hi - I am considering taking my pred in the evening. Now about 6 years into PMR- been flaring regularly after the first couple of years. Can’t seen to shake being stiff and sore in the morning now - frustrating because that’s when my energy is highest.
Anyway after reading here that a well know rheumatologist advised a poster to take it at night- and reading some articles about the benefits of doing that, I have decided to give it a go. To be clear I know there is something to be said for taking it in the early hours of the morning but that wouldn’t work for me. I also should say I tried splitting the dose ( with the bulk in the morning) as some recommended and it didn’t make any difference.
So if anyone has tried taking it in the evening did you just go straight to an evening dose - or was there a transition where you took a bit in the morning as well?
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CarnationLily
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No real need for a transition, you just take the first dose early. Don't do it the other way round, taking it later, doesn't work for some and you are obviously sensitive.
The main problem with taking pred in the evening, apart from it possibly interupting sleep, is at lower doses once you get to the return of adrenal function stage of 8mg and below. The trigger for the adrenal glands to start producing top up cortisol is a very low level of pred in the blood at about midnight. If you take your pred at 10-11pm, the blood level will be at its peak at about midnight and that trigger for cortisol production won't be there. If you are in the UK and on enteric coated pred, that doesn't apply as it takes 4-5 hours to get into the system. so it is ideal for taking at bedtime.
Our immune systems do a 'deep clean' while we sleep. It kicks in at about 3 or 4am. Unfortunately, some of us with an 'overactive' immune system find this 'boost' to immune activity makes our autoimmune symptoms harder to bear. That's why some patients split their steroid dose. They take most of it early, ideally with breakfast, to fit in with the body's normal cortisol cycle. Then they take the remainder late on (or in the wee hours) to take the edge off the surge.
Taking the whole dose in the evening is a bigger step.
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