Insomnia While on Solu-Medrol Steroids
Temporary insomnia is part and parcel of receiving an IV of Solu-Medrol steroids, which is prescribed to combat a MS flare-up. The insomnia is one of the reasons MSers don't want to consider steroids unless the flare-up is very crippling or very long lasting. No one wants to be up for nights at a time, unless it is absolutely necessary. If MS fatigue is already an ongoing part of your disease, as is the case with me, just thinking about being even more exhausted than usual is most disconcerting.
At least, as with all of the other side effects of high-dose steroid treatment, the insomnia will not be chronic. Usually, your normal sleeping routine will not be upset more than a week or so after the steroid pulse has been discontinued.
Still, many wonder why the insomnia occurs and what, if anything, can be done to handle all the lonely nights spent unable to get some quality rest.
Why the Temporary Insomnia Occurs
Solu-Medrol is used to calm the inflammation that occurs when our body attacks itself, resulting in a flare-up. The dosage is very high, over-stimulating, and almost totally controls our endocrine system.
It's as if the steroids have successfully invaded your endocrine system and set itself up as the new commander-in-chief. It plans on staying forever but doesn't realize it doesn't have the full support of your endocrine system, which has decided to retreat and regroup until the nasty steroid pulse is over, at which time it will slowly reassert itself as head of your adrenals.
While in retreat mode, however, the steroids get to wreak havoc on all your crucial glands and hormones, including all of the systems that allow you to relax and get some sleep. Not to fear—just remember this is a temporary thing. Once the steroids are out of your system, your endocrine system will reset, reestablishing your natural body clock in the process.
Obviously, if your MS is flaring up and causing you disability, unusual limb weakness, or even severe eye problems, such as optic neuritis, you will welcome the steroid pulse your doctor recommends. It will lessen the attack your body is waging on itself, and shorten the duration of the attack. Although it might not necessarily have you back to your old self for a couple of months or so, it is still welcomed by many for whatever good it will do after it is absorbed into the system and has time to work.
So the step that comes next, is how to handle the temporary side effects of the steroids, particularly the insomnia.
Coping With Insomnia
I have a great collection of DVDs that I use when I'm bedridden or on a pulse of steroids and find myself wide awake at 2:00 or 3:00 in the morning. I also have a Netflix account, which provides a wide variety of movies at a great monthly price.
Riding Out the Long and Lonely Nights
- Mental preparation is key to handling the insomnia. If your doctor has prescribed a pulse of steroids, begin mentally preparing yourself for the ordeal to come. It is important to remain as calm and tranquil as possible, so try not to fill yourself with dread at the impending loss of sleep and other uncomfortable side effects of the Solu.
- Next, try to make the initial appointment for the first infusion as early in the day as possible. In my own experience, I have a home health company that sends a nurse out to get my infusion set-up so that I can take it from there. I ask that she comes as soon as early as possible because I know I will be up for at least 18 hours after the infusion is concluded. When I am setting up my own infusion, I do it first thing in the morning, as soon as the IV solution reaches room temperature, which allows me to get about 4 hours of sleep. If you are going to an out-patient facility, try to arrange an early appointment. I have actually waited a day or so to get the earliest appointment because it is so much harder on me when the first infusion begins after Noon. If you find this to be true in your case, an earlier appointment might be helpful to you.
- If you take a sleep aid in order to combat restless leg syndrome, or the inability to stay in a deep sleep. Ask your doctor if it is OK to increase your dosage until your steroid treatment is over. I take 1-1/2 of my normal sleep aid whenever I am on a steroid pulse. Even with that, I can only count on 4 hours of sleep, at the most.
Once the Steroids Kick In
Now the real fun begins. You have that disgusting metallic taste in your mouth, so you know the steroids are kicking in.
Most people love the initial surge of energy they get from the steroids. MSerswho haven't had the energy to clean the way they want, or the focus to balance the check book or pay the bills, dive into any and all activities with a zest that hasn't been felt since the last time they were on steroids. If you are brand new to steroids, you just can't believe how much energy you have. You plan to cook, clean, bake, sew, garden, exercise, paint . . . the list seems endless matching your new energy level. It's here you need to s l o o w w w . . . yourself down.
Yes, your system is raring to go, but remember there is a reason you've been put on steroids. You are trying to weather an intense attack your body's own immune system is raging on itself. Fight the urge to do too much. Pace yourself and be glad to accomplish tasks in small allotments. You are so revved up that you can literally go non-stop, but don't allow it to happen. Your body pays the price and it actually hurts your recovery when you wear down an already over-taxed body.
Use this time to engage in activities that are fulfilling and calming. Once you've engaged in physical activities, plan to engage in some mental activities that don't take much energy.
- Sewing, knitting or crocheting
- Balance that check book and pay those bills
- Read whatever you'd like
- Take a relaxing bath
- Write some overdo letters or e-mail
- Browse the Internet
- Play a computer or video game.
- Listen to music
- Watch your favorite DVD's
- Pick up that musical instrument you haven't played in ages.
- Actually THINK about your life and positive things
- Use the time to do something nice for your family, surprise them!
As you can see, with some forethought, the list of things you can do BESIDES cleaning or other physical exertion is endless. Becoming your own best friend is a great comfort when you are the only one awake in the middle of the night. Its then that you can journal or blog, or do something just for you. Give yourself a manicure, change your hair style. Anything that makes you feel good about yourself is worth considering.
Once the Steroid Course Is Over
You've made it through the mania, now you have to manage your way through the CRASH! It is difficult, you will be tired, grouchy on edge and sick and tired. Again, remember this too shall past. It is important to face the fact that all the energy is gone and your body is now awakening from its sleep and trying to reestablish control. It is slowly getting itself back up to its normal level, but as you can feel, it is not easily doing so.
Help your body, help itself.
- Drink plenty of water still. Your body now has to flush all the toxins and waste left over from the steroids.
- Remember your blood pressure is now higher, as is your sugar level. Since your craving for sweets and anything fattening has probably subsided, concentrate on eating healthy. Eat fruit and vegetables and fish. You will suffer constipation, so fruits, veggies and water will help.
- Don't be discouraged if the problem that put you on the steroids is still there. It can take 2 to 3 months before the steroids really help. It will be a slow climb upwards, but it will come. In worse cases scenarios, if your flare is aggressive enough, you will be asked to do another course of steroids. Many times though one pulse does the trick, and if results aren't immediate, they will still come.
The Return of Sleep
The signal that tells me the steroids are successfully moving out of my system is the first night that I'm finally able to fall asleep and feel as if I've slept soundly. If you have been on steroids a number of times, then it may only take a couple of nights before your sleep clock resets. If it is your first time, or if your body has a harder time riding itself of steroid residue, you may find it takes up to a week before you get that good night's sleep. It will come, though, so patience is required.
You are to be congratulated any time you can make through a pulse without any significant problems. Hopefully you won't need another pulse for a long, long time—but if and when you do, you will know how to handle all phases of the treatment, and your body will hopefully quit attacking you for a good long time!
FDA Information about Solu-Medrol
- Solu-Medrol Official FDA information, side effects and uses.
Drugs.com provides precise medical explanations of Solu-Medrol which might interest some researchers of current MS treatments. Under "Indications" you will notice numbers 6 and 12 are directly related to Multiple Sclerosis treatments.