I've been struggling for a very long time with my cortisone schedule, specifically the last dose... i try to take it fairly late (10:00pm) as I always wake up too early, haven't gotten enough sleep, but am in need of cortisone. However, I also have a difficult time getting to sleep when it's taken so late.. is this the way it is? MY circadian rhythm is so screwed up and I NEVER feel rested when I wake up....and what wakes me up is my need for cortisone. I take hydrocortisone and a wondering if i ought to take a little prednisone before bed, as it's longer acting.
So I guess my question is, what time do you all take your last dose and how much?
Every Addisonian has to figure out what works out the best for them, but normally a person's cortisol levels are peaked in the early morning. it is the goal to mimmick the "normal" levels of cortisol- and, Aldosterone, for that matter. That is why most of us take higher doses of glucocorticoids in the morning. That is also why we take Fludrocortisone in the mornings. I have really messed up sleeping patterns also. Ever since I can remember I have had insomnia, but I LOVE to sleep the whole morning away. That is why i have recently stopped taking my evening dose altogether. I take 25 mg of Hydrocortisone about 6 am (I set my alarm and keep my meds in a glass on my bedside table), and then I take 10 mg about 2 in the afternoon. I seem to be doing fine without taking 5 mg at 8 pm like I did for 12 years. You have to do what works best for you, but what I do is very normal for an Addisonian. I used to take Prednisone for my morning dose because, like you say, it has a longer shelf life. That worked out fine for me. The only reason I quit taking Prednisone is because I was concerned that it was partly to blame for my chronic thrush. ...But it is disturbing to me that you take your hydrocortisone so late. I would be up all night if I did that!!! I hope this is helpful for you. Good luck!!!
I take 20 mg when I get up in the morning then typically 2.5 in the afternoon around 5. I was told when I was first diagnosed that the ideal time is 4 pm to mimic the "second wind" pick up in the afternoon we used to get back when we had adrenal glands. Sometimes, I take it later, for instance, last Friday night, I went to my son's sporting event, didn't get home until 11:30 PM, and took my evening dose then. When I take it late like that, it doesn't seem to effect my sleep. (I was taking 20 morning, 2.5 pm which seemed to be adequate, but started noticing darkness in my creases inside my elbow pit, so have now started taking 5 mg for evening dose on Monday's, Wednesday's and Friday's.)
i have adjusted times and dosing several times. what works for me is 20mg as soon as i wake up and 20mg 8 to 10 hrs later. sleep is less of a problem that way. still a problem but not as bad as taking it later. melatonin helps with sleep issues too.
i know it sounds crazy but i have found that becoming nocturnal is the single best thing i have found dealing with addisons. i wake up around 3 or 4pm feeling great. at night never felt better. the opposite of getting up early in the morning and feeling terrible all day. i understand everyone has responsibilities and some kids. but my responsibility is doing what is best for me. that single move has changed my life for the good. the only time i get up early is for drs appointments and other responsibilities. otherwise live like a vampire..lol.