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On a different tack, I am wondering about the timing of prednisone for minimizing morning pain and stiffness. I am thinking of splitting my dose in a different way: taking part at 2 AM (if, as I often do, I wake up then) and part after breakfast.
A post I found on a British forum explains why I might want to try this:
"A study found that the optimum time to take prednisone for minimal morning symptoms is 2am, Prednisone is absorbed in about an hour and then processed by the liver to make prednisolone which also takes about an hour, getting the level in the blood to its peak by about 4am which is when the inflammatory substances are shed in the body. By having the antiinflammatory effect present in advance, the inflammation never gets a hold and there are fewer morning symptoms. In the case of prednisolone, you can take it about an hour later as it doesn't need the time to be processed by the liver but is active as soon as it is absorbed.
The trigger for return of adrenal function is a low level at midnight or thereabouts. By taking the pred at 2-3am you allow the maximum possible time for the pred to be washed out of the body by midnight. (It takes 5.5 half lives to get there and that is up to 22 hours)."
Source: https://healthunlocked.com/pmrgcauk/posts/149131000/purpose-of-taking-prednisone-at-2-am
I have looked for the study alluded to but haven't found it. Has anyone tried this?
Replies to "On a different tack, I am wondering about the timing of prednisone for minimizing morning pain..."
Yup when I first started taking steroids I realized I needed to take them between midnight and 2 am for maximum effectiveness, otherwise I would wake up with terrible myalgias and no additional amount throughout the day would relieve it! It was like my body was busy self-destructing in my sleep and the better I slept, the worse the symptoms were upon waking. Now that I have been taking them for a while my issue seems more to be with combating fatigue perhaps from being on a lower dose and possibly secondary adrenal insufficiency…I ‘run out of gas’ between 10 to 11am and need naps fairly often. I am experimenting with dose splitting but haven’t found the perfect timing yet because my work hours can be very unpredictable…
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I have taken prednisone at 2-3 am and it did make a difference for me. I would like to see what that study says.
I took prednisone at 2-3 am out of necessity. My job demanded that I call in sick early so they could replace me if I wasn't able to function well enough to work at 7 am. I couldn't wait until later to decide I was too sick to work.
I would routinely wake up in pain at 2-3 am . When I woke up in pain at 2-3 am, I would take my prednisone dose. Most of the time I was good to go to work by 7 am no matter how badly I felt at 3 am.
I never thought it had much to do with inflammatory substances being released only at 3 am. In my opinion, it had more to do with the circadian rhythm of cortisol levels in the body.
Autoimmune disorders are associated with "chronic inflammation" meaning it is happening all the time. The inflammation isn't caused by sudden spurt of inflammatory substances released only at 3 am in the morning. When you think about it, your immune system is on constant alert and can respond instantly when there is a threat. The perceived threat in autoimmune conditions is always present so the inflammation never completely stops.
My PMR pain was always present which makes me think the inflammation was always present. My inflammation markers could be done at anytime of day and were generally elevated. PMR pain was only partially relieved with prednisone. The greatest pain relief happened within a few hours after taking my prednisone dose.
Cortisol is what regulates inflammation. Normally, your cortisol level is at the lowest at midnight and gradually increases during the night and peaks between 6-8 am. The cortisol your body naturally produces is insufficient or not being produced when we take prednisone.
When the cortisol we take in the form of prednisone starts to decrease at 3 am we need more cortisol. This would happen when my last dose was sometime around 8 am the previous morning. The prednisone dose I took at that time was starting to wear off at 3 am. In essence, I would wake up with pain and think it was time to take some exogenous cortisol in the the form of prednisone.
When I took prednisone in the evening, I usually didn't have pain during the night. However, my higher than normal cortisol level would keep me awake and it was hard to sleep well.