Fatigue and Sleeping Problem While on Prednisone

[Hamed]

Hi all,
This is my first post in this forum. I am 30 and as indicated in my medical history, I was put on prednisone since 2 weeks ago, starting with 40 mg and tapering 5 mg/week.
I started getting back to work last week (desk job, 8 hours/day).
I have two major problems:
1. Physical fatigue possibly because of long hours of sitting behind desk & Not doing any exercise.
2. Sleeping problem which worsens last problem: I go to sleep rather easily (from 11 pm) but wake up on 4~5 am, then I can't get back to sleep for 2 hours! I have to get up around 7 am to go to work.
This cycle of sleep deprivation is making me (& maybe my flare) crazy.
Has anyone on Prednisone have experienced this? I am wondering if I shoud go swimming or jog after work, but I doubt that this may hurt my flare-up.
Any advice is appreciated


---------------
Crohn's symptoms since 2000,
Diagnosed with Crohn's 2002,
Put on Prednisone & Pentasa 2002,
Reduced drugs to only Pentasa (2*400 mg) until 2007,
Obstruction & Severe inflammation & bleeding in 2007,
Back to Prednisone and Azathioprine (plus Nortriprylin), 2007-2014,
Perforation and ileum resection (32 cm) in July 2014,
Stopped Azathioprine, on Asacol, Clidinium C, Nortriptylin, Metronidazole from July 2014- December 2014,
Flare-up & internal bleeding at small intensine, hospitalized in December 2014,
Put on Prednisone IV, then after a week oral prednisone 40 mg tapering 5 mg/week, since January 2015,
Current meds: Asacol 800 (4/day), Clidinium C, Pantoprazole 20, Folic Acid, Ciprofloxacine 500, Nortriptyline 10 (each 2/day), Eisen plus 1/day.

 

[UnXmas]

The first time I was on prednisone, I had awful insomnia. After trying many sleep meds, my doctor prescribed me amitriptyline, which fixed it completely, I had the best sleep of my life, and still do, except that very recently, I've started on prednisone again. I'm still taking amitriptyline, and have none of the terrible insomnia I had the first time, but the prednisone is causing me to wake up at about five am this time, despite the amitriptyline. I don't know why. If it becomes a problem I'll try increasing my ami dose or maybe taking my ami later in the night.

I actually just posted about this, on the last post of this thread: http://www.crohnsforum.com/showthread.php?p=841774#post841774

Ami may help you sleep longer into the morning, because its effects last a while, it doesn't just send you to sleep like some meds, but keeps you asleep. But it may make you more tired the next day.

As you taper off prednisone, your sleep should go back to normal anyway.

I'm not sure about the physical fatigue: prednisone can cause muscle wasting, but you usually have to be on it a long time for that to become noticeable. Exercising may help. Maybe exercise when you wake up if you have extra time in the morning now?

 

[scottsma]

I'm on a short course of Pred.Tapering from 30 to 5 mg over the a month.
I was advised to take the whole days allowance as early in the morning as possible,which for me is between 5 and 6am with a glass of milk to avoid heartburn/indigestion.Taking them early is also supposed to help with sleep,but I don't know why.I did manage an extra hour or two light sleep afterwards.
But I have to admit,I do take a low dose over the counter sleep aid as well.

 

[UnXmas]

I'm on a short course of Pred.Tapering from 30 to 5 mg over the a month.
I was advised to take the whole days allowance as early in the morning as possible,which for me is between 5 and 6am with a glass of milk to avoid heartburn/indigestion.Taking them early is also supposed to help with sleep,but I don't know why.I did manage an extra hour or two light sleep afterwards.
But I have to admit,I do take a low dose over the counter sleep aid as well.

I'd also heard it was better to take them early so the effects wear off by nighttime, but it never made any difference to me.

 

[Hamed]

Thank you Unxmas & Scottsma. I will ask my doctor about amitriptyline. I read a lot in this froum about taking prednisone all in the morning but my doctor prescribed 3-2-3 (40 mg, 3 morning, 2 noon, 3 night) and tapering off 5 mg/day. I take them them every 8 hours and went to 3-2-2 last week and now to 2-2-2. Maybe 2 tablets before sleep is the problem, though I don't dare to change the dosage above!
About exercise, I wonder whether it is too early for me as it has been less than a month since my bleeding and my last hemoglobin count was 12.3 which is too low.
---------------
Crohn's symptoms since 2000,
Diagnosed with Crohn's 2002,
Put on Prednisone & Pentasa 2002,
Reduced drugs to only Pentasa (2*400 mg) until 2007,
Obstruction & Severe inflammation & bleeding in 2007,
Back to Prednisone and Azathioprine (plus Nortriprylin), 2007-2014,
Perforation and ileum resection (32 cm) in July 2014,
Stopped Azathioprine, on Asacol, Clidinium C, Nortriptylin, Metronidazole from July 2014- December 2014,
Flare-up & internal bleeding at small intensine, hospitalized in December 2014,
Put on Prednisone IV, then after a week oral prednisone 40 mg tapering 5 mg/week, since January 2015,
Current meds: Prednisone 30 mg (been two week now), Asacol 800 (4/day), Clidinium C, Pantoprazole 20, Folic Acid, Ciprofloxacine 500, Nortriptyline 10 (each 2/day), Eisen plus 1/day.

 

[scottsma]

I think your body will tell you when it's ready to exercise Ahmed.Don't try to do too much too soon. I'm only on a Pred.for one month and I'm halfway through now,on only 10mg this week,but I feel extremely tired by the afternoon.Perhaps a walk or a swim might suffice for now ?

 

[UnXmas]

Well I followed my own advice yesterday and took a higher dose of amitriptyline, later in the evening, and didn't wake up until 8:00am this morning - much later than I have been doing since starting pred again.

Hamed - I just replied to you on the amitriptyline thread. Amitriptyline and nortriptyline are closely related, but I've read that the effects a person gets from amitriptyline can be quite different from those they get on nortriptyline, so it is possible you may not find ami as bad, however, I don't think you'd be able to take both together.

I've never been that strict about my medication: I often play around with my dosages, but you might want to ask your doctor about taking all your pred earlier in the day. How much longer are your going to be taking it for? You should find things start going back to normal as you taper.

As for exercise, how much energy do you have for it? Don't exhaust yourself. Just taking a slow walk or a slow swim may make your feel a little better.

 

[Hamed]

During the past 10 days, I seemed to have bleeding (again), so the exercise is off the table
My doctor told me like before that "all is in your head" and prescribed chlorodiazoproxide for that, and insomnia.
I asked him that pred supposed to make me better soon, and he told that Crohn's has gone too resistive in your case because of your streess, lifestyle, etc.
Well, I'm on 25 mg pred daily and should taper to 20 mg tomorrow but stay at 20 mg for two months according to my doctor. Just an awful time for now with re-bleeding and insomnia and fatigue; I hope time (&pred) heal my wounds!

 

[scottsma]

I finished Pred.yesterday but have had lots of bleeding while taking it.I thought Pred was supposed to clear inflammation,not make things worse.I haven't had a flare this intense since being diagnosed 8yrs ago.I hope things improve for you when you're on a lower dose.

 

[Hamed]

Hi Scottsma, it's somehow odd to me, since I've had a much worse inflammation than this in 2008 and been on pred then and there was no flare. I had also been on pred in 2002 when diagnosed first and there was no problem then, either. I don't know why this third time has got so complicated. Maybe according to my doctor, Crohn's has got resistant (an advisor fellow of him recommended Remicade immediately for this reason but my doctor says not now).
It's a relief to know that although you had a similar problem you could make it. I hope this terrible period will be over soon.

 

[scottsma]

This has been my first time on Pred.Although mild inflammation was discovered after a colonoscopy then a fecal calprotectin test (300) I felt reasonably well.I will be interesting to see if things settle down now that I've finished taking Pred.,and what shows up on the MRI scan next week.

 

[Hamed]

Although different patients experience different conditions, from my own experience you will hopefully go into remission for a long time. In my both last cases of being on prednisone, I went into remission for six years each time. I may have run out of my options, since during the 2nd round of remission the doctor put me on Azathioprine, and now that a new flare-up came up, the only option I have is Remicade. I hope this won't be the case for you.

 

[scottsma]

I hope you're getting enough sleep Hamed.Fatigue can wear you down and make you feel worse than you ought to. Try to rest when you can. Best wishes for the future,

 

[Hamed]

Hi Scottsma,
I've had intermittent bleeding since 3 weeks ago. 3 or 4 days I'm ok, then I feel pain in the site of earlier bleeding (happened 2 months ago) and I will be dizzy and out of breath (presumably the signs of bleeding) for 2 or 3 days. I feel helpless as I don't know when it's going to stop. My doctor told me nothing new: split up your meals into 6 meals and avoid flatulent and spicy food. I've more or less done so, but the on/off bleeding cycles haven't stopped yet. Just one thing, my doctor prescribed domperidone 3 weeks ago, wich somehow makes the intestine move so I could eat more at each meal ever since.
I'd like to know, from your experience, if there was any specific medication or diet to help stop bleeding. I appreciate your sharing the experience.