My 2 a.m. battle with prednisone-induced hunger and insomnia
Every night, I have a standoff with my refrigerator
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It’s 2 a.m., and the building is quiet. The only light in my apartment comes from the refrigerator, and I am standing in front of it in my bathrobe, like a man waiting for a bus that isn’t coming. I am not hungry. Let me rephrase that: I ate a perfectly reasonable dinner five hours ago, and by every law of nature I should not be hungry. But my stomach has received different orders, and they come from a small white pill.
Living with myasthenia gravis (MG) means my immune system mistakenly interferes with the signals my nerves send to my muscles. One of the oldest tools for suppressing this immune response is prednisone. It works. It also turns a grown man into a raccoon.
Prednisone belongs to a family of drugs called corticosteroids. Doctors use them to quiet an overeager immune system, and for many of us with MG, they ease symptoms within a few weeks. They also come with a long list of side effects, two of which are the villains of this column. Prednisone makes me hungry and keeps me awake.
I’m not exaggerating the second one. Insomnia is one of the most common side effects of corticosteroids. Put the two together, and you get a hungry man with nothing but time. Prednisone is a synthetic cousin of cortisol, and it scrambles the signals that help us recognize when we’re full.
‘I want some more’
Charles Dickens gave us the patron saint of this condition. In “Oliver Twist,” a starving workhouse boy walks up to the master, bowl in hand, and says, “Please, sir, I want some more.” Oliver had a far better excuse than I do. He was living on thin gruel, and I had a full dinner. But I understand. Every night around 2 a.m., something in me picks up a bowl and makes the same request.
The refrigerator and I have a nightly routine. I walk in. It hums at me. I open the door, and the light comes on. I tell myself I’m only checking. Inspecting the premises. Making sure the milk is still there. I certainly am not there to down the Ben and Jerry’s that I bought “in case company stopped by.”
The milk is always still there. So is everything else, and all of it is looking at me. The little devil on my shoulder whispers in my ear, “Go ahead. Just a couple of spoonfuls. Then it’s back to bed.” I’m no good at resisting little devils. As Oscar Wilde said, “I can resist anything except temptation.”
A history teacher can’t help noticing that the great sieges were usually lost from the inside. Troy held out for 10 years, and the Greeks never broke down the walls. The Trojans opened the gates themselves for a wooden horse. My defenses are about as sturdy. They fall for The Tonight Dough and a spoon.
The experts have advice, and it’s good advice. Keep sensible snacks within reach. Drink a glass of water first. Brush your teeth after dinner, which supposedly tells the brain the kitchen is closed. My brain has a key.
The real hope is that this standoff doesn’t last forever. Doctors know long-term steroids carry a price, and bringing the dose down without stirring up MG is a stated goal of researchers. Until then, some nights I close the door and go back to bed. Some nights the refrigerator wins.
An old preacher once concluded that “a man hath no better thing under the sun, than to eat, and to drink, and to be merry.” He was a wise man. I suspect he also slept through the night.
Still, I’ve decided to take him at his word. I won’t scold myself over a 2 a.m. snack. Prednisone is doing important work in my body, and a little extra hunger is the price of admission. I’ve always believed the one thing we must learn in life is how to forgive, both others and ourselves. That includes forgiving ourselves for the leftovers.
So, if you’re on steroids and find yourself in the kitchen at an hour when only owls and night-shift nurses are awake, you’re in good company. Close the door gently. Drink your water. Go back to bed.
And if you can’t, pull up a chair. Oliver and I will be right there with you, bowls in hand, asking politely for more.
And stay tuned to this space. I have some exciting news to share vis-à-vis the prednisone wars. Whatever could it be? You’ll find out.
Note: Myasthenia Gravis News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Myasthenia Gravis News or its parent company, Bionew
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