My Dilemma

I always took my am first thing in the morning

Hi Ingo,

I can't remember how much pred you are on but I think it was above 10mg.

I was taking my pred (unfortunately back at 10mg reducing to 9mg after a flare) at about 10:00pm and was really having trouble sleeping.  On the advice of Mrs. O and others I started taking it at between 10:00pm & 11:00pm and it seems to have helped.  I do have prescribed sleeping pills that I will take if I have a few nights of being up during the night but that is rare now.

I hope you find the magic formula because the fatigue from PMR is bad enough without lack of sleep.  Oh, don't forget a short siesta is a real energy saver.

Sweet dreams😴😴😴😴

Diana🌸

The antiinflammatory effect of pred lasts for between 12 and 36 hours - if you are lucky and at the higher end then you will be able to take pred once a day and the effect will last until the next dose. Some doctors, especially in the US, suggest splitting the dose if you can't find a good time to achieve that effect. Usually they suggest about 2/3 in the morning and the rest in the evening. Or you have to decide when being stiff is least of a pest. Many people have tried waking early, taking their pred with a drink and sandwich/yoghurt they took to bed with them and then settling down again for another couple of hours before getting up for the day - that might help if you can identify the latest point that achieves reasonable results for the morning and it still working for bed. You are looking for about one and a half to 2 hours from taking the tablets to the peak blood level.

I had this problem except I took them at 4 am.

I split the dose into 2 lots taken about 12 hours apart.

Sorted.

My doctor gave me prescription for cyclobenzaprine 10mg. That really helps me sleep.

After my first month of taking pred at 7:00 am, I began taking it at 2:00 am, since I like being able to take early morning walks, etc.  It was fabulous! What a difference. I had heaps of energy and absolutely no morning stiffness.

However, as I started to reduce, I started to get the “wearing off” effect in the evening, and sometimes would go to bed with pain in various places in varying degrees. Sometimes the pain bordered on being quite severe. When I shared this information with the rheumatologist, she suggested I split the dose.

So I began experimenting. I am on 11mg at the moment. As the pain in the evening was getting increasingly worse despite my excellent mobility during the day, I decided I would not consider any kind of pred reduction until I found some sort of equilibrium in pain management. Initially, I tried a half dose at 2:00 am and half dose at 2:00 pm. Results were somewhat improved but some morning stiffness returned. Then I changed to 8mg at 2:00 am and 3mg at 2:00 pm. I found the effect was better in the morning in particular, and the pain in the evening still abated somewhat. I continued my method of “trial and error” and for the past month have been on this schedule: 8mg at 2:00 am, 2mg at 2:00 pm, and 1 mg at 5:00 pm. For me, this is a very harmonious balance. (At one stage I did try to go back to 7:00 am/single dose but I did not like waiting for the stiffness to subside.) To be honest, I would prefer one dose a day but I do not feel this is an option at the moment for me personally. Also, while taking medicine twice a day is manageable, having to remember to take medicine three times seems to be a bit excessive, particularly if you are a person like me who never even took aspirin before PMR. While I would not recommend it for anyone else, this is what works for me at the moment.

As I work from home in front of a computer, I have prompts to remind me when to take my medicine, as necessary. When I go out for the day, that is another story and I am very likely to be late at taking medicine even with my iPhone prompts, but I accept this risk.

Because of rearranging my schedule, I did not reduce my pred even by 0.5 mg in the last 2.5 months, but I feel better now and confident that I can reduce. I intend to reduce by 1mg next week, probably like this: 7.5mg at 2:00 am, 1.5 mg at 2:00 pm, and 1mg at 5:00 pm. Or, I just might go from 8mg to 7mg at 2:00 am to simplify things. If this does not work, I will try something else, or I will just go for a 0.5mg reduction. The split reduction, I imagine, will be more of a challenge in the process of reduction. But I will continue to experiment with caution.

In the same way I accept my PMR, I accept that my management of it has to be “tailor-made.” At the same time, I derive confidence to experiment from all the good advice I receive from this site (thank you, everyone!) and from the support of my rheumatologist. I hope that some day I can return to one dose and then NO DOSE but in the meantime, I will cater to pacifying my unique aches and pains when and where they occur. Hope sharing my experience helps you a little, and that you can find the best way for you.