Prednisone Prescription.

Does Prednisone Keep You Awake? (Doctor’s 11 Sleep Solutions)

by
Dr-Babar-Naeem.

This article was written by Dr. Babar Naeem (MBBS, MRCPCH) – a licensed and practicing medical doctor – to ensure maximum factual accuracy and unique content.

Prednisone is a corticosteroid that reduces inflammation in the body and is used to treat conditions like asthma, COPD, allergies, eczema, inflammatory bowel disease, rheumatoid arthritis, and cancer.

But will taking prednisone keep you awake?

Prednisone can keep some patients awake because prednisone is the synthetic version of the natural glucocorticoid hormone that is produced by the adrenal glands that makes you alert and counteracts the onset of sleep.

So how can you sleep better when taking prednisone?

Taking prednisone early in the morning before 9 am is the most effective way to stop prednisone causing insomnia because the side effects will be reduced by bedtime – reducing the dose, taking steroid-sparing drugs, and tapering off the medication under your doctor’s guidance can help.

The rest of this article explains in more detail how prednisone keeps you awake and the steps that you can take to sleep better whilst taking this medication.

Although this article was written by a licensed and practicing medical doctor, you should always consult with your doctor before altering the dose or stop taking prednisone because doing this incorrectly can have severe consequences.

Related: see the best mattresses we have reviewed to get a better night’s sleep.

How Does Prednisone Keep You Awake?

Most Common Prednisone Side Effects: Short Term and Long Term, and Solutions | Corticosteroids

There are three main ways in which prednisolone can cause sleep disturbances [1] and they are as follows:

1: Activates the Flight or Fight Response

Prednisolone acts on receptors in the body that activate the ‘flight or fight response’ chemicals that keep the body awake, causing insomnia.

Furthermore, prolonged use of prednisolone can cause atrophy of the brain, which also leads to sleep disturbance.

2: Changes in the Natural Sleep/Wake Cycle

The natural sleep/wake cycle is controlled by an area of the brain called the hypothalamus, which controls melatonin release from the pineal gland.

Research has demonstrated that the use of prednisolone is associated with the disturbance of this cycle, decreasing the production of melatonin, and causing sleep disturbance.

The brain produces a group of chemicals called orexin to keep the body awake during the day.

Prednisolone causes an overproduction of orexin, resulting in steroid-induced sleep deprivation.

Orexin antagonist is a newer class of sleep medications aimed at reducing the hyperarousal and insomnia caused by the steroids.

3: Hyperarousal State

Certain chemicals in the brain, such as γ-aminobutyric acid (GABA), inhibit the brain’s activity and induce sleep.

Prednisolone causes a decrease in the production of GABA that results in hyperactivity and sleeplessness.

There are certain drugs that mimic the action of GABA and have anxiolytic and sleep-inducing properties.

11 Ways to Sleep Better While Taking Prednisone

Below are 11 ways that you can try to help you sleep better whilst taking prednisone:

1: Take Prednisone in the Morning

Taking prednisone in the morning can decrease insomnia caused by the steroid.

When a drug is administered, all the maximum effects and side effects are observed at that time.

As time passes, levels of the drug are reduced in the body, and the effects wear off.

This remains true with prednisolone: all the effects, including sleep deprivation, are at their highest at the time of administration.

If we administer the prednisolone in the morning, the level of the drug will be lowest in the evening, and chances of getting a night of good quality sleep will be increased.

The NHS also recommends taking prednisolone in the morning before breakfast to minimize side effects.

Click here to find out if Afrin keeps you awake.

2: Use the Minimum Required Dose of Prednisolone

The side effects and toxicity of prednisolone are dose-dependent, which means if the dose is increased, the side effects – including insomnia – will also increase [2].

Although the dose of prednisolone is different for different diseases, I always recommend that my patients start with the minimum dose, and increase only if symptoms are not controlled.

Sometimes it is not possible to use a low dose due to the nature of the disease; in that case, the best solution is to use the prednisolone in small, divided doses, rather than taking a single, large dose.

R Turner and Elson have demonstrated that bad dreams and insomnia are resolved when the dose of the steroid is decreased [3].

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3: Use Prednisone for the Shortest Possible Period

Using prednisone for a shorter time period can help you avoid the side effects caused by chronic use.

As the duration of using prednisone increases, so do the adverse effects.

I always tell my patients to use it only when the disease flares up and to taper off as soon as possible after discussing with their doctor.

Please remember that you should not abruptly stop taking prednisone, as it can cause life-threatening problems – prednisone suppresses the production of the natural steroids necessary for the body’s functionality, so when it is discontinued suddenly, the body will have reduced availability.

This results in weakness, fatigue, hypotension, electrolyte imbalance, and worsened insomnia.

So always taper off prednisone slowly to the lowest dose before stopping completely.

How to decrease the dose of prednisone depends upon the patient’s condition, and the dose they are using.

For the sake of discussion, here is a proposed method for tapering prednisone off, but always discuss it with your doctor first.

  • Decrease the dose by 1mg per day, and then monitor your condition for disease flare-up and the symptoms of withdrawal syndrome.
  • If everything is okay, then decrease the dose again, and observe.
  • When you reach the lowest dose, shift to the alternating-day regimen; i.e., take the dose every other day.
  • After 2-4 weeks of the alternating-day schedule you can discontinue the prednisone safely.
  • Contact your health care provider urgently if you experience any symptoms of withdrawal syndrome.

Click here to find out if nicotine can keep you awake.

4: Use Steroid Sparing Drugs if Dose Control Isn’t Possible

Steroid sparing agents decrease the requirements for prednisone and help in the prevention of side effects, including sleep disturbance.

Most of the side effects of prednisone are caused by high doses, and by taking the medicine for an extended period.

I always advise my patients to keep the dose of prednisone as low as possible and to taper the dose off when the disease improves.

However, in certain conditions, it is not possible to decrease the dose or duration.

Steroid sparing agents are drugs that alter the immune system so that it is easier for steroids like prednisone to work.

Therefore, a lower dose of prednisone can perform the same function as the higher dose.

They also perform the same functions as the steroids themselves, so that steroids can be safely stopped.

These agents include azathioprine, cyclophosphamide, cyclosporine, methotrexate, etc., and using them will prevent the side effects caused by prednisone, including insomnia.

Please remember that these medications can only be used when prescribed by a specialist, and they may have their own side effects.

These agents are used only when steroids are ineffective, or cannot be used due to significant side effects [4].

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5: Avoid Drugs that Increase Sleep Disturbance

It is essential to avoid drugs that may worsen sleep disturbances or increase the side effects of steroids.

The worst thing you can do while taking prednisone is to add another medicine to your prescription that shares these side effects.

Therefore, it is essential to keep in mind the medications that should be avoided by patients taking prednisone.

I have prepared a list of medications that can exacerbate sleeplessness:

  • Antidepressants including escitalopram (Lexapro), fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft). These drugs cause insomnia in 10-20% of patients. Alternative medicines that can be used for depression include duloxetine, venlafaxine, and clomipramine, but be sure to discuss with your doctor first.
  • ACE inhibitorsare another category of drugs that can worsen insomnia. These include captopril (Capotene), beazrpri (Lotensin), enalapril (Vasotec), and lisinopril (Zestril), and are commonly used to treat blood pressure and heart disease. They cause sleep disturbances due to the release of a chemical called bradykinin, resulting in a severe cough. Alternative options include calcium channel blockers and diuretics.
  • Beta blockers are commonly used to treat hypertension, arrhythmia, glaucoma, tremors, and migraine. These include atenolol (Tenormin), metoprolol (Lopressor), propranolol (Inderal), and sotalol (Betapace), and they decrease the production of melatonin that is already suppressed in patients taking prednisone. Alternative options include amlodipine (Norvasc), verapamil (Verelan), and diltiazem (Cardizem).
  • Non-sedating antihistamines that cause sleep disturbances include cetrizine (Zyrtec), loratidine (Claritin), and fexofenadine (Allegra). They cause insomnia by blocking the action of acetylcholine. The alternative is to use non-sedating antihistamines in the morning, or replace them with sedating alternatives at bedtime.

6: Reduce Sugar Intake

Eating a balanced diet and avoiding foods that can disrupt our sleep are integral parts of the sleep improvement plan.

A lot of research is being done to explore the relationship between diet and insomnia.

A recent study published in 2019 has demonstrated that consuming foods high in carbohydrates and refined sugars increases the chances of developing insomnia [5].

Examples of such foods include cakes, cookies, processed meats, sugar-sweetened beverages, white bread, sodas, etc.

I always recommend that my patients avoid the following foods to decrease the chances of insomnia:

  • Fast foods, as they cause obesity and breathing problems which are disastrous for sleep.
  • Spicy foods as they cause indigestion, heartburn, and increased body temperature.
  • Foods with a high glycemic index, such as sweets, white bread, and cakes, as they trigger an inflammatory response that disrupts sleep.

There is a way of eating called the Dietary Approach to Stop Hypertension, or DASH Diet, which is primarily used to control high blood pressure.

This lifestyle includes fruit, vegetables, fish, low-fat dairy products, nuts, grains, and other healthy foods.

A study published in 2019 states that adherence to the DASH diet is associated with lower incidences of insomnia [6].

Kiwi, cherries, fatty fish, rice, and nuts have also been linked with improved sleep.

Click here to find out if kiwi can help you sleep better.

7: Avoid Stimulants

Caffeine, nicotine, and alcohol are stimulants and have a negative effect on sleep quality.

Caffeine is found in tea, coffee, and sodas.

It has stimulant properties, keeping the consumer alert.

Several studies have reported difficulty falling asleep, and poor quality sleep after consuming caffeine.

Although the sensitivity and tolerance of each person to caffeine is different, caffeine consumption should be avoided close to bedtime.

Nicotine promotes wakefulness by stimulating cholinergic neurons in the brain.

Sleep problems are also very common in the early stages of nicotine withdrawal.

Sleep hygiene recommendations suggest the avoidance of all forms of nicotine for better sleep.

Alcohol consumption at bedtime can cause increased wakefulness during the second half of the night.

As the dose of alcohol consumed is increased, so sleep impairment increases accordingly.

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8: Use Melatonin Supplements With Caution

Melatonin is a hormone released by the pineal gland, which tells the brain to prepare the body for sleep.

Melatonin decreases the length of time required to fall asleep and improves the reduction in steroid levels that cause sleep disturbance and insomnia.

Research has demonstrated that the use of prednisone and other steroids results in the reduction of melatonin levels in the blood [7].

Therefore, restoring normal levels of melatonin is essential to improving the quality of sleep for patients taking prednisone, as it improves sleep and boosts the immune system.

However, melatonin supplements can cause headaches, nausea, dizziness, depression, tremors, drowsiness, and may reduce the effect of prednisone – so you should always consult your doctor before starting to take melatonin.

Click here to find out if it’s safe to take melatonin when you have a fever.

9: Exercise in the Morning

Exercise is a simple, inexpensive, and effective means of improving sleep.

Exercise promotes sleep by reducing anxiety and creating a thermogenic effect that has a positive influence on the circadian system [8].

Many studies have confirmed the beneficial effect of exercise on inducing sleep.

I recommend doing moderate aerobic exercises such as walking, as these are most beneficial for insomnia.

Vigorous exercises like lifting heavy weights and running are not very good at improving insomnia.

I have compiled a list of recommendations that should be followed for maximum benefits:

  • The best time to exercise is in the morning.
  • Always start with low-intensity exercise and then increase the intensity as your stamina builds up.
  • Stretching prepares the muscles for exercise and prevents injuries.
  • A 30-minute session of moderate activity is associated with the best results for sleep [9].
  • Yoga, walking, treadmill, pushups, and other strength training exercises are some of the best options to improve your sleep.
  • Do not exercise shortly before bedtime.
  • Don’t forget to take deep breaths throughout the workout.
  • Exercise should preferably be done in an open space.
  • Exercising with a partner is much better than exercising alone.

10: Sleep Hygiene

Practicing sleep hygiene recommendations is essential for the success of any sleep-promoting therapy.

Sleep hygiene is defined as a set of environmental and behavioral changes intended to promote healthy sleep.

I have always given special attention to practicing sleep hygiene recommendations as unhealthy habits destroy the normal sleep-wake cycle, making it impossible to sleep well, even with sleep medications.

Here is a summary:

  • Adopt a regular sleep and wake cycle.
  • Avoid daytime naps, or keep the duration to 30 minutes or less.
  • Make your sleeping environment comfortable, dark, quiet, and clean.
  • Control the noise level in the room, or use earplugs.
  • There should be no electronic devices in your bedroom, or at least put them on silent mode.
  • Avoid heavy meals before bedtime.
  • If you cannot sleep within 30 minutes, get out of your bed and return when you are feeling sleepy – comfortable and boring activities can help.
  • Try to clear your mind from any distressing thoughts – practice deep breathing and relaxing exercises.

11: Join a Support Group

There are a lot of prednisone support groups available on the internet, and joining a support group may help you adapt better to your situation.

It will allow you to discuss your problems with people who have experienced the same thing.

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Prednisone and Sleep FAQs

Below are some of the most common questions answered in relation to sleep and taking prednisone.

Can You Take Melatonin With Prednisone?

Melatonin should be used cautiously with prednisone.

Prednisone and other steroids cause decreased melatonin production, so melatonin is prescribed to counter this effect.

However, melatonin could make the steroid ineffective in some cases, so it is essential to discuss it with your doctor before starting melatonin supplementation.

How Can You Relax when Taking Prednisone?

Prednisone tends to produce hyperactivity and anxiety.

The best way to relax while taking prednisone is by practicing breathing exercises.

Deep breathing relieves anxiety and helps us relax.

Taking your prednisone dose in the morning, or reducing the dose and switching to other steroids, are alternative options.

Studies have found that foods that contain tryptophan or L-theanine can help the body relax [10].

Why Does Prednisone Give You More Energy?

Prednisone has many effects on the metabolism of the body.

It increases the production of glucose by the liver, while decreasing utilization, and it stimulates the breakdown of fats and proteins to generate energy.

All of these changes increase the availability of glucose that serves as an energy source, which is why you feel more energetic while on prednisone.

Conclusion: Talk to Your Doctor First

Prednisone is a wonder drug used for a variety of disorders but tends to cause sleep disturbance.

You can decrease the severity of insomnia by taking the dose in the morning, reducing the dose, or switching to an alternative medicine, but this must always be discussed with your doctor first.

Sleep hygiene recommendations are inexpensive and easy-to-follow lifestyle modifications that can make much difference to your quality of sleep.

Sources and References:

[1] J. L. Cole, “Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically Ill Patients,” Fed. Pract., vol. 37, no. 6, pp. 260–267, Jun. 2020, [Online]. Available: https://pubmed.ncbi.nlm.nih.gov/32669778.

[2] D. Liu et al., “A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy,” Allergy Asthma. Clin. Immunol., vol. 9, no. 1, p. 30, Aug. 2013, doi: 10.1186/1710-1492-9-30.

[3] R. Turner and E. Elson, “Sleep disorders. Steroids cause sleep disturbance,” BMJ, vol. 306, no. 6890, pp. 1477–1478, May 1993, doi: 10.1136/bmj.306.6890.1477-d.

[4] A. Agrawal, M. Daniel, S. Srinivasan, and V. Jimsha, “Steroid sparing regimens for management of oral immune-mediated diseases ,” J. Indian Acad. Oral Med. Radiol., vol. 26, no. 1, pp. 55–61, Jan. 2014, doi: 10.4103/0972-1363.141857.

[5] J. E. Gangwisch et al., “High glycemic index and glycemic load diets as risk factors for insomnia: analyses from the Women’s Health Initiative,” Am. J. Clin. Nutr., vol. 111, no. 2, pp. 429–439, Feb. 2020, doi: 10.1093/ajcn/nqz275.

[6] H. Rostami et al., “The relationship between adherence to a Dietary Approach to Stop Hypertension (DASH) dietary pattern and insomnia,” BMC Psychiatry, vol. 19, no. 1, p. 234, 2019, doi: 10.1186/s12888-019-2220-6.

[7] S. Dokoohaki, M. Ghareghani, A. Ghanbari, N. Farhadi, K. Zibara, and H. Sadeghi, “Corticosteroid therapy exacerbates the reduction of melatonin in multiple sclerosis,” Steroids, vol. 128, pp. 32–36, 2017, doi: https://doi.org/10.1016/j.steroids.2017.10.006.

[8] S. D. Youngstedt, “Effects of Exercise on Sleep,” Clin. Sports Med., vol. 24, no. 2, pp. 355–365, Apr. 2005, doi: 10.1016/j.csm.2004.12.003.

[9] M. P. Herring, P. J. O’Connor, and R. K. Dishman, “The Effect of Exercise Training on Anxiety Symptoms Among Patients: A Systematic Review,” Arch. Intern. Med., vol. 170, no. 4, pp. 321–331, Feb. 2010, doi: 10.1001/archinternmed.2009.530.

[10] G. Lindseth, B. Helland, and J. Caspers, “The effects of dietary tryptophan on affective disorders,” Arch. Psychiatr. Nurs., vol. 29, no. 2, pp. 102–107, Apr. 2015, doi: 10.1016/j.apnu.2014.11.008.

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