I have seen a few people mention on here that sleeping on your side can trigger AF, and I'm trying to understand why that is.
Since being diagnosed 3 months ago with PAF I have had to sleep on my back as I'd feel a tremble if I laid on my side. But I have mild sleep apnoea and sleeping on my back is causing attacks in the night which are really unpleasant. Twice in the last 2 weeks, I have tried to sleep slightly tilted on my side and within minutes I get a strong surge like a magic 8 ball being shaken in my chest and my HR starts to rev up like someone has a dial on it.
Does anyone else get this strong a reaction? And if yes, do you know why?
I have just had a conversation with the arrhythmia nurse at the hospital about this and she said it wasn't something she had ever heard of. I find this surprising as side sleeping seems to be a common problem for people on this forum.
Does anyone know if having an ablation solves this problem? Ablation isn't on the cards for me at this early stage as they are still trying to sort me out with medication but I'm not feeling hopeful about this as my night time attacks are relentless and dreadful, even though I'm sleeping on my back. I wake up multiple times a night with my heart racing and/or pounding very hard. It's all a bit of a nightmare.
Any info or shared experiences, especially success stories would be really welcome.
Kind regards and many thanks for reading.
Katrina
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For me and quite a few others it's just lying on our left side that makes us aware of our hearts, or kicks off AF, on the right it's fine. Really feel for you if you can't manage either side.
Do you suffer with reflux? Sometimes having that can make you aware of your heart rate, but taking pills called proton pump inhibitors can really help.
It's odd how your arrhythmia nurse hadn't heard about this problem some AF sufferers experience.
Thank you for responding. I don't suffer from reflux but have tried having a gulp of galviscon and few times before bed to see if anything was different and it wasn't. I was given a box of omaprezole a while ago at the hospital when they were testing me for a stomach infection (which I didnt have) so I may have a bash with them just to see what happens.
I hear what you're saying about being aware of your heart beat, but since going on Diltiazem I'm aware of every single beat all day and night as its really clunky. Drives me mad!
Regardless of how you sleep it is important that you get the sleep apnoea sorted out asap as this is a known cause of AF. My own take on your question is purely that the pressure of other organs laying on our hearts makes us aware which in turn can trigger an event.
Thanks for replying. I know you're absolutely right about the apnoea, but I'm in a bit of a trap at the moment as I can't use the CPAP machine they gave me as it makes my heart pound and I have to take it off after a few minutes. I never really coped with it before, but now its impossible. I may have to try taking a sleeping pill to see if I can cope better if I'm knocked out!
You will often find medics will not acknowledge (at least not to patients) the potential benefits of lifestyle changes as they feel it would be unprofessional to stray out of their trained zone but don't let that put you off trying to identify what helps you.
Lying on your left side, I believe can cause AF as it puts more pressure on the Vagus Nerve than the right side. I deal with this by having two extra cushions on the left to stop me rolling onto that side. If you Vagus Nerve is 'sensitive' that can be an AF trigger.
Mild sleep apnea, I have not recently been tested but I know my sleep has improved considerably. I dealt with this by having 3 pillows to rest my head on, nasal strips and recently mouth tape (still testing this). With the mouth tape waking up with fuzzy head, blocked nose & not fresh has gone but I need to test this for 3 months to see if the benefits are every day. Your symptoms sound quite strong so do check out any tests you can have first and before any unilateral action like I mention able run it past your medics.
I majored in nursing i want to say this is the most helpful info i saw yet. Vagus nerve can trigger AF absolutely. Only way my AF doesn't attack me at sleep is if i sleep on stomach with knee to my chest on right side only as if pregnant i also use a pregnancy wedge to support stomach so not triggering vagus nerve. Or i sleep sitting up feet up. A recliner pushed back causes fluid in my lungs. I have congestive hrleart failure as well. But sitting upward in recliner helps as well.
Hi, thank you for replying. I too have been experimenting with mouth tape, many many cussions in various configurations, mouth piece to stop mouth opening and pull jaw forward, but nothing is helping at all. And since I'm now on Diltiazem, the mouth piece causes large swellings all over my gums which is horrible and wierd! As I said to Bob above, I think I'm going to have to try harder to find a way to cope with teh CPAP. If I manage to get any relief I'll update the post.
Hope you get something sorted out that works. The mouth tape I use is only 2cmx2cm over both lips in the middle (like a Charlie Chaplin moustache that has slipped down a bit!).
Lifestyle changes such as mouth taping take months and plenty of book research as well as trial and error to establish whether they are any good for the individual. The new book 'Breath' by James Nestor persuaded me finally to give mouth tape a try. The book also mentions breathing through the left nostril calms the body (parasympathetic nervous system) and the right nostril gets you alert (sympathetic nervous system). This would be fine I guess for most who breathe evenly but my problem for some reason is my left nostril is always more blocked than the right. I wonder, if the author's research is correct, whether it has contributed to my AF through an imbalance of anxiety?? Despite the possible negative effect of this on my sleep when using mouth tape I seem to wake up much fresher without any side effects so far...but too early to be confident yet.
I hope something in that ramble helps you or someone else!
Hi Katrina. Prior to my PVI (pulmonary vein isolation) cryoablation, left-side sleeping would always trigger an AFib episode. The medical experts have figured out that 'misbehaving' pulmonary veins are the principal cause/trigger of AFib for the majority of PAF sufferers. Since having my PVI croablation (Aug. 2018), I have been completely free of AFib. Post ablation, left-side sleeping is no longer a problem for me.
It is my own theory that left-side sleeping positions the heart and pulmonary veins (PVs) in such a way that the PVs have a much greater negative influence on the heart (specifically the left atrium). I recommend researching PVs and the how's & why's they will trigger AFib in some people - it makes for interesting reading.
Interesting Richard, thanks for sharing your 'left side' theory, it seems very credible more so than my Vagus Nerve under pressure theory. The important thing is that we all develop ways, whatever the reasoning incl the placebo effect, to keep AF at bay.
When I was suffering with PAF, I considered my AF to be of the "vagal" variety, as many/most of my so-called 'triggers' were stomach/gastro related. With research I eventually discovered that the pulmonary veins (particularly the PV's myocardial sleeves) are heavily innervated by specific subsets of sympathetic, parasympathetic and sensory nerve fibers. Note the vagus nerve interfaces with the parasympathetic control of the heart, lungs and digestive tract.
In my case the principle (and really ONLY) "trigger" for AF was 'misbehaving' pulmonary veins, however my PVs were evidently strongly influenced (i.e. made worse) by the activity/state of my vagus nerve. We can try to avoid all the potential 'vagal' triggers in our daily life (to the extent we can), but that unfortunately doesn't address the underlying issue of misbehaving PVs. And based on my experience and those of others, misbehaving PVs tend to get worse over time.
That's great Richard I wasn't aware of those PV details. From what you have said and my limited knowledge it seems (if I have got it right) that it should still be a priority to reduce the stress factor for many of us, as this is indeed a trigger upsetting the myocardial sleeves of the PVs via the subsets of sympathetic & parasympathetic nerves you describe, which I guess are all part of the same 'Vagus Nerve system'. Does this make sense?
Secondtry, to be clear the vagus nerve is a part of the parasympathetic nervous system. The parasympathetic nervous system is one of three divisions of the autonomic nervous system. Misbehaving PVs can be further influenced/worsened by the 'parasympathetic' nervous system OR the 'sympathetic' nervous system, as nerves from both systems innervate the PVs.
Reducing stress is always a good thing when it comes to your heart! But to be honest, stress never caused an AFib episode in my situation - it was almost always the result of digestive issues or how my body was positioned (think vagal nerve in both scenarios). Some PAF sufferers have an AF episode as a result of physical exertion, such as running. In this situation the protagonist is likely the sympathetic nervous system influencing the PVs.
You may consider researching the autonomic nervous system, and the function of each of its three divisions. Interesting stuff! The body is truly complex.
Thank you for replying and for the info. I will indeed doing some research.
I'm so happy for you that you are AF free, it really reasures me when I hear stories like yours.
Can I ask how it was identified that it was PV's causing your AF and whether you had attacks at night? I have had an echocardiogram and they said everything looked normal. I can't help wondering if the medication is causing my problems. Before they medicated me, I only had AF symptoms on exercising or bending forward, but I had no issues at night and was able to live a normal life. Now I'm medicated my nights are a nightmare with an average of 4 attacks a night of being woken with a pounding and racing heart, and when it races too fast it kicks into AF and a shoot out of ectopics. And that's with me sleeping on my back. It just happens harder and faster if I attempt to sleep on my side. I was on bisoprolol, now on Diltiazem and I have had the night time attacks on both, but they did feel slightly different. Are you now medication free?
Thank you for your kind reply. In response to your first question I'll provide some background detail re PVI ablation...
Specialist-cardiologist researchers learned in the late 1990s (at a medical facility in Bordeaux, France actually) that for the vast majority of PAF sufferers, AF is initiated in the myocardial sleeves of the pulmonary veins (PVs). The researchers identified the presence of automaticity in cells within the myocardial tissue of the PVs. 'Pacemaker' activity from these cells is thought to result in the formation of ectopic beats that initiate AF. Further, PVs are also thought to be important in the 'maintenance' of AF. Based on these amazing findings, the standard interventionalist practice (first step) for cardiologist-EPs nowadays is to target the PVs for ablation. There was no discussion/decision to be made with my EP as to what sort of ablation they were going to be doing - it was to be a PV Isolation (PVI) ablation, period. PVI ablation is now the "gold standard" for sufferers of PAF who have no structural heart issues or other related comorbidity(s).
Prior to my ablation my AF episodes would initiate at many different times of the day, however the majority of them occurred in the evening (not long after dinner) or during the night after I'd gone to bed. Physical positioning would also trigger AF sometimes, such as bending forward, leaning over to my left to reach something, and of course, left side resting/sleeping.
Since having my very successful ablation I no longer take antiarrhythmic drugs, but I do take an anticoagulant (apixaban - 5 mg BID) due to my CHADS2 score as well as an ARB (candesartan - 4 mg BID) for my borderline high blood pressure.
Thank you again Richard and proves the point it is so good if people who have had successful ablations or other treatment still report in here with their experience to balance & maximise information. The role of PVs is much clearer now.
I was another patient with Lone PAF who was offered a PVI ablation by my EP and no discussion; the only difference being I opted for anti arrhythmic drug Flecainide instead.
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Post ablation, left-side sleeping is no longer a problem for me.
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