How steroids affect your sleep
If you’ve been prescribed steroids, you’ll likely experience difficulty sleeping, with unwelcome feelings of excitement, agitation, or even mania keeping you awake at night. Poor sleep is one of the most common side effects of steroid use and can happen after the first dose. In a recent study of asthma patients, more than half of those exposed to steroids reported trouble sleeping.
A lack of sleep can impact every aspect of your daily life, but simple changes to your routine, such as when you choose to take your steroids and trying to maintain a fixed sleep pattern, can really help.
Why do steroids keep us awake?
Steroids are powerful medications that affect the brain and body in a range of ways that can make it difficult to sleep - particularly when they are taken in the evening.
Dr Jane McDowell, a respiratory doctor and academic clinical lecturer at Queen's University Belfast in Northern Ireland, explains:
“We all have small glands in our bodies called adrenal glands. The adrenal glands make steroids and start producing them early in the day, around five o'clock in the morning, peaking at nine o'clock in the morning before decreasing production over the course of the day. This leads to very low levels overnight.
“Whenever patients are given steroid treatments, the doses are much higher than our bodies produce normally. In addition, [they] stay around in the body for a lot longer.
“This means that instead of having very low levels of steroids at nighttime when you're going to sleep,[steroid-treated patients]often have much higher steroid levels and this disrupts sleep, reducing sleep quality and the length of sleep.”
Steroids affect our sleep by:
Increasing energy levels and alertness
Steroids, such as prednisone, can leave you feeling more energized and alert than usual. This heightened state can make it difficult for you to quiet your mind, relax, and fall asleep.
Altering sleep cycles
Steroids can disrupt your natural circadian rhythms, which are the internal processes that regulate your normal sleep-wake cycle. These disruptions can make it difficult for you to fall asleep or stay asleep.
Affecting you on a psychological level
As you may already know, steroids can cause mood swings, anxiety, and increased stress. These can also play a part in keeping you awake at night, in some cases leading to insomnia.
Affecting you on a physical level
Steroids cause other physical symptoms that can interfere with your chance of getting a good night’s sleep. These include things like an increased heart rate, sweating, and muscle cramps.
Take your steroids as soon as you wake to reduce their impact on your sleep.
What to look out for
Dr McDowell recommends keeping an eye out for any changes in your ability to fall asleep or to stay asleep as well as looking for patterns and recording what you find.
“The main thing to do is to look for patterns and if sleep is becoming a real problem to make sure that you speak to your clinician to make sure that your steroid dosage is at the lowest it can be and to make sure that there are no other factors such as depression or anxiety that could be influencing your sleep.
“Sleep is very important. So if it is becoming an increasing problem, it's worth seeking medical advice.”
Top tips for a better night's sleep
Getting a good night's sleep is fundamental to both your physical and mental well-being. Here are Dr McDowell’s top tips for improving the quality of your sleep:
1. Take your steroids as soon as you wake up
Taking your steroids early in the day can help to reduce their impact on your sleep.
2. Commit to good sleep hygiene
Maintaining good “sleep hygiene” (healthy habits) is crucial. Try your best to:
- Keep a consistent sleep schedule. As much as you possibly can, aim to go to bed and wake up at the same time every day.
- Create a comfortable sleep environment — cool, quiet, and dark.
- Avoid stimulants such as caffeine and nicotine close to bedtime.
- Limit your exposure to screens including computers, tablets, and smartphones in the hours before bedtime. The blue light they emit can really interfere with your ability to fall asleep.
3. Exercise regularly
Regular exercise helps improve sleep quality, gentle, relaxing exercises like yoga or stretching in the evening can be beneficial. It’s best to avoid vigorous activity close to bedtime.
4. Keep an eye on your diet
Avoid large meals, big drinks, and alcohol before bedtime. Some foods promote sleep, consider foods containing tryptophan (e.g., turkey), magnesium (e.g., pumpkin and chia seeds), and calcium (e.g., green leafy vegetables).
5. Avoid caffeine in the afternoon
Even if you are feeling tired, avoid caffeine after 2 pm.
6. Reduce your stress levels
Techniques such as deep breathing or meditation can be helpful in managing stress and promoting relaxation before bedtime.
7. Adjust your medication (with a doctor)
If sleep issues persist, it’s essential to discuss them with your healthcare provider. They may adjust your steroid dose, prescribe a different formulation, or offer additional medications to help you manage your side effects.
To hear more from Dr McDowell, watch our film on sleep.
The bottom line
While steroids are an incredibly useful medication for helping patients manage inflammatory and autoimmune conditions, they can really make it difficult to get a good, restful night’s sleep. By making small changes such as taking your steroids as soon as you wake up in the morning and keeping a consistent sleep routine, you can improve the quality of your sleep.
If you are at all concerned, make a note of your symptoms and speak with your doctor as soon as possible.
Remember, always consult your doctor before making any changes to your medication or lifestyle to ensure the best care for your specific health needs.