory levels? All kinds of things, even the common cold can make them go up. It is more reliable to be guided by your symptoms. I have just spent a sleepless night, Pred often does this. It is best to aim for the lowest effective dose when tapering. I have changed my time of taking Pred about three times over the years. My Endocrinologist recommends early in the morning. 2 am worked for me for a while, this means that when the Cytokines ( inflammatory substance) is shed at about 4 am you have Pred in your system to combat it.

[PMRpro Ambassador]

A single test showing raised markers that aren't accompanied by symptoms shouldn't result in a kneejerk increase of the dose. The blood markers should be checked a week or so later to see if there is an upwards trend before considering increasing the dose. The markers are non-specific, many things can cause an increase.

I don't think you can blame the timing - just the increased dose.

[winfong]

Apart from the marker vs symptoms issue, is there anything about timing of pred that would affect insomnia? I know that, overall, pred is not good for sleeping, and all about the cytokine storm. Just wondering if the timing of the pred affects insomnia in any way. Thanks

[PMRpro Ambassador in reply to winfong]

A cytokine storm is not what we experience in PMR - a cytokine storm is far more serious and potentially life-threatening being dysregulated and uncontrolled. In PMR there is a shedding of cytokines in the body in the early morning - it is a normal process and some cytokines are pro- and some anti-inflammatory. This is disturbed in autoimmune disorders but not to the same extent.

cancer.gov/publications/dic...

The later in the day you take your pred, parallel to the size of the dose, the more corticosteroid remains in the body in the evening. For some people it may be enough to interfere with sleep. The lowest level of corticosteroid should be about midnight but whatever time you take your pred, the blood level will halve about every 2 to 3 hours. It usually takes about 5 half lives to get rid of all of a dose.

[winfong in reply to PMRpro]

Ah, yes, "shedding." That's what I meant to say. <embarrassed emoji>

You say, "For some people it may be enough to interfere with sleep." That's because of the steroid that remains in the body, right? So, taking them when I do should be just fine then. Do I have that right?

I guess I can just put the insomnia down to doubling my dose then. Hopefully, I'll be able to reduce once I get my bloodwork done next week.

[PMRpro Ambassador in reply to winfong]

The sooner you take your pred after midnight, the lower it will be by the next midnight.