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Inverse relation between sleep and PMR symptoms
I am tapering prednisone, currently at 10 or 11 mg. I observe that when I sleep poorly (up for part of the night, or rising at 4:30) my PMR pain and stiffness is reduced in the morning. If I only get up once or twice for the bathroom but sleep OK, it will be a bad morning: more discomfort, more fatigue. (The sleep issues existed before the PMR and prednisone.) Is this common? Symptoms increase with more overnight inactivity?
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I'm curious - do you take your prednisone at the same time every day, or does it vary by the time you get up? The body releases cytokines (inflammatory substances) during the night around 4 am. So if you take your prednisone early in the morning close to the time the cytokines are released, you might get better relief from your PMR for that day.
Sleeping poorly is a problem. Taking Prednisone won't help your circadian rhythm. For PMR symptoms to increase with more overnight inactivity is typical I would think. Since your sleep issues existed before PMR and Prednisone it is possible that your sleep / wake cycle was already dysfunctional and probably is a separate problem.
PMR symptoms of pain and stiffness are well known to be worse in the morning or after periods of inactivity. My pain and stiffness was so severe it woke me up in the early hours of the morning usually at 3 a.m. What worked for me was to take a small portion of my daily dose of Prednisone in the evening before going to bed. I was able to sleep the entire night without any pain. Getting a full 8 hours of uninterrupted sleep was good for me. I had a great day when I took the rest of my daily Prednisone dose in the morning when I woke up.
The combination of pre-existing sleep issues, the disruptive effects of prednisone, and PMR pain creates a complicated problem. I think we need more information.
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3 ReactionsI 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.
"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.