Steroid therapy can contribute to sleep difficulties. Prednisone is the steroid most commonly prescribed for lupus. Prednisone use is reported to be associated with daytime somnolence (i.e., excessive sleepiness during waking hours), which results in difficulty initiating sleep. 

University of Illinois at Chicago

A significant proportion of women with SLE suffer from poor sleep quality. Findings from current research suggest that depressed mood, prednisone use, and lack of exercise contribute to decreased overall sleep quality.

Determinants of sleep quality in women with systemic lupus erythematosus (SLE)

Costa, D. D., Bernatsky, S., Dritsa, M., Clarke, A. E., Dasgupta, K., Keshani, A., & Pineau, C. (2005). Determinants of sleep quality in women with systemic lupus erythematosus. Arthritis Care & Research: Official Journal of the American College of Rheumatology, 53(2), 272-278. https://doi.org/10.1002/art.21069

Determinants of sleep quality in women with systemic lupus erythematosus

Components of sleep disturbance can include difficulty initiating sleep, maintaining sleep, and/or early awakenings. Sleep disturbances are relatively common in women, in older individuals, and in individuals with fewer socioeconomic resources.

Sleep Disturbance

Depressed mood in women with SLE is typically associated with poor sleep quality. Depressed mood is specifically linked to sleep disturbance, adequacy, and quantity. This could be due to sleep disturbance as the most prominent symptom in depressive patients and was formerly regarded as a main secondary manifestation of depression. 

Depressed Mood as a Determinant of Sleep Quality in Women with Lupus

Exercise participation is associated with better sleep quality. Evidence suggests that physiologic pathways such as muscular relaxation, decreases in sympathetic tone, or thermal changes induced by exercise may promote sleep. Exercise has also been associated with improvements in depressed mood and anxiety levels that influence sleep quality. 

Exercise Participation Promotes Better Sleep Quality in Women with Lupus

Disease activity may indirectly influence sleep quality. Women in a more active state are more likely to be taking prednisone and less likely to engage in regular physical activity. 

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