Prednisone is a drug used to treat a variety of conditions, but it can also cause insomnia. Individual people react differently to Prednisone and its related insomnia, but a few steps can be taken to minimize the effect.

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9+ Tips for Prednisone Insomnia Video Transcript

Transcription autogenerated from the video above so some errors are possible

Are you struggling to sleep while on prednisone? Well, I don’t blame you because prednisone definitely causes insomnia. Hi, I am Dr. Megan, your Prednisone Pharmacist, and right now I’m having flashbacks to when I took prednisone and I got such terrible insomnia. The reason I’m awake right now at the wee hours in the morning is because I have a toddler who is sick tonight and not letting me sleep

So here I am to talk about prednisone causing insomnia.

Is Insomnia even a side effect of Prednisone?

First of all, you might be wondering, does prednisone cause insomnia? And the answer is definitely yes.

Well, what’s crazy is if you look at the package insert, that little patient leaflet they print out at the pharmacy, it doesn’t say insomnia on it. It’s insane. Why would they leave that out?

Scientists did a study of people’s tweets about drugs and they counted every single time somebody mentioned “Prednisone” in a Twitter post. They found that people commented the most about which side effects? First, insomnia and second, weight gain from prednisone.

People are talking about prednisone insomnia all the time, but it’s somehow not listed in the package insert. Isn’t that wild? 

So yes, prednisone insomnia is real, but there isn’t a lot of great data about it. But let me share with you what we do know about it. 

What can I do about it? When does Prednisone Insomnia go away?

Well, to answer that, I have to explain how it causes insomnia first, and then I can explain more about the timing and how to make it go away. 

Prednisone, we’re taking it as an anti-inflammatory drug and it’s mimicking a naturally occurring hormone in our body called cortisol. Cortisol is amazing and it keeps us alive during emergencies like famines or war. It’s a stress hormone. And if we were in a famine or in a war, we wouldn’t want to fall asleep in a stressful time. So cortisol keeps us awake. 

It makes sense evolutionarily why our bodies would do this; so how does cortisol keep us awake?

There are 3 ways they’ve proposed in the scientific literature that prednisone causes insomnia.

1. Behavior changes

Through modification of the hypothalamic pituitary adrenal axis or the HPA axis, the cortisol system I mentioned above. We don’t want to die even though we’re so hungry, it’s keeping our species alive.

2. Changes in your sleep-wake cycle

Normally cortisol is secreted early in the morning and it falls off throughout the day. By the time you fall asleep, it’s nearly gone. And at that time melatonin goes up and then it falls off throughout the night so that when the cortisol’s ready to wake you up, it does. And they’re opposite and they balance each other out. 

But when you take prednisone or dexamethasone or any other steroid, it’s messing that cycle up and the melatonin stays low. And so you don’t get as much of that vampire hormone, that helps us get sleep at night. 

Prednisone is actually depleting melatonin from our bodies.

Other hormones that are affected include tryptophan. Tryptophan is the one we always talk about  you know, “The thanksgiving turkey is making it hard to stay awake” after the big feast because of tryptophan in it, right? That’s an amino acid that causes sleepiness. 

Another hormone is called orexin, it’s affected as well. 

3. Hyperarousal of the GABA-A System

GABA or Gamma-Aminobutyric Acid is important in keeping us calm. If it’s out of control, then it’s really hard to stay calm. It says they slow the rate of recovery of GABA-A and inhibit the transmission of GABA-A. So it’s blocking it and slowing it down, slowing the little pump down. So you’re not being able to use GABA-A as well. Other hormones that are affected could include Acetylcholine, N-methyl-D-aspartate (NMDA), Serotonin, DHEA, and Allopregnanolone. 

All of these hormones are being affected by prednisone.

So wow, no wonder prednisone is causing insomnia.

How Long Does Prednisone Insomnia Last?

But how long do these symptoms last then? If there’s that many systems being affected, how long does it last? Well, some of those recover really quick, but some of  them don’t.

Guess what it depends on? It depends on the dose you’ve been taking, the actual drug you’ve been taking, whether it’s Dexamethasone; which is long-acting or Prednisone or Hydrocortisone, which are shorter acting. The higher the dose generally the worse the insomnia.

Prednisone insomnia recovery depends on 1. the dose and 2. which drug you take

One study they did of Methylprednisolone, which is really similar to Prednisone; it’s also called Medrol. They showed that symptoms of either insomnia or mania developed within three days and persisted for the entire eight day course of therapy. Most people, it recovers after you stop taking it. But for a few people, mania, anxiety, other like jittery feelings don’t go away for a while and you need to get help from your doctor. There are medications they can prescribe that will help you out. 

How to Treat Prednisone Insomnia

So finally, how to treat prednisone insomnia or how to deal with prednisone insomnia. 

There are others in this scientific article that I’ve been referring to throughout this video. They said that most important thing is minimizing the dosage and duration. So the lowest number of pills, the lowest amount of time and then is usually reversed once we stop taking it.

They have an acronym called “Help Me Sleep,” published in a study specifically for people who are in in intensive care unit taking steroids in the injectable way:

H E L P M E S L E E P

• H stands for herbal tea or warm milk. 
• E is to evaluate a medication list for causes of insomnia, like steroids. There are other medications that do too.
• L is for limit nighttime in interruptions. So for example, not having the lab draws in the middle of the night poking somebody for blood, right?
• P stands for postpone morning laboratory tests. So do the testing in the morning, not in the middle of the night.
• M is for massage.
• E is for evaluate daytime activity.
• S is for sound reduction.
• L is for light reduction.
• E is for environment changes.
• E is for easy listening or white sound.
• P is for pain relief. 

So if you can get all that covered, then people are going to feel so much better. You will feel so much better while on prednisone. 

Remember, there are hormones that are being changed by prednisone. If we can replenish them, hopefully that makes it so you can sleep better. 

The easiest, most simple like option to counteract prednisone insomnia is because the cortisol and melatonin cycle is being interrupted because the cortisol you’re now taking is way up here. Then give some melatonin to balance it out.

Because your body’s not able to make melatonin as much anymore when you have such high cortisol. So give melatonin. That’s pretty simple, right? 

And if you’re wondering a really easy way to get melatonin while you’re on prednisone, since I suffered from that prednisone insomnia and it was awful. I came up with Nutranize Zone. It’s the first and only supplement for people on prednisone and it comes in two bottles because we want this bedtime one to have the melatonin in it to help you fall asleep.

So you can just take this to replenish melatonin! Plus, not only is melatonin depleted, but there’s actually at least eight other, if not 13 other ingredients in here that we are replenishing that prednisone has stolen. So you can go to Nutranize.com to get Nutranize Zone for people on prednisone.

References:

1. Cole JL. Steroid-Induced Sleep Disturbance and Delirium: A Focused Review for Critically Ill Patients. Fed Pract. 2020 Jun;37(6):260-267. PMID: 32669778; PMCID: PMC7357890.
2. Patel, R., Belousov, M., Jani, M. et al. Frequent discussion of insomnia and weight gain with glucocorticoid therapy: an analysis of Twitter posts. npj Digital Med 1, 20177 (2018).