Steroids such as prednisone or prednisolone are central to controlling polymyalgia rheumatica, particularly in the early phase of treatment. Many people notice rapid symptom relief, sometimes within days. At the same time, the first weeks of steroid use often bring noticeable short-term effects that can feel surprising or unsettling if you are not expecting them.
This article explains the most commonly reported early effects related to sleep, mood, appetite, and fluid balance. The goal is to help readers recognize what is typical, why these changes happen, and how people often adapt while working with their clinician toward the lowest effective dose.
Why Early Steroid Effects Occur
Glucocorticoids act in ways that overlap with the body’s natural stress hormone, cortisol. When introduced at doses higher than the body normally produces, they can temporarily influence sleep–wake rhythms, brain signaling related to mood and motivation, appetite regulation, and how the body handles salt and water.
These effects tend to be dose-related and are most noticeable in the first days to weeks after starting treatment or increasing a dose. For many people, they ease gradually as doses are reduced during tapering.
Sleep Changes: Difficulty Falling or Staying Asleep
Sleep disturbance is one of the most frequently reported early effects of steroid treatment. People often describe trouble falling asleep, lighter sleep, or waking earlier than usual. These changes are more common at higher doses and when medication timing does not align well with the body’s natural cortisol rhythm.
Many individuals find that taking steroids earlier in the day makes sleep disruption more manageable. Others focus on reinforcing regular sleep routines, such as consistent bedtimes, a dark and cool bedroom, and limiting stimulating activities late in the evening. As doses decrease, sleep often improves on its own.
Persistent or severe insomnia is worth discussing with a clinician, especially if it begins to affect daytime functioning.
Mood and Energy Shifts: Feeling “Wired” or Irritable
Steroids can influence mood and energy in noticeable ways. Some people feel unusually energetic, alert, or upbeat, while others feel restless, irritable, or anxious. These effects are often described as feeling “keyed up” or overstimulated.
For most, these changes are temporary and settle as doses taper. Planning demanding tasks earlier in the day and allowing time to wind down in the evening can help people adjust during this phase. Letting a clinician know about prior mood disorders or past reactions to steroids is also important, as it allows for closer monitoring.
Rare but serious mood changes, such as severe depression, mania, paranoia, or hallucinations, require urgent medical attention.
Appetite Changes and Early Weight Fluctuations
Increased appetite is another common early effect of steroid use. Hunger may feel stronger or more persistent than usual, sometimes appearing within days of starting treatment. Changes in digestion or blood sugar regulation can also influence food cravings and eating patterns.
Many people respond by paying more attention to meal structure rather than strict restriction. Emphasizing filling foods, such as protein and fiber-rich vegetables, and being mindful of portion sizes can help limit unwanted weight gain during the early phase. Some people find it reassuring to track trends rather than daily fluctuations, recognizing that appetite often settles as doses are lowered.
Fluid Retention and a Feeling of Puffiness
Steroids can temporarily affect how the body retains salt and water, leading to swelling in the hands, ankles, or lower legs, or to rapid changes on the scale that do not reflect true weight gain. This sense of puffiness can feel uncomfortable, even when it is short-lived.
Gentle movement, leg elevation during rest, and being mindful of very salty foods are common strategies people use during this period. Fluid retention related to steroids usually improves as doses taper, but sudden or uneven swelling, shortness of breath, or chest discomfort should be evaluated promptly.
When Changes Deserve Prompt Attention
While most short-term steroid effects are manageable and temporary, certain symptoms warrant urgent medical contact. These include severe mood changes such as suicidal thoughts or psychosis, persistent insomnia that becomes unmanageable, or swelling accompanied by breathing difficulty or chest pain.
Recognizing these situations early helps ensure that treatment remains both effective and safe.
Habits That Many People Find Helpful Early On
During the first month of steroid treatment, small daily habits can make a noticeable difference. Taking the full dose early in the day, keeping caffeine earlier rather than later, and maintaining regular follow-up appointments can all help smooth the adjustment period. Many people also review bone and stomach protection strategies with their clinician early, rather than waiting until problems arise.
Bottom Line
Short-term steroid effects involving sleep, mood, appetite, and fluid retention are common in the early treatment of polymyalgia rheumatica. They are typically dose-related, often most noticeable at the beginning, and tend to improve as doses are gradually reduced.
Understanding these effects ahead of time, staying attentive to how your body responds, and maintaining open communication with your care team can make the early weeks of treatment feel more predictable and manageable while steroids do the work they are intended to do.
