Do Steroids Cause Insomnia? How To Avoid It.

From that late-evening espresso to the thrill of an impending holiday or the relentless pressures of a busy workweek, numerous factors can disrupt our nightly slumber. Yet, what often escapes our notice is the stealthy role that steroids, commonly taken for allergies or inflammation, may play in keeping sleep at bay. Gaining a deeper understanding of the intricate relationship between steroids and sleep is crucial in safeguarding ourselves against sleep disorders such as insomnia. This awareness is key to not only recognizing the potential impact of these medications but also to implementing strategies to ensure a peaceful night's rest.

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What Are Steroids?

Corticosteroids or steroids are anti-inflammatory medicines that treat autoimmune and inflammatory conditions.

Corticosteroids reduce inflammation and weaken the immune system.

Steroids are prescribed to treat and manage conditions like the following.

Asthma
Atopic eczema
Hives
Hay fever
Lupus
Chronic Obstructive Pulmonary Disease (COPD)
Multiple Sclerosis
Addison’s Disease

Corticosteroids are different than anabolic steroids, which are used to increase muscle mass.

Types Of Steroids

Steroid medications come in different forms.

Oral medications
Injections
Inhalers and sprays
Topical solutions (creams, lotions, or gels)

Do Steroids Cause Insomnia?

Steroids usually don’t cause significant side effects if they are taken for a short time in smaller doses.

When used for more extended periods, steroids may cause the following side effects.

Increased appetite
High blood sugar levels
Swelling of limbs
Muscle weakness
Bruising
Weight gain
Cataracts
Sleep disturbances

One of the very commonly noticed side effects of steroids is sleep disturbances, including insomnia.

Insomnia is the inability to fall asleep or stay asleep all night.

People with insomnia don’t get good quality sleep at night, making them groggy in the morning.

An older study looked at the effects of hydrocortisone (a type of corticosteroid) on brain function and sleep. This study reports that hydrocortisone decreased Rapid Eye Movement (REM) sleep, which is associated with poor sleep quality.

Why Do Steroids Make It Harder To Fall Asleep At Night?

Studies suggest that steroids have similar structures to cortisol, the stress hormone.

The body makes cortisol when it is under stress. Usually, cortisol levels are high in the mornings and low at night to help the body rest.

Steroid medications disrupt the natural cortisol rhythm and keep the brain active at night.

Steroids may also reduce serum melatonin levels. Melatonin is a hormone produced by the brain during darkness.

Melatonin encourages the body to sleep. Steroids may cause sleep problems by reducing melatonin secretion.

Do All Types Of Steroids Cause Insomnia?

All types of steroids may cause insomnia when the dosage is high or the period of usage is extended.

Corticosteroid tablets may show substantial side effects because the medication affects all parts of the body compared to injections or sprays that have more focused areas of action.

Who Is More Prone To Steroid-Induced Insomnia?

The following are the risk factors for steroid-induced insomnia.

Type of steroids used (oral medication seems to cause more severe side effects than other types).
High doses of steroids or taking them for longer periods.
Existing sleep disorders.
Children and the elderly

How To Prevent Steroid-Induced Insomnia?

While it is clear that corticosteroids may cause insomnia, for some people, these drugs can be important and cannot be avoided.

So, here are some tips from sleep experts on handling the drug's side effects.

Tips From Sleep Experts

Dosage and period of use

All studies report that the higher the dosage and the more extended the period of use, the risk of insomnia is high.

A 2020 study reports that symptoms of insomnia may start from day three of corticosteroid therapy and continue for as long as the medication is taken.

Talk to your doctor about the dosage and period of use, and try lowering both if possible.

Timing of dosage

Taking steroids in the evening or before bedtime may increase the chances of staying awake. Morning doses seem to be better for this reason.

Replenishing lost melatonin

Since corticosteroids drain melatonin levels, replenishing lost melatonin may help fall asleep at night.

Talk to your doctor to see if you could start melatonin supplements while on corticosteroids.

Avoid Steroid Withdrawal Syndrome

Steroid Withdrawal Syndrome (SWS) is an unpleasant side effect of stopping steroids abruptly, especially if you have been using them for a longer period.

SWS can cause muscle stiffness, fatigue, joint pain, fever, or sleep disturbances. SWS could also be a contributor to insomnia.

Doctors recommend slowly waning off the dosage to help prevent SWS.

HELPME SLEEP

HELPME SLEEP is a nomogram created to help handle sleep problems in critically ill patients.

H - Herbal tea or warm milk
E - Evaluate the medications that may be causing insomnia
L - Limit nighttime interruptions
P - Postpone lab draws to mornings
M - Massage
E - Evaluate daytime activities
S - Sound reduction
L - Light reduction
E - Environmental changes
E - Easy listening sounds or white noise
P - Pain relief

Individuals struggling with steroid-induced insomnia can also pick up pointers from this nomogram to help handle the issue.

Some tips that can help include:

Drinking warm milk or herbal tea before bedtime
Staying away from screens or stimulating environments at night
Evaluating your steroid medications
Making sure the room is pitch dark when you sleep to improve melatonin secretion
Using white noise
Avoiding steroid medications at night

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Summary: Do Steroids Cause Insomnia?

Corticosteroid medications are often used to handle inflammatory and auto-immune conditions.
Prolonged consumption of steroid medications or using high doses may cause insomnia, a condition that makes it difficult to sleep.
Oral steroid tablets may have stronger side effects than nasal sprays, inhalers, or injections.
Studies report that steroids mimic the actions of cortisol, the stress hormone, and put the body in an alert state. Steroids may also deplete melatonin levels, lowering the ability to fall asleep.
Correcting the dosage and period of use, avoiding using steroid medications before bedtime, making up for lost melatonin, and gradually waning off the drugs to prevent Steroid Withdrawal Syndrome are all ways to avoid steroid-induced insomnia.