Steroids and Night Sweats

Corticosteroids are powerful anti-inflammatory medications used for a wide range of conditions — from asthma and rheumatoid arthritis to inflammatory bowel disease and organ transplant prevention. Night sweats are a recognized side effect, particularly at higher doses and during dose changes.

How Steroids Cause Night Sweats

Adrenal suppression. When you take exogenous corticosteroids (prednisone, prednisolone, dexamethasone, methylprednisolone), your body reduces its own cortisol production. The adrenal glands, receiving a signal that cortisol is sufficient, down-regulate. This suppression can persist for weeks to months after stopping steroids.

During the tapering phase — when the steroid dose is being reduced — the adrenal glands haven’t yet recovered full function. The resulting adrenal insufficiency can cause temperature instability, night sweats, weakness, and fatigue.

Direct metabolic stimulation. At higher doses, corticosteroids raise metabolic rate and glucose levels, generating excess heat. This direct effect is most pronounced in the hours after the dose.

Dose timing matters. Many people take prednisone in the morning to mimic the natural cortisol peak. Taking it in the evening can cause cortisol levels to be elevated at night when they should be lowest — directly causing nighttime arousal, elevated temperature, and sweating.

High-Dose vs. Low-Dose Effects

• High doses (above 20mg prednisone/day): Night sweats are common and often pronounced. The metabolic and adrenal effects are significant.
• Moderate doses (10–20mg/day): Night sweats occur in a meaningful proportion of users
• Low doses (below 10mg/day): Less common but still reported, particularly during tapering
• Inhaled steroids: Systemic absorption is low; night sweats are uncommon but reported with high doses of inhaled corticosteroids

During Tapering

The tapering phase — when prednisone is being gradually reduced — is often when night sweats peak. The body’s adrenal function is recovering but hasn’t fully caught up to the reduced exogenous supply. Symptoms of adrenal insufficiency during taper include: fatigue, weakness, nausea, joint pain, and night sweats.

If night sweats during tapering are severe, contact your prescribing physician. The taper may need to be slowed.

What You Can Do

• Take your dose in the morning if not already doing so — this reduces nighttime cortisol elevation
• Cool your bedroom — steroid-induced sweating responds well to environmental interventions
• Don’t stop steroids abruptly — adrenal crisis can result from sudden discontinuation of long-term steroids
• Communicate with your physician — dose adjustments and timing changes can meaningfully reduce sweating

Related articles:

• Medications That Cause Night Sweats — Overview
• Cortisol, Stress, and Nighttime Sweating
• Best Cooling Sheets for Hot Sleepers