Mollycat

[RSG0345]

I was diagnosed with PMR in July 2019. Started on 20 mg prednisone and began the long tapering. One flare went up to 5 mg and then tapered all the way down to 2 5mg. Last week became concerned with symptoms that could be GCA. Jaw pain, dry cough, fatigue, tenderness in the back of neck, no headache but tightness. So I went to the ER and had ESR and CRP and platelets. All were elevated. The ERdoc made me a referral to a rheumatologist. First appt. Is a month from now. Call my PCP and got in. He started me on the CCA protocol of 40mg 2 weeks, 30 mg 2 weeks, 20 mg 2 weeks,etc to get started. And he wants me to come in for blood work regularily to watch it return to normal. I started on the 40 mg. I have always taken my prednisone at 2AM as that is when i go to bed. I am a night worker. I am finding i can't sleep. Is it the high dose? Can i split it ? I have so appreciated this site and all of you. Thanks so much.

[piglette]

It is better not to split the dose if GCA is suspected. Steroids do tend to cause insomnia, I know I have terrible problems, and you are on quite a high dose now. You could mention the insomnia to your doctor.

[DorsetLady PMRGCAuk volunteer]

Hi, and welcome,

In respect of GCA it’s the lowest start dose - so some would say high - I’d say medium to high [having started on 80mg]…. and it will affect your sleep, but that’s to expected, unfortunately.

As it’s affecting your work then either request some sleeping medication from your doctor or buy some from your pharmacy. From a personal point of view and ex GCA patient I wouldn’t recommend splitting dose, especially early days when the Pred is working it’s hardest to get symptoms under control… hope that happens for you. Please keep us informed. Any change of getting a couple of weeks off work to get you through this difficult period .

Just for info , had your post title included something like “suspected GCA or increased dose or sleeping problems” - the system would have brought up related posts for you to view.

[PMRpro Ambassador]

If you are consistently working nights your circadian rhythm will be different from if you work days. At that high dose you would be better getting some sleep if you can so maybe changing the time you take the pred to when you would usually get up would be better.

But at 40mg pred, you may need to consider your working at all for now - high dose pred has various effects including on judgement which may affect your work.

And please try to put a title to posts that is relevant to your problem or question - I was expecting a picture of your pet and might not have looked at it.

[RSG0345]

Thanks so much for your advice. Can you believe when I called my doc his advice was to split it. I will change my header to GCA newbie.

[PMRpro Ambassador in reply to RSG0345]

There has been a study in splitting the dose in GCA that found it was no different in controlling the inflammation. And after all - if the symptoms return with in 24 hours it does suggest that the inflammation is not fully under control doesn't it?