Sleepless Nights: The Dark Side Of Steroid Use

Steroids can have a detrimental effect on sleep, causing insomnia and worsening conditions like sleep apnea. This is true of both legally prescribed steroids and those used illicitly for performance enhancement or muscle building.

The effects of steroids on sleep are thought to be caused by their impact on the body's natural sleep-wake cycle. They can also decrease melatonin levels, a hormone that plays a key role in regulating sleep.

The disruption to sleep caused by steroids can have a negative impact on overall well-being, and may also be linked to changes in mood, anxiety, and irritability.

Steroids disrupt the body's natural sleep-wake cycle

Steroids can have a disruptive effect on the body's natural sleep-wake cycle, causing insomnia and sleep disturbances. This is true for both legally prescribed steroids and those used illicitly for performance enhancement or muscle building.

Cortisol, a hormone produced by the adrenal glands, helps regulate the body's sleep-wake cycle. Typically, cortisol levels drop at night to promote sleep. However, corticosteroids, which are often prescribed to reduce inflammation, can raise these levels, leading to increased brain activity, restlessness, and difficulty falling or staying asleep. This disruption can be intensified by higher doses or taking steroids later in the day.

Additionally, anabolic androgenic steroids (AAS), such as testosterone, which are sometimes misused by athletes and bodybuilders, have been found to significantly disrupt sleep quality. Users of AAS reported lower quality sleep compared to non-users, and sleep quality was even worse during withdrawal. AAS misuse has also been linked to an increased risk of developing obstructive sleep apnea, a condition where breathing stops temporarily during sleep due to muscle growth around the neck and throat.

The mechanisms behind steroid-induced sleep disruption are not entirely clear, but several theories have been proposed. One theory suggests that steroids, such as prednisone, mimic the natural hormone cortisol, disrupting its usual rise and fall and causing insomnia. Another theory involves the decrease in melatonin levels caused by corticosteroids. Melatonin is a hormone that regulates the sleep-wake cycle, and lowered melatonin levels can contribute to insomnia.

To manage steroid-induced insomnia, it is recommended to consult a healthcare professional, who may adjust dosage or timing. Taking steroids in the morning can help minimise disruption to the sleep-wake cycle. Additionally, gradual dose reduction, sleep hygiene practices, relaxation techniques, and therapy can also help improve sleep quality.

They can cause or worsen sleep apnea

Steroids can cause insomnia and other sleep disturbances, depending on the type, dosage, and duration of use. One way they can disrupt sleep is by mimicking the natural hormone cortisol, which is involved in the sleep-wake cycle. Typically, cortisol levels drop at night to promote sleep, but steroids can raise these levels, leading to increased brain activity, restlessness, and difficulty falling or staying asleep.

Steroids can also worsen sleep-related conditions like sleep apnea. Obstructive sleep apnea (OSA) is a condition in which breathing stops temporarily during sleep due to muscle growth around the neck and throat. Anabolic androgenic steroids (AAS) can increase the risk of developing OSA, especially when misused. One study found that AAS users reported lower quality sleep compared to non-users, and that sleep quality was even worse during withdrawal from AAS.

The misuse of anabolic steroids is also linked to changes in mood, anxiety, and irritability, which can further disrupt sleep patterns. Additionally, steroids can decrease melatonin levels, a hormone involved in regulating the sleep-wake cycle, which can contribute to insomnia.

If you are experiencing sleep problems while taking steroids, it is important to consult your healthcare professional for management and adjustments to your treatment.

They can cause changes in mood, such as irritability and anxiety

Steroids can cause changes in mood, such as irritability and anxiety, which can further disrupt sleep patterns. This is sometimes referred to as "roid rage".

Steroids affect the regulation of neurotransmitters like serotonin and dopamine, which are known as "feel-good" hormones. Some people experience euphoria when taking steroids, while others have negative reactions such as anxiety and irritability. These psychological side effects can occur even when steroids are not taken long-term.

In one study, researchers found that nearly 5% of patients who were prescribed oral corticosteroids for more than 28 days developed a mental disorder, with anxiety being the most commonly reported disorder. Another study found that among people who were prescribed more than 28 days of corticosteroids, nearly 1 out of every 20 developed a mental disorder, with many experiencing anxiety, depression, and panic disorder.

The risk of psychiatric side effects increases with higher doses and longer durations of steroid use. These side effects can include anxiety, depression, mania, delirium, and psychosis.

It is important for individuals taking steroids to be aware of the potential psychological side effects and to seek medical attention if they experience any mental health symptoms.

They decrease melatonin levels, a hormone involved in sleep regulation

Steroids can disrupt the sleep-wake cycle, causing insomnia and worsening conditions like sleep apnea. One of the reasons steroids can cause insomnia is by decreasing melatonin levels. Melatonin is a hormone, secreted by the pineal gland in the brain, that helps regulate other hormones and maintain the body's circadian rhythm. The circadian rhythm is an internal 24-hour "clock" that plays a critical role in when we fall asleep and when we wake up.

Normally, cortisol (a hormone that increases blood sugar and energy levels and regulates blood pressure) is high in the morning when we wake up and then drops throughout the day. Its opposite, melatonin, causes drowsiness and helps us sleep at night. This is the circadian rhythm—a dance throughout the day and night that helps us wake up and fall asleep at the right times.

When people take steroids, they are introducing artificial cortisol into their bodies, which causes melatonin levels to decrease. Even a single dose of steroids can deregulate the circadian rhythm and cause insomnia. This is because steroids, such as prednisone, mimic the natural hormone cortisol, disrupting the usual rise and fall of cortisol throughout the day. Cortisol naturally has a diurnal rhythm, meaning it is highest in the morning and lowest at night. When someone takes steroids for long periods, this rhythm is disrupted, causing insomnia.

They can cause insomnia during withdrawal

Steroids can cause insomnia and other sleep disturbances, depending on the type of steroid, the dosage, and the duration of use. Insomnia is a common side effect of corticosteroids, which are commonly prescribed to reduce inflammation in conditions such as asthma, autoimmune disorders, and various chronic diseases. These steroids mimic the hormone cortisol, which is naturally produced by the adrenal glands and helps regulate the body's sleep-wake cycle. Typically, cortisol levels drop at night to promote sleep, but corticosteroids can raise these levels, leading to restlessness and difficulty falling or staying asleep.

Withdrawal from steroids can also cause insomnia and even worsen sleep quality compared to when using steroids. This is known as steroid withdrawal syndrome, which occurs when anti-inflammatory steroids are rapidly withdrawn, and the body suddenly stops producing its natural cortisol. This can lead to fatigue, joint pain, muscle stiffness, and fever, all of which can disrupt sleep.

Additionally, the misuse of anabolic androgenic steroids (AAS) has been linked to sleep problems, including worsened sleep apnea. A study found that participants who were withdrawing from AAS experienced the worst sleep quality, which researchers theorized could be due to an association between sleep and testosterone deficiency. The longer someone takes steroids, the greater the risk of developing insomnia.

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