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Conflict with Rheumatologist over taking Prednisone for PMR in AM/PM
Polymyalgia Rheumatica (PMR) | Last Active: Jul 29 2:54pm | Replies (29)Comment receiving replies
"Taking Prednisone in the early morning mimics the circadian rhythm of cortisol release more closely."
That's what some doctors say. Others recommend delayed release prednisone tablets to be taken at night that take effect before we wake to do away with morning waking pain. (Delayed release are not available in Australia). Split doses are recommended by other doctors to control morning pain, usually with the recommendation that no more than 1/3 of the daily dose should be taken at night.
One reason for not dosing at night, or for keeping the evening split dose fairly small, is that it can upset sleep in some people. That doesn't seem to be the case for @brian1950 and others of us who take a split dose.
Although it's repeated often and I used to repeat what you're saying too, the graphs of actual natural cortisol production say otherwise. Natural cortisol drops fast after we wake up.
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I guess you could read from the chart that it tails off fast but it still says between 6a - 9am is the highest all day. Yes it tails off but I dont read the chart contradicting anything that was said. Its highest in the morning and tails off to nothing but midnight. I did read somewhere, to lazy to go look, that people that work night shift or up during the evening manage to manipulate their circadian rhythm. It definitely was not me. I worked third shift for about a year. About died from no sleep. I think Brian1950 original question was why the Rhumy pushback. I think this is a good explanation but only his DR knows. I say whatever works best. Maybe Brian1950 sleeps all day. I take about an hour nap.