AF happening every night...fine during the day

Hi guys...my dynamic has changed last 2 weeks never used to have a problem  sleeping. Im on 1.25 bisoporol and flecainide  x 2 100 mg. I exercise during the day and cope well with few symptoms during day. As soon as i lie down to sleep my af kicks in. I prop myself up with a few pillows which helps slightly but there seems to be a correlation with lying down or is it anxiety because im not sleeping ... i know your heart works harder when you lie down. Any one else experience this.

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  • Yes many people.  Some people find that resting triggers AF and others that exercise.  This is usually an indicator that the vagal nerve is activated which in turn triggers the AF.  

    Research Vagal AF - usually people with vagal AF should not be prescribed beta blockers such as Biso.

    Try different sleeping positions - propped up can help some as does supine - off or others it is lying on one or other side. 

    Look back on EngMac posts a few days ago on AF & Sleeping - good info.

    My AF was often, but not always at night.

  • Thanks for the info. Lying on either side makes it worse. I can only lie on my back. I will research vagal AF. I have a echocardiagram scheduled for 22 April will they pick up that condition then I wonder? 

  • No it will not as it is not something that can be seen - see YouTube - Dr Gupta on vagal AF.

    This is an article looking for evidence of vagal AF which may give you some sense of the complexity.

    ncbi.nlm.nih.gov/pmc/articl...

    You will find many different medical opinions on if there is even such a thing and as you will gather from the article evidence that vagal tone has a significant effect on AF is practically impossible to find - but ask a great number of people here and they will provide anecdotal evidence that it does.

  • Thanks for the info. I think I know what you mean (e.g) sometimes I am just about to fall asleep and its like my brain panics and tells my heart to go into AF. ....I will read the article. Thanks again 

  • I am a firm believer in getting the right drug combination and the right dose. Everyone is different so finding the best combination can make all the difference. I'm on Bisoprolol 5mg once a day and flecainide 100mg twice daily.  Have you considered a higher dose of Bisoprolol? The only thing to watch is increased tiredness perhaps.

  • I agree absolutely. My af was controlled for years with sotolol which stopped  working about two years ago. Since then it has been trial and error to get the right combination. Like the original poster I was getting af episodes at least once a day, usually at night, and have experimented with different doses of flecainide and bisoprolol. What's working for me at the moment is 2x 5mg bisop and 2x 150 mg flec. I know this is the higher end of dosage for both drugs but it was when I maxed out the flecainide that it seemed to do the trick. I know we are all different but I seem to tolerate both drugs well with minimal side effects. I'm aware that this is probably only a temporary solution but meantime I get to live an af free life for a while.....result!

  • I may see if upping my bisp to 2.5mg helps. Although like you say getting the right medication combo is so important and tricky. Sometimes I think less is better. Last night I resorted to a sleeping tablet which I dont want to do..even if im in afib all night.

  • Some people find that a course of Meltonin helps with sleep. It did not work for me.

  • My consultant advised maybe a change to Soltalol but I dont like switching meds if I tolerate them well. I do think the flecanide has probably stopped working for me though. 

  • I find if I drink water before bed, the incidence of AF decreases.  My EP told me that AFib is brought on by either being too dry or too wet (I have congestive heart failure too).  The worst is waking at night with bubbling in my breathing and my heart racing with Afib.  It's so hard to get everything in balance.

  • Hi jbrucej. Can I ask how your CHF was diagnosed. Im always being checked for swelling around ankles and stomach so I guess thats what they are checking for CHF. I have echo planned for 22nd april planned 

  • I had the feet and tummy swelling, but also fluid in my lungs at night. Apparently, I get swelling during the day.  After I go to bed at night, the fluid from my legs hits the vascular system causing it to become overloaded leading to <flash> pulmonary edema (oedema).  I would wake up feeling like I was drowning and my breathing all bubbly.  AFib would just add to the fun.  I take diuretics now which helps.   My CHF is a result of a couple of major heart attacks that left a significant part of my heart scarred; and some valve damage from another heart problem.

    I'm not sure the Echo will tell much about your CHF.  Most of the time, they can catch it from listening to your breathing.

    I have another gadget, an SPO2 (Amazon for about $20) meter that I use to determine if the fluid in my lungs is causing oxygen problems. It has been great to help me quantify the problem and report back to the docs.

    Good luck.

  • Thankyou so much and when I read what you are going through I feel guilty for complaining about my AF keeping me awake at night. God bless. 

  • well said, me to

  • My EP/Cardiologist told me when I went into AF to drink a large glass of cold water and relax....RELAX??? yeah easy for him to say. lol

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