Afib starts in the night ...any ideas why ? - AF Association

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Afib starts in the night ...any ideas why ?

Suntanann profile image

Hi all,

Am now finding im being woken up in the night around 3 with a pounding heart and afib attack ....I try to sleep through it but it's definetly disturbing my quality of sleep ...it's still the same i get up in the morning ....

I'm taking currently verapmil 40mg 3 times a day ...

Any ideas as to why and any solutions ?

69 Replies
BobD profile image
BobDVolunteer

Sounds vagally mediated. Use search facility to read other's experiences .

Suntanann profile image
Suntanann in reply to BobD

Ok ..thanks Bob 👍

What is your daytime resting HR and what time do you roughly eat/drink your last meal??

Suntanann profile image
Suntanann in reply to john6

Hey Daily resting.HR is in the 60s unless I'm in afib then it'll.go upto to 80s to 100.BPM

I eat my.last meal at 7pm.anf then at bedtime which is around half 10 I have a cup a Decaf tea and a couple of digestive biscuits .

john6 profile image
john6 in reply to Suntanann

When I had similar it was due to my HR going too low whilst asleep, probably into the 30s, a change of medication stopped that. The other thing that also affects me is eating a heavy meal or food that had a high fat content, as such it was putting energy into my body that nowhere to go.

As innocuous as it sounds it could even be those "digestive biscuits" as they will more than likely have a high fat content. As Bob said it is probably "vagal", as such I would skip your light supper (tea included) and go to bed on as near an empty stomach as possible, it makes an amazing difference to your heart not having to work pumping stuff through your digestive system.

ETHEL103 profile image
ETHEL103 in reply to john6

I eat nothing after 6pm and I still get a fib all night grrr

john6 profile image
john6 in reply to ETHEL103

What is your medication and what time do you take it? What is your daytime heart resting rate?

ETHEL103 profile image
ETHEL103 in reply to john6

Hi I take 40mg verapimil 3 times daily. Tried 120 slow release. No good. Tried 120 Sr then another 40 at about 10pm.Took my HR down to 40 and below during night. Maybe wht my a fib is troublesome during night but had uneven pulse and occasional high HR since 18th June.

ETHEL103 profile image
ETHEL103 in reply to john6

Daytime can be 45 to 120.Need rythmn meds.

john6 profile image
john6 in reply to ETHEL103

My daytime resting rate for Bisoprolol 5mg was 44 bpm. Night after night I was getting Afib episodes and eventually came to the conclusion that my sleeping resting rate was dropping into the 30s. I changed to Nebivolol 5 mg which took my daytime resting rate up to 58bpm which eliminated 95% of my night- time episodes. On that basis you could be experiencing similar from your medication.

One other potential side affect of Verapmil that needs checking is whether you have low blood pressure, or not is the case. Whatever you decide, do not swap one problem for another - speak to your medic.

secondtry profile image
secondtry in reply to Suntanann

Try eating light (e.g. no meat) 6pm latest, then just water until breakfast. Simple to do and helped me when I had similar.

You could try altering your snack . Try a piece of toast or a ryvita. And a glass of milk or vegetable juice rather than tea. You could if you don't want to skip it altogether try eating it a bit earlier. Are you hungry again at this time or is it habit?

My Afib usually occurs between 11:00 pm and 1:00 am and last for approx 5 hours and is very regular.

I have tried keeping food diaries and cannot find a connection there.

I've recently had an ablation so no problems since then apart from ectopic beats.

john6 profile image
john6 in reply to Griffin9

It could be something that is so innocuous that you will hardly believe it. Just to eliminate a food or drink cause I would not eat or drink (save water) some 6 hrs before going to bed, literally go to bed on a stomach as empty as possible for a night or three and work back from there.

Suntanann profile image
Suntanann in reply to john6

So that's my beloved bedtime cuppa and digestives out then to ! Not.much left on the happy front these days ! Thanks for the tip ...will.try it

Suntanann profile image
Suntanann in reply to Griffin9

Great news on the ablation front ...I'm on the list but it's a good 6 to 8 months away as yet ...How did. You find the procedure and what are ectopic beats ?

Griffin9 profile image
Griffin9 in reply to Suntanann

The procedure went very well without any discomfort afterwards. I was tired for a few days after but took it easy for a week and started walking slowly during the next week.

Ectopic beats are extra beats or beats that happen out of sync. I had a couple of days when I would feel an odd beat, then normal again, then an odd beat again. it happened last night at about 2:00 in the morning and kept on for about 45 minutes. It's nothing like the constant drumming of Afib.

A lot of we AF people find that sleeping on our left side can bring on an attack. Also raising the head of your bed slightly could help.

Jean

Hey thank you for your advice . I never sleep on my.left side as it definetly. Makes rhe afib worse .I start of propped up almost.sitting yp to sleep but during the night I do find I end up flat so maybe there is a link there

john6 profile image
john6 in reply to Suntanann

Also worth a try of what Jean is saying, "Raise the head of your bed", as [gravity] plays a part in the way blood is pumped around our body.

I find sleeping on either side can lead to an episode which is inconvenient as I don't like sleeping on my back.

You poor thing, when it kicks off AF is so horrible.

Sleep apnea can be a cause - have you had sleep problems prior to AF developing? Has that been ruled out by GP?

Other possibilities apart from those mentioned above is HR or BP dropping too low during sleep often caused by Autonomic Dysfunction, similar to vagal although vagal is usually about rest or exercise, food or drink or posture whereas other Autonomic Dysfunction can cause low HR or BP at rest - if so raising head of bed by 15 degrees helps and not eating anything at all for at least 3 hours prior to bed so cut the biscuits because they are carbs and sugar and both are triggers for me so to eat them just before bed is not a good idea.

Hope that helps.

Suntanann profile image
Suntanann in reply to CDreamer

Thank you will try what tou said . I have a hunch it may be my HR and BP dropping to low while I sleep ...Any other rips for keeping Hr and bp up much appreciated

CDreamer profile image
CDreamer in reply to Suntanann

As per RosyG’s suggestions - keep electrolytes up - I found Coconut water very good but make sure it’s the pure coconut water & not coconut drink. Stay well hydrated & make sure you don’t abstain from putting salt on your food - that’s only when you cook from scratch - processed food will often have enough salt. Recommended amount for anyone with low BP is 6g daily.

HiAgree about low heart rate triggers I hav vagal AF and found trigger was low potassium levels so eat more potassium rich food like salmon tomatoes jacket potatoes etc

Threecats profile image
Threecats in reply to rosyG

That's interesting rosyG. I too have AF that only comes on in the early hours. May I ask how you discovered your potassium levels were too low?

rosyG profile image
rosyG in reply to Threecats

Just the three blood tests when in a and e with bad AF episodes.

Threecats profile image
Threecats in reply to rosyG

Ok, thank you rosyG

Suntanann profile image
Suntanann in reply to rosyG

That's how I found out I was low potassium to . Blood tests in a N e when I was having a bad afib eposted ...I was told to eat 4 bananas and then get my go to retest my levels after 3 weeks and after the 3 weeks the levels were back to normal thank fid as u don't like bananas !

Ann I have pm you.

Suntanann profile image
Suntanann in reply to ETHEL103

Hey . I've not received a pm from you 🤔

ETHEL103 profile image
ETHEL103 in reply to Suntanann

I have Ann on our chat.

ETHEL103 profile image
ETHEL103 in reply to Suntanann

Have you looked at chat?

Mine always started at night, or late evening, after a busy day at work, I would get it just as I lay down or it would wake me in the night. I asked the same question of my cardio and he said it was quite often the case when sufferers of A/F relaxed. I also ate my main meal in the evening and what made the night times worse for me in A/F was the constant need to pee. My daughter in law, a nurse, told me that they always advised patients to sleep on the right hand side, especially those with heart problems.

opal11uk profile image
opal11uk in reply to opal11uk

I should clarify, the need to pee throughout A/F episodes is due to the heart not pumping correctly or going into overdrive to rid the body of excess fluid, often wondered if A/F is due to fluid retention in some form or other,

Singwell profile image
Singwell in reply to opal11uk

It is the body trying to get rid of sodium which is part of the chemistry involved in the electrical system. that's why we pee a lot in AF

As CDreamer mentions, could be Sleep Apnea, someone on this site suggested the same to me nearly three years ago, I'm not overweight but when tested I did have it and my cardiologist was convinced it what was giving me AF episodes in the night and what had originally caused my heart issues, Well worth ticking off the list as it changed my life when controlled.

I’m just having tests for sleep apnea - which I do think I experience. May I ask how yours is controlled?

Check out nasal strips (currently Breathright original medium/small are in short supply) and breathing, consider mouth strip at night; I will be reporting here soon after trialling the latter for a year. More information on YouTube James Nestor & Patrick McKewan. I was diagnosed mild SA but sleep better now and no waking choking.

When tested I was shocked to find that I was experiencing 68 episodes an hour , anything above 24 is classified as severe so it was decided to put me on CPAP ( a machine with a mask to control the airwaves ) if it is mild apnea it can be controlled by simple nasal strips. The first 4 weeks were a real struggle as I am extremely claustrophobic now I use the nose cushions far less intrusive than a mask and it doesn't bother me at all and always sleep like a baby and gone are the getting up for what I thought was a wee 5 times a night. Please do ask if you want any further info. Good luck.

Thanks so much that is very helpful!

I’ve read that around that time our protective steroid levels are at their lowest levels. It might be that? Also…

- Sleep apnoea and snoring can affect the heart and cause arrhythmia.

- In some people the stomach and intestinal gases can press stomach high against the diaphragm, forcing that against the heart, bringing on palpitations and then fibrillation.

- Acid reflux can cause the oesophagus to contract and in some people that presses tightly against the heart and can spark off palpitations, and, for a few, fibrillation.

Steve

AussieHeart profile image
AussieHeart in reply to Ppiman

Interestingly my aFIB (irregular heartbeat) became pronounced after erosive gastritis episode!

Same here I always thought

Loafinabout profile image
Loafinabout in reply to Ppiman

Thanks for info - worth knowing! Currently my consultant consultation is via ‘phone so little opportunity for tests etc.

Ppiman profile image
Ppiman in reply to Loafinabout

I had an initial gastroenterology appointment using Zoom. I really felt that it was a waste of time.

Steve

goldey profile image
goldey in reply to Ppiman

see my message a little further down about sleeping in a chair. It will help all these things you talk about.

Suntanann profile image
Suntanann in reply to goldey

Thank you goldey

Loafinabout profile image
Loafinabout in reply to Ppiman

That’s very interesting. For a couple of years I’ve had trouble with getting a really intense and sharp pain under my left rib. It’s usually brought on by a twisting movement combined with lifting my left knee - often when putting socks on or getting out of bed. The pain is so bad I’m temporarily immobilised. I’m wondering if it’s an enlarged spleen and if that could be affecting my heart in any way?

Ppiman profile image
Ppiman in reply to Loafinabout

You would need a scan of some sort to find that out - an ultrasound at the least. I get similar pains, not so intense though but mine is accompanied by nausea and fullness. it's no fun at all. I think they're likely to be muscular rather than spleen, liver or stomach though, perhaps a temporary trapping of an organ a little, like a hernia?

Steve

Suntanann profile image
Suntanann in reply to Ppiman

I think mine could be acid reflux ans stomach issued possibly having an affect on my heart . I had gastritis for months but it's now cleared up but I still get some acid reflux

Ppiman profile image
Ppiman in reply to Suntanann

I have to take lansoprazole which controls the acid well, but since last December I've had nausea and problems in my upper left stomach, even going into my back. This sparks of high heart rate and bits of fibrillation, it seems. It's hard work to cope with.

I suspect the effect is caused not so much by the reflux as what the food pipe does when it is attacked by it. I imagine it would go into some kind of colicky spasm much as the bowel does in IBS, say. The oesophagus presses against the heart in some people, and that spasm could easily spark off palpitations and, from those, for a few, atrial fibrillation.

Steve

Hi, I have bought a softer pillow and tuck it into my neck when I go to sleep. I only use the one pillow and it supports both my neck and head, this relieves any headaches and a fib, may be worth giving it a try. Hope you are able to sort it out soon.

AussieHeart profile image
AussieHeart in reply to Byke

Oh so headaches are a symptom of aFIB? I get a lot, some migraine-like (eg: squiggly lines and nausea). If I get onto it early with panamax it eases

Mine always starts between 1-2 am my cardiologist thinks my heart rate may drop too low on these occasions and when it tries to kick start itself it goes out of rhythm. I’m not on any meds though and have PAfib

Sorry, I should have added to my earlier reply AF is a 'mongrel' condition and very individual and therefore I conclude it is unlikely one change in Lifestyle will do it but don't abandon any suggestions for that reason, keep making Lifestyle improvements on all fronts. My pet analogy is relating it to an overflowing glass of water; for some one change will reduce the level to below the rim but for most it will require several changes before it stops overflowing.

When I was first diagnosed I also had problems in the middle of the night. It has to do with the laying down position. Get yourself a nice comfy chair that reclines only a little bit, and learn to sleep in it. When you have a problem at night, move over to the chair. I sleep just as well in the chair as I do in bed.

Suntanann profile image
Suntanann in reply to goldey

Thank you for that ....I did sleep propped up last night and it was a lot better but may of just been coincedance so will see how I go over next few weeks

Hi there,Years of nocturnal afib for me. I have a low heart rate (50-53) on average. I asked for a sleep study and found out I had sleep apnea. I am also on verapamil three times a day. I was put on propafenone at the same time so they together cover both rate and rhythm.

I used a Kardia machine to make sure it was afib, as for me, it could be afib. Or tachycardia. It is also helpful to have a ecg strip showing what is going on. Has your doctor done a holter monitor to try and catch the events?

Long story short..for me, the nocturnal afib was due to sleep apnea and my heart rate going low.

Also, you should check out the stomach-heart connection. If I go to bed with a full tummy, it is likely I will go into afib that night. I will also say there was absolutely no continuity in anything when it came to nocturnal afib. You are asleep, so… 🙂

Mine triggered by a heavy pasta meal, later than my usual dinner time of 5:00 PM.Now eat a larger lunch and light supper, no issues since. Just me though.

For afib and non-afib folks alike, they recommend 5 hrs from supper to bed.

wrcameronwellness.org/blog/....

Eating a heavy supper then heading to bed a couple of hours later is a recipe for afib...as I found out the hard way.

Near every night after 12, I've found that drinking some warm water calms and set down…It could be dehydration due to meds taken (I’m on Digoxin, Flecainide, Rivaroxaban and others) because I’m vegan and not salt or sugar in my diet. By the way, I can only have warm water even with the meds.

Get tested for sleep apnea. There is a correlation between those that suffer from sleep apnea and having AF.

I'm a bit late to this thread so hope I'm not repeating everyone else's good advice. I've read some. There's 3 likely candidates triggering your AF at night - your HR drops / sleep apnoea/ acid reflux and digestive disturbance. As a long term acid reflux sufferer and voice trainer (singers and other vocal performers are a bit obsessed with acide reflux!), advice is to raise the head of your bed using two bricks. DON'T use pillows. Try to think of your stomach as a hot water bottle without a stopper and treat it as such. Regarding which side to sleep on - you'll have to experiment - reflux sufferers are always advised to sleep on the left because it puts less pressure on the stomach, but I know if I'm in AF that I don't want to sleep on the left. Eating time - the advice is to leave 3 hours between meal completion and bedtime, and eat a light supper rather than heavy duty evening meal. If you do eat later - stay up later. You can also go for a short walk to help the digestion. Personally I don't need a 6 hour wait and it would be too much for me anyway. The advice re electrolytes is good - organic coconut water is what I have. I know the bedtime ritual will be hard to get rid of but I think everyone's advice here in this is worth trying at least. Hope this helps - I'm a bit of a walking book on acid reflux if you need more info. I've almost eliminated mine with dietary changes.

Suntanann profile image
Suntanann in reply to Singwell

Hi singwell. .thank you for that ...I'm. Guessing. You've never taken PPI'S for gastritis ...? I was diagnosed with gastritis in September last year afterm having a camera down my throat and was pit on PPI'S ...I took those for.months and started to get breathing difficulties in January this year after walking and then one day when into full blown af attack and got taken to hospItaly in an ambulance . I still believe to this day that the PPI I took caused the afib or contribited to it by blocking magnesium and potassium absorption as when tested I was low in both ...any thoughts on this ?

Singwell profile image
Singwell in reply to Suntanann

YES! I will try to find them but there are some science papers on links between AF and acid reflux which obviously included people on PPIs. You could do a Google scholar search on AF and GERD or AF and acid reflux. If you're suffering from acid reflux and want to get off the PPIs then diet is the best way.

Suntanann profile image
Suntanann in reply to Singwell

I stopped taking the PPI'S back in march time aa decided I didn't want them in my body in any more as I thought they were having a detrimental effect on my health I stick to a healthy plant bases diet so aa not to poke the gastitis into reawakening ..also a good diet for afib ....a month after coming off of them the verapmil seemed to start helping the afib and my potassium and magnesium levels went back to normal levels and I felt better in general ...although I still have the afib attacks regularly

Singwell profile image
Singwell in reply to Suntanann

So you're doing lots of good things for your body and can rule out the PPIs. It's possible you're getting silent reflux in the night which MIGHT contribute to the nighttime AF. Have a look on the internet for silent reflux and see what you think - if you might have it. There's two great free articles on the website of the British Voice Association that explain it. It's just another thing to rule out maybe. I'm wondering if you can persuade your cardiologist or EP to let you have a holter monitor for a few days to check what's happening to your heart in the night?

Suntanann profile image
Suntanann in reply to Singwell

Have worn a holter monitor for 3 day periods twice now ans my heart behaved impecabally! Sods law ay

I will have a look at the online sites and info you recommended

I've also spent the last two nights propped up sleeping Instead of sleeping flat as mamy ha e said flat out ianr a foos idea for adiv and it seems to have helped ...touch wood ..but now dealing with a stiff neck and bad back from trying to sleep upright ! Lol

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