Try these doctor-backed solutions

If you're taking steroids like prednisone, prednisolone, or dexamethasone, you're not imagining it: sleep can become a real challenge. Trouble falling asleep, waking up at odd hours, or just not feeling rested in the morning are very common complaints. 

 

But the good news is, you're not alone, and you’re not powerless. With a few smart changes and evidence-based strategies, you can reclaim your sleep and start feeling more like yourself again.

 

Here's what works, and why.

1.  Dose timing: morning matters

One of the most effective ways to reduce steroid-induced sleep problems is to take your dose in the morning, ideally before 9 a.m. This mimics your body’s natural rhythm of cortisol release, which peaks in the early hours. Taking steroids later in the day can trick your body into thinking it's daytime when it's not, making it harder to wind down at night.

 

If you're unsure about adjusting your dose timing, talk to your doctor or pharmacist first. 

 

2.  Set a caffeine cut-off

Steroids can make you feel more awake than usual, and caffeine only adds fuel to the fire. Consider setting a caffeine curfew at least six hours before bedtime. That means switching to decaf tea or herbal drinks by mid-afternoon. And remember, caffeine isn't just in coffee, it's also in chocolate, some sodas, and certain painkillers.

 

3.  Bedtime rituals that signal sleep

Creating a predictable bedtime routine helps your brain shift gears. Start dimming the lights an hour before bed. Put away screens, or use blue-light filters. Consider gentle activities like stretching, reading a paper book, or listening to calming music. This creates a pattern that your body starts to recognize as a cue to sleep.

 

4.  Try relaxation audio or guided sleep meditations

Many people find audio tools helpful and can make a real difference. Look for guided relaxation or breathing exercises. These techniques can reduce the racing thoughts that steroids sometimes cause, making it easier to fall asleep.

 

5.  Consider melatonin (with medical advice)

Melatonin is a hormone your brain naturally makes to help regulate sleep. Steroids may suppress your body’s own melatonin levels, which can throw your sleep-wake cycle off course. Low-dose melatonin supplements (0.5mg to 2mg) taken about 30 to 60 minutes before bedtime may help.


However, it’s important to speak with your doctor or pharmacist first, especially if you’re on other medications or have health conditions that may be affected.

 

6.  Use sleep tracking mindfully

Wearable sleep trackers and smartphone apps can offer helpful insights. But try not to get too hung up on the data. The goal is not perfect sleep scores but spotting patterns, such as whether late-night screen use, late meals, or dose timing are affecting your rest. Use what you learn to make small, manageable changes.

 

7.  Doctor-approved medications

If your sleep struggles persist, speak to your healthcare team. Sometimes, a short course of sleep medication may be appropriate. Options include:


Antihistamines like promethazine or hydroxyzine

Melatonin receptor agonists such as ramelteon

Certain antidepressants with sedating effects, like mirtazapine (in very low doses)


These are not first-line solutions and aren’t suitable for everyone, but they may provide temporary relief while you get other strategies in place.


Final thoughts


Steroid-induced insomnia can feel frustrating, but you’re not alone, and there are practical ways to feel better. Start with the basics: morning dosing, reducing caffeine, and creating a sleep-friendly routine. From there, explore safe tools like melatonin, relaxation techniques, and, if needed, doctor-guided medication support.


You deserve a good night’s rest, and with the right mix of strategies, a good night’s sleep is still within reach.


Hear Dr Jane McDowell’s advice on reclaiming your sleep.