Insomnia from Steroids: Causes, Symptoms, and Solutions
Understand how steroid medications can trigger insomnia, what symptoms to look for, and practical ways to improve your sleep.
Steroid medications, such as prednisone and other glucocorticoids, are commonly prescribed for various inflammatory and autoimmune conditions. While highly effective, these drugs can significantly disrupt sleep—leading to insomnia and affecting overall well-being. Understanding the connection between steroids and insomnia can help you better manage these side effects and maintain good sleep hygiene during treatment.
What Are Steroids and Why Are They Prescribed?
Steroids (specifically corticosteroids) are synthetic versions of natural hormones produced by your adrenal glands. They are prescribed to:
- Reduce inflammation
- Suppress immune system activity
- Treat chronic conditions such as asthma, arthritis, lupus, inflammatory bowel disease, allergies, and certain cancers
Common corticosteroids include:
- Prednisone
- Hydrocortisone
- Dexamethasone
- Methylprednisolone
Other forms such as topical creams, inhalers, eye drops, nasal sprays, or injections may be used for more localized effects.
Can Steroids Cause Insomnia?
Insomnia—the inability to fall asleep, stay asleep, or get restorative sleep—is a well-documented side effect of steroid use. This issue can arise early in treatment and may persist throughout the duration of steroid therapy.
- All forms of steroids may disrupt sleep, but oral corticosteroids (tablets) tend to cause more prominent insomnia than localized forms such as inhalers or topical applications.
- Incidence increases with higher doses and longer durations of use.
How Steroids Disrupt Sleep
First, understanding the body’s natural rhythm is important. The hormone cortisol regulates stress, blood sugar, and energy—and guides your sleep-wake cycle.
- Cortisol is naturally high in the morning to help you wake up and alert.
- Levels drop at night to promote rest and sleep.
When you take steroids, their effects often mimic cortisol, keeping your body in an alert, wakeful state when you should be winding down to sleep.
Research also suggests steroids may reduce melatonin production, the hormone that signals to your brain it’s time to sleep.
Common Experiences with Steroid-Induced Insomnia
What others are reading
- Difficulty falling asleep (“sleep-onset insomnia”)
- Waking up frequently during the night
- Early morning awakenings and being unable to go back to sleep
- Feeling restless, alert, or “wired” at night
- Poor overall sleep quality; not feeling refreshed in the morning
How Common Is Insomnia from Steroid Use?
Insomnia is among the most common side effects of chronic oral steroid use.
- In a large survey of over 2,400 people who used steroids long-term, more than 60% reported insomnia as a side effect, with severity increasing as doses increased.
- Sleep studies and clinical trials show that even short-term use can significantly alter sleep patterns, increasing time spent awake and delaying the onset of REM sleep (the dream phase).
Who Is Most at Risk?
Several factors increase your chances of experiencing insomnia from steroids:
- Type of steroid formulation: Oral steroids generally cause more pronounced effects than targeted forms (e.g., inhalers, creams).
- Dosage: High doses are more likely to impact sleep.
- Length of treatment: The longer you’re on steroids, the greater the risk.
- Time of day taken: Dosing later in the day is more disruptive.
- Age: Children and elderly adults tend to be more vulnerable.
- History of sleep problems: Preexisting insomnia or sleep disorders worsen risk.
Why Do Steroids Cause Insomnia?
Researchers are still unraveling the precise biological pathways, but several key mechanisms have been identified:
- Cortisol rhythm disruption: Steroids keep your brain and body active, counteracting normal nighttime wind-down.
- Reduced melatonin production: Steroid use may suppress the secretion of melatonin, delaying sleep onset.
- Heightened alertness or anxiety: Some steroids induce symptoms similar to mania, restlessness, or agitation, further reducing sleep quality.
What’s Happening in the Brain?
- Steroids interact with receptors in the hypothalamus and pituitary gland, which help control your circadian rhythms.
- Disruption of these pathways means your body may “think” it’s daytime, even late at night.
- Studies also show changes in sleep architecture such as less REM sleep, more frequent awakenings, and less time in deep restorative sleep.
Other Side Effects of Steroids
Beyond insomnia, corticosteroids can produce a range of additional side effects, including:
- Increased appetite and weight gain
- Mood changes, including irritability or anxiety
- High blood sugar levels
- Muscle weakness
- Swelling (edema)
- Bruising
- Delayed wound healing
- Increased risk of infections
How Can You Improve Sleep While Taking Steroids?
Although steroid-induced insomnia can be distressing, evidence-based solutions can help you sleep better. Consider these medical recommendations:
- Take your steroids in the morning: Dosing earlier reduces interference with your body’s natural rhythm and helps hormone levels drop before bedtime.
- Consult your doctor about dosing schedules: Ask if your medication can be taken once daily in the morning, or about a tapering plan.
- Practice good sleep hygiene:
- Go to bed and wake up at the same time every day
- Create a cool, dark, and quiet sleep environment
- Use your bed only for sleep and intimacy—not work or screen time
- Limit caffeine and alcohol, especially late in the day
- Unwind with relaxing activities before bed—gentle music, a warm bath, or meditation
- Avoid screens before bedtime: The blue light from electronics can inhibit melatonin further and worsen sleep issues.
- Stay active during the day: Moderate exercise early in the day can help promote better sleep at night, but avoid vigorous workouts in the evening.
- Discuss medication alternatives: Some conditions allow for the use of non-steroid anti-inflammatory drugs, inhaled steroids (for asthma), or lower dosages that may be less disruptive.
- If insomnia persists, discuss sleep medications or supplements: In some cases, your doctor may recommend a short course of sleep medication or melatonin supplementation.
How Your Doctor Can Help
- Monitor your sleep and adjust steroid dosing schedules as needed
- Recommend strategies for managing steroid withdrawal if you’re reducing or stopping steroids
- Assess for other potential causes of sleep difficulties, such as anxiety, mood disorders, or other medications
Research Snapshot: Steroids and Sleep Studies
| Study | Sample & Design | Findings on Sleep |
|---|---|---|
| Dexamethasone Sleep Study (Polysomnography) | Healthy volunteers, 3 mg every 8 hours for 48 hours | Increased time awake, delayed REM onset, fewer REM periods |
| Chronic Steroid User Survey | 2,446 steroid users (varied indications) | >60% reported insomnia; increased with higher doses |
| Cancer Patients with High-Dose Steroids | 240 patients, open-label | Significantly lower sleep quality as measured by sleep index |
| Prednisone Bursts in Asthma | 32 patients, daily dose >40 mg | Higher scores on the Young Mania Rating Scale with disrupted sleep; resolved after stopping meds |
When Should You Call Your Doctor?
Let your healthcare provider know if you experience:
- Difficulty falling or staying asleep that does not improve with self-care
- Persistent daytime sleepiness or fatigue
- Mood changes such as irritability, depression, or mania
- Any worsening of pre-existing sleep disorders
- Other significant side effects from steroid use
Your provider may adjust your treatment, recommend sleep aids, or investigate for other possible causes.
Frequently Asked Questions (FAQs)
Can all types of steroids cause insomnia?
Yes. While all corticosteroids—oral, inhaled, injected, or topical—can potentially disrupt sleep, oral and high-dose steroids are most likely to do so. The risk is dose-dependent and increases with longer use.
Does prednisone specifically make you sleepy or keep you awake?
Prednisone itself does not make you sleepy. On the contrary, it usually keeps you more alert and can disrupt your natural sleep-wake cycle, leading to insomnia and resulting daytime fatigue due to poor rest.
How long do insomnia symptoms last after stopping steroids?
Symptoms usually resolve a few days to a couple of weeks after stopping steroids, but this can vary based on duration, dose, and individual sensitivity. Tapering steroids slowly helps the body reestablish its natural hormone rhythm and may minimize lingering sleep disturbances.
Are children and elderly adults more likely to have insomnia from steroids?
Yes. Age is a risk factor. Children and elderly individuals are both more susceptible to sleep disturbances from steroids, and may require closer monitoring during treatment.
What if I can’t reduce my steroid dose due to my medical condition?
Never adjust or stop your medication without medical supervision. Work with your healthcare provider to explore alternatives or combination therapies that may help reduce your risk, and use the self-care strategies noted above.
Summary: Key Takeaways on Steroids and Insomnia
- Insomnia is a common side effect of systemic (oral or injected) steroid therapy.
- Steroids exert their effects by mimicking cortisol, disrupting your body’s natural signals to sleep.
- Taking steroids early in the day, practicing good sleep hygiene, and involving your healthcare provider can help you manage insomnia symptoms.
- Most people see their sleep return to normal after stopping treatment, but it’s vital to make adjustments under medical guidance.
References
For detailed research and further reading, consult the following peer-reviewed sources:
- PubMed Central articles on steroid-induced sleep disturbance
- Xcode Life overview on steroid and sleep issues
- Healthline and Medical News Today’s guides to prednisone and insomnia
References
- https://www.xcode.life/genes-and-sleep/do-steroids-cause-insomnia/
- https://pmc.ncbi.nlm.nih.gov/articles/PMC7357890/
- https://www.healthline.com/health/drugs/does-prednisone-make-you-sleepy
- https://www.medicalnewstoday.com/articles/does-prednisone-cause-insomnia
- https://www.medicalnewstoday.com/articles/9155
- https://pmc.ncbi.nlm.nih.gov/articles/PMC10804719/
- https://www.mayoclinic.org/tests-procedures/cortisone-shots/in-depth/steroids/art-20045692
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