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Inverse relation between sleep and PMR symptoms
Polymyalgia Rheumatica (PMR) | Last Active: 5 days ago | Replies (4)Comment receiving replies
I split the dose of prednisone, breakfast and dinner, 7:30am and 6:30pm more or less, pretty consistent. The sleep issues are pre-existing, and not particularly due to the prednisone though I suspect it doesn't help. I don't have problems with overnight pain. It's not surprising that PMR symptoms can be worse on rising, but I am struck that both the soreness and the extreme fatigue (which I see as a PMR symptom) are less likely to occur if the sleep is disrupted. Puzzling to me.
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"I am struck that both the soreness and the extreme fatigue (which I see as a PMR symptom) are less likely to occur if the sleep is disrupted. Puzzling to me."
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This is puzzling to me too.
Extreme fatigue might be a problem with your cortisol level. I had a problem with adrenal insufficiency when I tried to taper off Prednisone. The fatigue was "overwhelming" until my cortisol level improved. The overwhelming fatigue improved as my cortisol level improved a few months after tapering off Prednisone.
Cortisol also plays a role in your sleep/wake cycle. Cortisol levels vary on a circadian rhythm and are lowest during the night and peak in the morning to promote wakefulness. A low cortisol level at night allows inflammation to increase at night because more cortisol is needed to regulate inflammation. A disrupted sleep/wake cycle can also cause more inflammtion.
Hormones are complicated but the following link attempts to explain the circadian rhythm of cortisol.
https://pmc.ncbi.nlm.nih.gov/articles/PMC8813037/
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If your cortisol rhythm is disrupted then your sleep cycle is disrupted. Disruption of this natural rhythm because of stress, poor sleep hygiene, or shift work, can lead to disrupted sleep, elevated inflammation, and difficulty falling asleep and staying asleep.