Hugged by a bubble of dim computer light, the keyboard and tablet cast a faint glow over the blankets. While sleep eludes, night thoughts invade the quiet darkness. He slumbers beside as his slow baritone rumbling comfortingly quivers throughout the room. Sleepless nights seem merciless when rest seems needed most! Lingering weariness from a busy day and goosebumps from a cool winter chill disrupt efforts to relax. Drawing the soft comforter up is warming and eases the chill, but still fails to bring on sleep.
A recent bout of insomnia has made ordinarily foggy lupus mornings more difficult. Perhaps there are multiple culprits to sleep deprivation. After spending the last couple of years in college, writing research papers well into the night has destroyed circadian rhythms and perhaps deregulated sensitive endocrine balances. To reach the arduous goal of earning a late-life college degree, unfortunately, sleep became secondary to prescribed bed times, and school work took precedence. Life has not yet fully adjusted to new patterns after recently finishing college. Graduation just before the holidays blended into the normal seasonal stress and distractions.
After graduation, there were ten days until Christmas, so the few remaining nights were feverishly used for shopping, wrapping, decorating, and cooking. There has still been no post-graduation let down. Immediately after New Years, we moved our bedroom furniture into our home office, and began the reconstruction project in the master bedroom suite. Dust, noise, contractors, and morphing levels and states of household chaos have permeated all the other rooms in the house. This has affected any sense of normalcy, and perhaps sets life on just enough edge to rob me of rest in the night.
A surge in nightly onset of peripheral neuropathy pain in legs and feet has contributed negatively to attempted sleep outcomes. Recently careful timing of nighttime Gabapentin to equalize between twice daily doses is helping reduce the frequency and severity of nightly symptoms. When the thirteenth or fourteenth hour arrives after morning doses, it is more likely that neuropathy symptoms will set in. If medications wait until after the onset, it takes over an hour after a new dose to get any relief, and often pain medications are required to quiet the pain enough to allow sleep. Overall exhaustion increases the likelihood of the this sleep enemy, so this might be a cause, too.
Perhaps the split dosing of prednisone between morning an evening might also contribute some to the problem. A few months ago, quite by accident, we discovered that adjusting daily prednisone doses from single morning 7 milligrams to split dosing of four milligrams at nights and three in the morning immensely improved morning mental clarity. The Rheumatologist described the positive result as a reduction in “trough effect”, or more simply put, a lack of prednisone dropping to very low blood levels in the night. A potential drawback impacting sleep may be increased nighttime steroid levels. Even so, because the net morning result is so much better than it was with single dosing, despite any negative influences in reduced nightly REM sleep, split prednisone dosing was still well worth the risk of any lost rest.
Finally, this spilt dosing is not good for everyone, and in fact, is usually medically discouraged for good reason! While ordinary medical wisdom recommends full daily steroid doses are best given in the morning to better replicate normal endocrine activity, this was not a concern in my situation. Since we no longer have any realistic hope that my normal cortisol production will ever resume, after years of failed trials to do it, normal precautions that protect future steroid production were meaningless. However, in patients that still have some normal cortisol production, morning dosing is recommended to reduce potential suppression of adrenal production of natural cortisol. But, for those who are completely steroid dependent, the medical wisdom notably shifts to equalizing blood levels throughout the day. So, split dosing in this case makes perfect sense.
This quickly aging new year is a fleeting annual opportunity for new beginnings. So, speaking like a seasoned procrastinator who waits until tomorrow to start getting more sleep, here I sit in the night lamenting my loss of it. I am determined to start earnestly seeking this elusive commodity of sleep. So, after reaching the bottom of a third cup of decaf tea, my thoughts of sleeplessness finally give way to sagging eyelids. Slipping the computer onto the bed table and sinking under the warm blankets, darkness finally wraps around me with the promise of dreams.