Splitting low dose of prednisone?

Hi Nick,

How did you choose the 1 am time?  Is that convenient for you or do you set your alarm to take it?  I usually go to bed about 11 and get my only uninterrupted sleep between then and about 4 so not sure if I should mess with that. 

Also how did you decide to take the slightly larger dose in the evening vs in the morning?

thank you for your comments!

I agree with you.  I have seen this explanation on her before about the release of cytokenes, but my sleep is my priority.  I have trouble sleeping.  If I were to set an alarm to take any mediction during the middle of the night, it would destoy my sleep.  Also, with the non coated prednison, it is very important to have food.  Eating would even make sleeping harder to get back to.  My split is breakfast and dinner.  I take a proton inhibitor about 45 mintues prior to those two meals.  My doctor is very insistent that I do that.  Once I started doing this pattern, I have been totally pain free.  Based upon the no pain factor foe me, I am not going to try something that would interfere with my sleep patterns.  This may not work for all, but the taking of the prednisone in the middle of the night may not work for all either.  I try to listen to my body.  I am eager to hear how people splitting their dose when it is a low dose have faired.  I am planning to continue doing the split as I go down to a lower dose.  Keep me posted as to what you decide to do.  Donna

All good questions.. I am up late and don't go to bed until 1-1:30AM, so I take pred just before I go to sleep.  The study that I have read shows that cytokines peak at 4:30 is higher. To match that, my dose late at night is higher. That was the logic.

However, at the lower dose (7.5 and below) our adrenals are waking up and they also tend to be more active between 2 and  5AM. It is a question if late dose interferes with adrenal production. I have not found clear answer.   I think that someone mentioned one study that implies that taking pred late at night could impair adrenal "re-start", but I have seen some comments that it is not conclusive and maybe other factors were in play. Who knows? Maybe it would be beneficial to reduce bedtime dose and increase morning one.

Each one of us is different , so it is OK to experiment and find the best time to take medication to match our daily schedule.

Thank you for explaining your dose timing. More things for me to consider!

That was my feeling too.  Being pain free seems to be the main goal.  Good luck!!!

I've just been to western Canada for 3 weeks, a 9 hour time difference, back to Chicago for a week, 3 hour time difference and now back home. Can't really say I noticed a lot of difference whatever time it was. Some of the cortisol production change (not adrenaline) must be associated with the jet lag feeling but I never suffer desperately badly with that.

I'm very tired now I'm back - but I had 24 hours working/travelling without a break and who can sleep on a 7-hour red-eye flight back to Europe that leaves late evening and arrives early afternoon and includes 2 "meals"?

Thanks Eileen, It was just a thought that maybe it was the body adjusting or maybe other effects. 

Had similar 'problems' on the flight back - Flybe supply 'meals' (had to pay for them)  at a very inflated price and not very good at that.  On the other side of the aisle was a very young child  who didn't enjoy the flight at all!  Packed us in so tight on these budget flights you can't settle down for a quite nap as I was on an aisle seat with other getting in/out and every time someone passed me I got knocked about, was glad to get back home.  I thought it would be cooler but how wrong - it's up to 30 deg. already, and no sign of rain!!

It probably is - and we are all different.

Never mind budget flights - I was on Lufthansa coming back and it was less than ideal! Going out we were on United - if nothing else, their international flights have lovely big seats with extra legroom (they boast about it apparently, one good thing about the size of the average uS citizen, but it doesn't apply on internal US flights). And the girl in the window seat moved to be closer to a friend so we got 3 for the price of 2!!!! Luxury...

The LH meal was a bit pathetic though their wine was OK  - I don't actually know why they feed you, a decent meal at the airport would be better, but we flew out of Chicago O'Hare Terminal 1 which is really an internal terminal and there were too few seats at the gate plus the choice of shops and eating holes was awful. Another plus for requesting assistance - we got a special area to wait in  

I guess the average Canadian must be a midget, then, as I have never been so uncomfortable on my journey as I was the last time I crossed the Pond about two years ago.  All to fit in an extra row or two of seats I guess.  

It was a flight to the USA, not Canada. The Westjet flights were fairly rubbish!

Should have clarified that I travelled with Air Canada.  I think I knew you were going via USA.  Chicago and all!  I was referencing your comment that average US citizens are, how shall I say it,  to quote McCall Smith "traditionally built".

I never saw any Canadians to compare with the generous proportions we saw in the uS. However, the biggest person we saw was in southern Germany - he even had a special table reserved for him in the restaurant/bar as he would have struggled to get behind any other... 

That is really so very sad. 

This one made me smile.  I am in the U.S.  We keep saying tthat wlhen McDonalds started super sizing their fries that people ended up bering super sized.  It kinds of blows my mind to see how many younger Americans are "generous" in proportion.  I am from the old school so probably considered to be underfed.  :-)  I just had to "weigh" in on this - pun intended.  

I was concerned I might offend someone! It was horrifying over the last few weeks to see some of the "generous" sized people. On the Alaskan cruise there were a lot of morbidly obese people - and many relatively young. When you see an entire overweight family where the young teen child was easily heading for double my weight already, the mother was using a mobility scooter and the father could only walk using a walking stick/cane - surely their eating habits have SOMETHING to do with it? They were always to be found in the cafe - where there were free of charge unlimited cakes and desserts to go with the iced coffees/lattes that are heaven knows how many calories per serving...

This is a trend that is very frightening.  It has been said here that life expectency is actually going down.   When eating healthy has become such a trend, it is confusing to me.  In the 70s, our family had a foregn exchange student from Spain.  A few years ago when he came for a visit, he asked me if people were bigger than they used to be.  Well, yes, they are.  I do not know if doctors don't say anything for fear of huring feelings or what.  Sadly the family with the father with the cane, the mom with the scooter, and the overweight child is becoming common.  We had neibhors who fit that description.  Sometimes the airlines have tried to make people pay for two seats.  That has caused problems of "descrimination" for the airline.  Anyway, you did not hurt my feelings, and I am sure that many on this site would agree with you.  Type 2 diabetes is rampant here too.  It is really sad. Have a nice evening, it is morning here.  

There's a whole slew of reasons why this has happened.  Not only are the children fed an appalling diet, empty calories mostly, but they also don't get any exercise.  We can blame all sorts of things, but a key issue was the prevalence of automobile culture which destroyed city neighbourhoods and gave rise to car dependent suburbia, and the simultaneous rise of television.  I understand that until trans fats were eliminated from processed foods this also was a major contributor to health and weight problems.  With the extreme food insecurity in many urban areas I don't know if things will get much better soon.  It's interesting that in Detroit there's been a movement to reclaim some of the now deserted streets as urban farms and community gardens. 

I agree.  When I was a kid, we played and played and played.  The kids are now stting in front of the TV and playing on their "smart" devices, activities that are not too smart in my opinion.  There are three schools near my house, the conjestion of cars picking kids up after school is horrendous.  I am sure that if kids walked in groups to their homes, they would be very safe.  Parents seem to think that there are predetors out there at all times ready to snatch their kids.  Predators have always been out there.  There is safety in numbers.  The kids eat fast food, fried foods, and just make poor choices.  It is surprising in some ways since there is such a movement toward gardening and eating fresh that this is still a huge problem  I think some of it is laziness too.  Preparing healthy meals in the home takes time and effort with good shopping and all.  I guess it is easier for parents after working all day to just grab burgers and fries.  With all of the education out there, it is sad.  I have grandkids who are being raised to eat properly and there is not a fat one in the group, so for that I am very grateful.  They are active in sports and are not allowed to sit around with video games.  Maybe I did something right there.  I hope so.

I don't see much obesity here.  There is some, but most people are normal or just a bit plump.  Even so, I think there is a similar diabetes epidemic, and I don't know why, unless it's something to do with a corrupted food supply which is making it really hard to eat a balanced diet without having a degree in chemistry!

If it were a corrupted food supply, I think it would be more widespread to all.  I think it boils down to choices and not moving around more.  That may soudn simplistic, but I just think we need to get back to not having everything processed.  

A lot of it on your side of the pond is the massive use of HFCS - high fructose corn syrup - in manufactured baked goods. It is cheap and allows very long use-by dates so increasing profits for the companies. That increases calories and palatability and they eat and eat and... HFCS is now implicated in the development of insulin resistance and, eventually, Type 2 diabetes. There is a massive amount of carbohydrate being eaten, particularly sugar, compared to when we were children. That increase has been paralleled by the increase in body weight and diabetes - paralleled enough to make it very likely there is a strong correlation.

Far less HFCS is used in Europe but the portions have more than doubled in size - and people clean their plates. Did you know that the size of dinner plates has increased from about 9" in the 1960s to 12" and more these days? Use a smaller plate and you are better satisfied than if you put the same food on a big plate.

There's nothing wrong with a burger - but not the 10oz one which was what was offered at a nice restaurant around the corner from the hotel! The whole week the food on offer at the conference was pastries and muffins at breakfast, we had little time to do more than seek fast food at lunchtime as lunch wasn't served, the mid-morning and afternoon snacks were more pastries and packets of chips and other such delights (the brownies were to die for mind!). The evening meal one night was sliders of some sort (I did well, I got a plate of the fillings being allergic to wheat!). At the banquet the steak was at least a pound in weight. Totally unnecessary - I think I was the only person who managed to eat it (David's actually) because I asked it to be packed and used it for lunch next day.

I've lost a pound since I got back - in 3 days!

I think there's more than one reason we all got PMR.  In many cases I think one of the triggers may turn out, on further research, to be diet.  How else to explain why many of us start to feel better overall when we improve our diet to deal with pred side effects?  I have been eating as healthfully as I could all my life.  And I've made a lot of changes and eat much better now.  In fact I feel bad that I didn't know more when I was raising my kids, although I guess one can only do one's best with the knowledge one has at the time.  

I doubt they will ever prove that - there are too many variables - but yes, there are probably a lot of triggers but as yet not one common factor. It's a load of factors that stress the immune system at various times and finally one tips the scales and you develop some form of autoimmune disorder. 

It could, after all, be worse...

I think that just as all our roads to recovery are different, so too is the cascade of events which placed us all in the PMR club.  Not quite as easy for the researchers as pointing to a pathogen - although I would be surprised if those weren't also implicated to some extent!

I agree about the processed food, and that is partly what I meant when referring to corrupted food.

It doesn't seem that hard, lots of "fresh" fruits and v veggies, seafood, boneless skinnless chicken breasts, unroasted nuts, primarily walnuts and pecans are my choice, oatmeal from old fashioned oats, just staying away from the processed stuff is a good start.  My snacks are always green apples, oranges, seasonal fresh fruits, lots of resh salads with avocados, apples, raisins and fresh dressing made with a very good olive oil, etc.  Of course, I am home, so I can prepare these things.  It is harder for working moms.  

Donna, there is another issue here, and that is the existence of "food deserts" much worse in your country than mine, but present here as well, where the poorer members of society simply do not have access to the kind of diet you are suggesting, and which we all agree is the best.

Education is also a factor, and the type of food provided in many schools is apparently not up to snuff and does not teach the children good choices.  When Jamie Oliver attempted to make this issue more widely known he encountered a lot of opposition.

Opposition from school boards, for example, not the children.

This may be true about diet.  Since I have always eaten all of the fresh things, lean foods, always exercised, walked daily, etc., etc., etc., my doctor really thinks that it was a bad fall that I had in early March.  I have written of that here before, but you may not have seen it.  I tripped, landing on all fours.  At the time of the fall, I actually felt the muscles in my back jerking.  A few days later, I could hardly get into bed without my back muscles just aching.  A couple of weeks alter my four extremities started aching as if I had been doing pushups and squats for hours, I was just sore all over.  I do have a slight tear in my left rotator cuff.  A cortisone shot has so far held that pain at bay.  My blood work definiely showed PMR.  It was the rheumatologist who said that the fall probably did do this to me, so my recovery may be different than others too.  Only time will tell.  Until I split my dose, my wrists were almost unusable for a few hours, they are fine now.  Oh, I also went to the gym three times a week and had a trainer, so this has been very foreign to me.  I do agree abotu poor diet, I just don't think it fits here.  My mom was a total maniac about us eating a balanced diet of fresh foods.  We always had a garden.  Of course it helps to live in California where a person can have a garden all year long.  I am blessed with that and a warmer climate.  

That was awful about your fall.  I think you'd be amazed how many of us on this forum can point to an incident, a fall or an illness, or some sort of major life stress, as the straw which broke the camel's back and triggered PMR.  I think that I'll never go back to eating as much wheat as I used to.  And I ate very little processed food.  It was whole grain bread, organic breakfast cereals, that kind of thing.  But now that I've cut back severely on wheat I find that when I have what I used to consider a normal amount of it, it makes me all gassy and sometimes I get a headache.  That isn't a good sign, is it?  And I was one of those who completely dismissed my friends who were trying to go wheat free, gluten free. I'm not saying its always or only wheat, but there is something in our diet which is affecting even those of us who eat healthy!

I totally agree with you.  I go for whole grains too, and I used to go for the whole wheat as we had been programmed to think that was the key.  I have a dear friend in France who has celiac disease.  It took months for the full diagnosis on her as her primary compalnt was of muscle pains.  She did not have PMR, but they just couldn't get to the root of it until they did the proper testing. So, she really is a case of having to be gluten free.  I talked to her for quite a while after I was diagnosed with PMR.  I did go gluten free for a while as a bit of a test, but found no difference.  She has to read labels for everything.  She said she has even found gluten in vitamins.  I spent a couple of week with her last summer.  She has found some really delicious gluten free breads.  One of my favorites that she served me for breakfast was a gluten free cinnamon raisin toast.  I couldn't get over how tasty it was.  I did keep thinking that I am not sure I could live in France with all of those croissants and not be able to eat them.  Ha Ha  Yes, I think that probalby all of us can think of an event that preceded our PMR.  Since my fall jarred my back muscles so badly, it was pretty easy for me to make that connection and the rheumatologist agreed with me.  Funny speaking of eating.  I just had a salad.  I got carried away in making it.  It was enough for three people.  It had a variety of fresh greens, an avocado, a green apple, raisins, pecans, and my olive oil and vinegar dressing that I make and about a 1/4 freshly grated romano cheese.  I was actually getting tired chewing and eating it.  LOL  Sure was tasty though.  Reading about fresh ginger on here made me wonder how that would taste in a salad.  I might give it a try, but I don't have any in the house right now.  :-)  Thanks, Donna

I'm sitting here thinking I should make supper (it's 6 pm) but tired of salad!  I don't think it's gluten.  I'm usually fine with rye and oats. Apparently wheat is dessicated by application of glyphosate.  That probably isn't doing us any good as it happens at harvest.

I agree, I think there is something about the wheat thing for sure.  I get tired of salad sometims too.  One thing I do a lot is get different kinds of squash, red onions, minced garlic, red bell pepper, or any pepper, and slice them up. I layer them on a large cooking pan, spritz with olive oil (I keep olive oil in a apray bottle) sprinkle parmesan cheese over the top and bake at a fairly high temperature for about 35 to 40 minutes.  I often serve this with salmon. I love salmon.  It really makes a very tasty meal.  

I don't travel much but recently visited an area that is 4 times zones ahead of my home. I just continued taking my Pred with breakfast which would be like taking it at lunch at home. I didn't feel any different and my aches started up during the night as usual - guess my body got in sync with the new time zone pretty quickly.   I can't remember how many days it took for this to happen. 

Its interesting to to read that Eileen travelled east to west across a lot of time zones and also didn't notice much difference. This PMR sure is puzzling!

I have to say - I never get tired of salad at home but after 4 weeks away, 2 of them effectively in the USA, I don't care if I NEVER meet a Caesar salad again! I so missed my olive oil, herbs and vinegar dressing and the wide choice of salad foods - iceberg lettuce is disgusting and the croutons even worse. Here I probably eat more salad/veg in a day than I managed in nearly a week there! And I roat veggies a lot - but just with herbs and olive oil, no cheese.

The wheat thing is thought to be something in the structure of the starch part of the wheat - due to the high commercialisation and breeding for high yield etc - and which trigger an allergic reaction in many people. I can eat Canadian soft wheat but not the hard durum wheat used for pasta and bread outside Canada and this is apparently not uncommon. Here it is quite easy - I can get pure rye, spelt and kamut breads and pastas if I want them - but in the UK it is not at all easy even now, just gluten-free most of the time. GF bread is awful - the pasta is fine though.

In a lot of cases the Parents!

I agree, I put so many yummy things in my salads that I am not a big fan of salads at restaurants and do get tired of Caesar which doesn't have much nurtritonal value anyway.  I love to add strawberries, different kinds of nuts, olives, raisins, dried cranberries, the list goes on.  I always make my own dressing too.  I do not like most commercial dressings at all.  Years ago I ate a lot of bleu cheese dressings, but have just totally switched over to my homemade dressing.  I do like Parmesan, Romano, or Asiago sprinkled on top to add a bit of flavor and protein.  

My dear son planted us a garden, so my salad-making lately has consisted not only making it, but actually harvesting it.  And I was "tired" of everything by suppertime yesterday.  Must plan better today.

True, so the educational thing really must cut across generations.  Most important to get the children on board, though.  Lots of our local schools have started small gardens.  It's just a pity that they are on summer holiday during the best part of a vegetable garden.

We have small garden that I work with my daughter.  I do hard stuff ( digging, etc) and then she plants and takes care of the garden.  We have some herbs and basic stuff, lattice, tomatoes ( several kinds), cucumbers, bell peppers, anions. My daughter picks tomatoes and other veggies just before supper.  She is so proud when she brings them in... because it is her garden.

One year I gave my younger son (age 9 or so?) for his birthday a bunch of peat pots and some seeds.  We still have, many years later, shasta daisies from that initial gardening project.  He's the offspring who comes home every weekend and helps maintain the garden we now have.