AF Association
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Af and sleep problem

Hi I've just had my first incident of atrial flutter with fast ventricular response, (I think this would be called "lone AF" as I'm healthy 56 year old otherwise), and cardioverted back to normal rhythm in A and E by iv flecanide 10 days ago. I now have a 100mg flecanide tablet of it to take in case it kicks off again, but am also on daily bisoprolol, 5mg, then 2.5mg for last 2 days. My issue is sleep, or rather, lack of it, due to a breathing problem when I'm falling asleep. I just breathe normally, out and in, but then breathe out and don't breathe in, just as I'm drifting off, then come round in a panic short of air. 2 nights out of last 4 I've had NO sleep to speak of, the other 2 nights, i did drift off eventually and then got a good 5 hours. My doc has said don't worry hopefully sleep will settle down, but its been on the verge of this since the cardioversion. I'm just worried if it gets worse, I'll be in real bother. Also, I feel ok walking or riding a bike, but coming back to rest I then get breathless. Its like the bisoprolol is messing up my breathing when at rest. Has anyone else had this, with or without bisoprolol?

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Bisoprolol is not recommended for people who have asthma as it can affect that but what you describe does sound a little like sleep apnoea I think. Are you trying to sleep on your side front or back? I can NEVER sleep on my back. It may be worth asking your doctor for a sleep test to see just what is happening as sleep apnoea is a well know cause of AF.

By the way. flutter and fibrillation are two quite different conditions and what you describe sounds much more like A Flutter not A Fib which is normally a fast and totally chaotic non rhythm.

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Hi Bobd, thanks for replying! I had asthma when I was a kid, but never since. I always sleep on my side, and as far as I'm aware I don't snore much. My wife thinks I could have central sleep apnoea, and I have had the odd occurence of this (but not to this extent) before the flutter incident, when extremely tired. And this incident has been a big shock to me and my wife, so I'm pretty exhausted. Was at the docs yesterday and mentioned the sleep problems, but at that point I'd only had one REALLY bad night. Make that 2 after last night. The doc just said hopefully it'll resolve as I get used to the bisoprolol, even though we mentioned a sleep clinic. I'm booked for a 24 hours holter monitor - the wait is a month. I've been referred to a cardiologist. The wait is longer, so God knows when I'll see them. So I'm at a pretty low ebb and feeling pretty desparate and unsupported. In fact the doc pretty much implied "might need to go to casualty to get bumped up the list"

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AF is a long journey but we have some good maps here. The Holter monitor (well done for getting the spelling right by the way most people don't ) will define just what is going on provided that something does when you are wearing it but sadly they seem to almost guarantee a day in NSR. I am always against using A and E unless really essential but if you do have an event it is a way of at least getting things on ECG . Always ask for a copy by the way . Some people to find that a private first appointment with a specialists is the best £250 they ever spent but you do need to have some data to discuss first.

We all know how scary this mongrel condition really is which few doctors understand but do remember it won't kill you even if it feels like it. Ask us anything and we will try to help.

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Thanks again Bob, wise and kind words. I did have quite a few ECGs done on my first hospital visit, and I didn't get copies. So I'll request them if I can. And to my non-expert eyes, the initial ECGs did look quote chaotic, though I'm sure that there must be telltale signs that it was flutter

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For what it is worth flutter shows up as a saw-tooth line whilst fibrillation is just all over the place. Reading ECGs is skilled art which few have and even the automatically generated diagnosis is often wrong my specialist tells me.

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Dave—

The wait you have is long. Can you afford to purchase a Kardia? If so, you can take EKGs at home and email or take them to your doctor which may speed up your place in waitlist line.

Your symptoms sound familiar to me.

Note: any steroids you take for asthma may kick up A-Fib. Look it up. Happened to me

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That's a good description how mine started 5 years or so ago Dave. I think as Bob will confirm the worry of it doesn't help and I followed the same route with flecanide PIP treatment when first diagnosed as you describe after being inverted intravenously in hospitial the first time. Sleep also is an important part of keeping it at bay I find for me, as now does any flu or virus symptoms. Dehydration also is a a very dominant factory for me, I drink a minimum of 2ltrs a day of water something all the group seem to agree on, I take a magnesium supplement every night which I find helps me sleep and I belive has kept the Afib at bay for many a day. If your not sleeping and axnxious I would ask for a diazapam for couple of days it helped me enormously when I couldn't sleep and was anxious, just a short term aid to relax and sleep. I'm not on bisoprolol as I get tachycardic with an attack and am on the ablation list now after having 5 years too long with it for my liking. I find if I sleep on my left it starts it when I got to bed, or back, so I sleep propped up with 2/3 pillows in my right and this helps immensely. I started bisoprolol three weeks ago and it does make you a little out of breath, but again being anxious can exasserbate this I feel. Its a great group in here with loads of people like Bob etc who have lived with it a long time and are a great source of help, I know it's hard but relax and be kind to yourself as much as possible it really does help and I hope you don't feel so alone, we are all in same boat and there is light at the end of the tunnel, and loads of support here.

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Thanks for that, very reassuring, and I'll look into magnesium! What's the stuff you take?! At least I did sleep well last night...after a few false starts! interesting that you've only just started with bisopropol though - have you been on any other rate controlling drug in the meantime? I ask because my consultant said that one possibility for me was to stop the biso altogether, and just take one with the flecanide as a PIP solution if I get it happening again. (I think the biso would be advised as I had flutter) The more I read about biso the more I'm tempted to try this. What with the breathing issues, sleep being affected, someone sitting on my chest, and no appetite either (all of which I think could be due to the biso) I really don't want to get addicted to it, as I've read here that it's very hard to get off too. My wife has done a lot of research on her days off, and biso's ability to prevent further attacks seems to be quite limited.

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It's cardio vascular magnesium taurate recommended from here Dave, I buy from amazon Next day , and I get the Epsom salts pure in tubs from there also which I use every bath, which my ep said wasnt a problem and can help relax etc and top up magnesium . I was only only flecanide pip up to about 6 weeks ago, but taken apixiban for a year since I asked to be on it. The bisoprolol for me gave me shortness of breath, chest pains, stabbing like a muscle pulled feeling, for about a week, then now I don't get anything on 2.5mg tbh it's settled down . My ep said its good for rate control and you can take another 2.5 to 5.0 on top of my dose if I get a bad episode like I did a few weeks ago down to a virus, which I ended up admitted to hospital a couple go times tachacardic . So far I manage on the 2.5 fine and the breathless and pains for me have subsided. I did a 1 mile walk yesterday and feel fine and can do stairs again which feels good . I did find the diazapam 5mg they gave me helped loads for 3-4days, relaxed me and I got sleep which has made a big difference, and the magnesium now alone is getting me sleep, half hour before bed and my eyes are like Lead, so sleeping until 6am now which I think has made all the difference. I have only had 5-6 bad episodes in 5 years usually when I'm run down,or I'll, my ep says I'm an ideal candidate for abaltionbefore it worsens, or I get Older, suffer more with it, and it's more chance of working, so I'm going for it. Wish I had sooner now but as he said last week technology is much more advanced with mapping etc, so it's a better shot at success.

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Hi I have read that magnesium is good for anxiety, sleep etc but tell me if you can ? Does it have any bad interaction with warfarin. Cheers Glad.

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Not sure I'm No doctor, but I'm on apixoban as I didn't want the constant checking that you get with warfarin, my doc was resistant as it's cost a lot more than warfarin seemingly, but I insisted and also got my dad into it, he's 73 and he says it's best thing he ever did as his warfarin levels were a nightmare to maintain, maybe ask the pharmacist or your doc as I'm not sure.

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Thanks for your reply, Cheers Glad.

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Dave I would strongly advise getting the sleep issue investigated ! Apnea (albeit mild) has been a major contribution to my af ! The link is very well established !

All the best

Andy

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I found a study that treating sleep apnea helps (regarding A-Fib) in 42% of cases, but this means it does not in 58% of cases. I do not believe it is a (root) cause of my A-Flutter/rapid heart rate. After all, how did I go 17 months w/o it after my 1st ablation, when it was returning only weeks apart prior to ablation?

I do not believe that (moderate) alcohol and caffeine consumption causes it in my case either, as I had both during those 17 months. As I posted in a different post recently, it sure seemed like that a spike in blood sugar level "triggered" my last three episodes.

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Thanks Andy, I'll certainly look into it.

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This has happened to me a couple of times after a lone af episode. At the time I wasn’t on medication. It was just at the point of falling asleep , my breathing was just as you described. I was given diazepam by the doctor but decided to try Nytol and herbal sleeping tablets first. I also started using a hypnotherapy relaxation recording to go to sleep. I didn’t have to take the Diazepam, the over the counter stuff worked.

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Be extremely cautious using herbal supplements and over the counter meds. They can cause MAJOR interactions with heart meds. Use your computer to look up these drugs and interactions. You’ll be glad you did. May save you a Hospital visit.

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Hi could you please tell me the name of the hypnotherapy relaxation tape and where I can buy it? Cheers Gladie. xx

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If you google Glenn Harold, there are some free ‘taster’ samples and then you can download other recordings which are chargeable but cheap.

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Hello thank you for your message I will look look it all up on Google, been watching the Royal Wedding all morning, so emotional. xx.

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I started Bisopropol about 3 weeks ago. It caused me to have exactly the same symptoms as you, despite taking it first thing in the morning. It did eventually settle down but I now have swelling in my ankle / calf with throbbing pain. I understand that this can be a symptom but as I am taking meds for another health problem, I am not sure if it is the Bisopropol that is causing this. I am still having AF and it was suggested I take an additional pill - I took it and the breathing problems / sleep problem returned so not going to happen.

Hope you get it sorted.

Netty

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Welcome to Bisoprolol !

I was on Metoprolol for Lone / paroxysmal AF for 6 years, then the hospital changed me to Bisoprolol saying I was used to may other. Well, first 10 days on 2.5 mg, no energy, low heart rate sub 50 and sleep apnea. Asked the Doctor not bothered. So off my own Bat and after reading the forums changed to 1.25 mg . Now I can do things and sleep and no AF (yet)

However, I was told that it will take 3 to 4 weeks to adjust to Bisoprolol.

I do get sleep apnea ( breathing ) and low resting heart rate - 50 - 55 all day. Went to see another GP , he says I am just a low rate person !!! . But I am now fine. So my layman's advice is to check the dose with your GP or Doctor

Hope this helps

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I'm on verge of going to 1.25mg as you did. I think the bisoprolol is exacerbating a tendency I had - I have had the "stop breathing just as you fall asleep" thing before, at altitude in Nepal (google "periodic breathing") and also back home very occasionally, when absolutely exhausted. Which is what the bisoprolol seems to make my ribcage feel - exhausted so it doesn't want to make the effort of breathing unless I tell it to!

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Sleep Apnea!!! And once confirmed, you will get immediate relief once you start treatment. I love my sleep apnea machine. I know that I am breathing properly all night and that relieves my anxiety.

Before A-Fib diagnosis, I was having problems skeeping even on machine. Once I started the Dilacor and the Pradaxa been sleeping mostly like a baby with my apnea machine.

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That's a coincidence! I had the exact same problem last night! ( for 1st time ever) . I have have numerous cardioversions since 11/14, and two ablations (almost 2 years apart), and have not had this happen before.

I have had (symptomless) sleep apnea for a few years now, and do not use a CPAP. 3 days ago, I had both cryo and electric ablations for A-Fib, A-Flutter, and rapid heart rate which was successful. That night, I had trouble falling asleep (even though it was pretty quiet in hospital, bed was fairly comfortable, and I was left for the most part undisturbed), but did NOT have the "panic" issue. The next night (at home), I went to bed quite early, as I was dead tired, and slept very well.

But last night, every time I was about to fall asleep, I'd wake up in a panic like I couldn't breathe. After several times of this aggravation, I got up and took some melatonin and L-tryptophan, and after that seemed to fall asleep just fine, and did not have the problem again.

BTW: I 1st started taking melatonin and L-tryptophan when I had trouble sleeping some time ago, when I was withdrawing from from opioids when I quit pain management. Then, I could not lie still when going to bed, long enough to fall asleep. Had to have almost constant motion.

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Dave,

As stated by several others if the sleep thing continues, I would ask the Dr. about having a sleep apnea test done whenever an overnight study is available. I have had a couple done over the last 20yrs. It's no big deal you will go into the outpatient or clinic 9-10 pm. and the nurse hooks up a bunch of wires like those used on an EKG and a mild sleeping sedative. On both occasions, the test was done by 5 am. The next day the Apnea Dr. will read the test results and contact you with the results. In the event, the Doc prescribes a sleep apnea machine request the one with a distilled water reservoir to keep the air moist. There are many masks available, my most recent and favorite to date is called the pillow type, the trick to that one is to adjust it to where the air doesn't leak still making it comfortable to wear, if your nose gets sore it is probably too tight. I had to mess around with mine until I got used to it

Anyway enough rambling, I wish you well!!

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