Cortisone is a type of corticosteroid, synthetic drugs that mimic cortisol, a hormone naturally produced by the adrenal glands. It is widely used in medicine to reduce inflammation and suppress the immune system, addressing various conditions such as allergic reactions, skin conditions, arthritis, and autoimmune diseases. Cortisone can be administered intravenously, orally, or as an injection into a joint. It works by calming the immune system’s response in the affected area, thereby reducing pain and swelling.
Cortisone’s Effects on Sleep
Cortisone and corticosteroids like prednisone do not induce sleepiness; instead, they cause wakefulness, insomnia, or disrupted sleep patterns. This is a common side effect, with some studies indicating that over 60% of individuals using prednisone report insomnia. The physiological reasons for this disruption involve the medication’s influence on the central nervous system, adrenal glands, and the body’s natural sleep-wake cycle.
Corticosteroids mimic cortisol, a hormone that regulates the sleep-wake cycle. Cortisol levels decrease at night to promote sleep, but the presence of corticosteroids can elevate these levels, leading to increased brain activity and restlessness. This interference can make it difficult to fall asleep or stay asleep, resulting in fragmented sleep and reduced overall sleep quality. Higher doses of corticosteroids, particularly when taken later in the day, can intensify these effects, causing vivid dreams or frequent nighttime awakenings.
The impact on the central nervous system involves glucocorticoid receptors in brain regions like the hippocampus and amygdala, which influence mood and cognitive functions. Corticosteroids can alter gene transcription in the central nervous system, affecting neurotransmitter levels like norepinephrine and serotonin, which influence alertness and mood. These medications can also decrease serum melatonin levels, a hormone that regulates the sleep-wake cycle, contributing to insomnia.
The adrenal glands, which produce cortisol, can also be affected by synthetic corticosteroids. Prolonged use or high doses of these medications can signal the adrenal glands to reduce or stop their cortisol production. The body’s circadian rhythm, which dictates the sleep-wake cycle, is also influenced by glucocorticoids. Corticosteroid treatment can disrupt the circadian oscillations of these hormones, leading to impaired sleep patterns.
Addressing Sleep Concerns
For individuals experiencing sleep disturbances due to cortisone, several practical strategies can help manage these effects. One effective approach involves optimizing the timing of medication administration. Taking cortisone in the morning can help align its effects with the body’s natural cortisol rhythm, which is typically higher earlier in the day and decreases towards night. This can minimize interference with nighttime sleep.
Maintaining good sleep hygiene is also beneficial. This includes establishing a consistent sleep schedule, even on weekends, and creating a conducive sleep environment (dark, quiet, cool). Avoiding stimulants like caffeine and nicotine before bedtime can further promote restful sleep. Limiting screen time before sleep and engaging in relaxing activities can also help prepare the body for rest.
Discussing any sleep concerns with a healthcare provider is important for personalized advice. They may suggest adjustments to the medication dosage or alternative corticosteroids if appropriate. Any changes to medication, including dosage adjustments or discontinuation, should only be made under direct medical supervision to prevent potential complications, such as adrenal insufficiency.