Sleep and Cortisol

[Exflex]

This article healthline.com/health/corti... describes the link between cortisol and sleep, but implicates levels higher the circadian cycle would regulate.

I’m having sleep issues. In summary I’ve been on Pred for 3 years and my current dose is 2mg. I have a benign enlarged prostate, the consequence of which is I do not empty my bladder properly; the urologist said I retain about 1/3 litre and during daytime I double void. At night time this is impractical and I wake around 3 to 4 am to go the toilet. At this hour I have difficulty getting back to sleep.

Relating to Prednisolone, is there a link between low levels of cortisol / corticosteroids and sleep pattern?

Thanks.

[Bcol]

I guess the simple answer is yes, there is a link, which I suspect many people on this site will be familiar with. Personally I've had problems with sleep for a very long time and gave up being worried about disturbed nights many years ago. If I can't get comfortable or sleep I just get up, go to the loo, read a book, have a hot drink, watch the TV. I did have to smile at one of the recommendations though - get a pet - at the moment I have a very poorly dog, who is in reality on end of life care, and for the last umpteen weeks I've been sleeping downstairs with her so that I can make sure she is comfortable, not in pain, and let her out every couple of hours.

[SheffieldJane]

I was also awake at 3 am. I find that listening to an audiobook or a podcast enables me to fall back to sleep quite easily. I have PMR (4 years) and GCA/LVV for a further 3+ years. My sleep patterns have changed numerous times over the years, always some sort of disturbance with Pred. I find that a regular afternoon nap is a lifesaver and it makes for a better evening. You may find that taking your enviably small Pred dose at a different time may change this pattern. Have you had your cortisol levels tested by an endocrinologist ? They may be inadequate. Ask for a Synacthen test if you haven’t already had one.

[Exflex in reply to SheffieldJane]

I requested it after my first attempt at a 2.5 to 2 slow 5week taper failed after feeling dizzy at wk 1. It was a clear signal to me that I did not enough cortisol. When I discussed the situation with the locum for my usual GP I was told in certain terms I could not have my morning cortisol measured.

I sort of succeeded on my second attempt at reducing to 2mg after a pause of 2 to 3 months from the first attempt. Some nights i have discomfort in my shoulders, but paracetamol deals with it. I’m 99.9% certain I’m on the edge of being cortisol sufficient and I’m now stuck on 2mg in fear that a further drop might send me over the edge.

As PMR said, I think habit has a role in terms of waking at 3am.

[PMRpro Ambassador in reply to Exflex]

The ignorance of some GPs is astounding.

You know the signs of adrenal crisis? Write a note and pin it on the fridge and if you feel ill, call 999 and tell them the situation. At least tell someone to come to you just in case But many get through the stage without mishap - just extreme fatigue.

[SheffieldJane in reply to Exflex]

I agree. My audio book is a reward of sorts. Any chance of a second opinion on the adrenal function? Your doctor is astonishing.

[PMRpro Ambassador]

"Adrenal insufficiency or Addison's disease is associated also with chronic fatigue. A study indicated that untreated patients with adrenal insufficiency demonstrated increased sleep fragmentation, increased REM latency, and decreased amount of time in REM sleep, findings that may explain the patients' fatigue"

ncbi.nlm.nih.gov/books/NBK2...

So yes, if your sleep patterns are being disturbed - for whatever reason - it can account for a lot. But habit also has a role to play - you get used to waking at particular times. Worrying about it makes it worse.

[Exflex in reply to PMRpro]

Thanks PMR. At least there could be causation at play, and something to discuss further with my new GP practice.

BTW, the link that you provided is locked. I would like to read it however.

[PMRpro Ambassador in reply to Exflex]

Strange, works fine for me. You do get the redirect notice from HU to click on.

Try googling the title and authors

HPA Axis and Sleep

Nicolas C. Nicolaides, MD, PhD, Alexandros N. Vgontzas, MD, Ilia Kritikou, MD, and George Chrousos, MD, MACP, MACE, FRCP.

[Exflex]

Working now, must have been a glitch. Thanks.