Yesterday, I walked for 7 hrs (not unusual), climbing 5 mountains and covering about 12 miles. I am careful to keep hydrated, and drink lots of liquid, fortified by re-hydrate powder. On such days I drink no alcohol or coffee/tea. At home, I drink, eat, rest and go to bed early. I'm a good sleeper. Then, as is typical in my case and happened again last night, I wake - somewhere between midnight and 3.00am with AF. Episodes typically last for up to 2 hrs, usually less. Can anyone offer an explanation - scientific or anecdotal - why this should happened when I'm at total rest, and fully 're-fuelled'? Why not during the activity itself? (Note - I take 1.25mg bisoprolol and 100 mg flecainide, each taken twice a day, prophylactically.)
Why do I get AF during the night - Atrial Fibrillati...
Why do I get AF during the night
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Kent2007
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34 Replies
•
BobDVolunteer
Sounds like typical Vagally Mediated AF to me. AF becomes far more likely when the vagal tone is low, for example after food or when sleeping.
Just to say hello to someone who feels the same. During the day, there is almost no AF in my life. At night, there is almost no AF-free night. It doesn't matter have I eaten or had coffee, when I am in bed, it comes to keep me company during the night. Strangely, when I stand up and get active in the morning, AF goes away. About a decade ago, I needed some time for it to happen - it would last till 9 or 10 a.m., but now, the moment I stand up, it stops. No two same cases, but a lot of similar, lol.
jeanjeannie50• in reply to
SteelHeart would it be an idea to raise the head of your bed a little (or even a lot) in the hope that this will stop your AF kicking off?
Ah I see you've already answered this question.
• in reply tojeanjeannie50
Thanks for the suggestion, Jeannie! Have tried already, even to a very steep degree of inclination, but for no avail. I am the last one here, to have right to complain! I am a mild case... But still researching and never going to stop! Kind regards! P.
I have tried with propping up, even had a special belt made for me, to sleep with and to correct body position , but nothing helps. Good thing is that there are no horrible symptoms, so I still sleep well. Also, I never have to stand up and go to the loo, so my nights are not a nightmare. The worst thing is my wife's snoring, lol!
I believe many never have AF during exercise but do at rest. Your exercise continues for a substantial time period so your AF has no chance to express itself until you are at rest. Also I feel no AF while exercising but believe it is happening but I am unable to feel it due to other body activity. Just a thought.
😀😀 thanks for that, I've just had a new garden shed delivered and put together ................. a new idea !!
😂😂
Hi,
Have to go along with Bobd. Absolutely.
Nowadays I get' wobblies' on and off all year, not volumes maybe 3 to 5 times a year and they go, and they are not very disruptive, just wobblies. However when I have had major bouts of AF they have been after my evening meal and tend to emerge at night around 2 am ish. and can last in severity for from 5 to 12 hours. Suggest you research Vagal (Vagus ) Nerve in particular have a look a schematic diagrams of it. An amazing device !
John
Sleep Apnea? I never thought I had it and don't snore or breathe out of my mouth, but was recently tested "moderate sleep apnea" after a horrendously violent AFib episode last May for a week that would no longer self correct. Always got it midnight to 3am timeframe and never during the day. I was told alcohol will triple the effect. I have not had AFib since, using CPAP and am off all rythym drugs and beta blockers.
Too many people underestimate Sleep Apnea. It took someone on this forum to make the possible suggestion to me so I pursued. As I'm not overweight it was brushed aside when I initially suggested it so I pushed had the test and yes I had severe sleep apnea. My sleep consultant was so very surprised it had never been suggested or picked up by my heart team over a 5 year period. So I would say CPAP has saved my life and given me so much more chance of a better quality of life.
Before I had my trusty pacemaker my A/F always kicked in when I lay down to sleep especially after a busy working day and I believed it to be due to adrenalin, during the day I was working flat out, fielding all the problems that come with working in public service and the general public and in charge of a large workforce and all that this entails, A/F then kept me awake most of the night, thankfully not everynight.
I can relate to everything you say,but in my case as soon as I consume sugar,AF kicks off,we have to eliminate what triggers AF ,it seems to be trial and error,best of luck.
I am so sorry to hear you are having these episodes, I had them for years probably 12 , never episodes during the day. I understand from my EP that this is often the case. Mine were worse on days I had not taken in enough fluids. Although I don't want to talk any thing up, I had an ablation last December which has been helpful. I hope things manage to improve for you
Your experience with AF describes my situation closely. Was told it was vagally mediated but try as I may have not identified any triggers. Let us know if your research throws up any clues !
Vagal nerve. That is what my EP would probably say. Heart rate slows, heart reacts to correct it, misfires and makes it worse. Nothing you can do if so! Except not add to it, ie heavy meal or alcohol. That is my guess. My AF was always in the night
Kent2007• in reply to
This is very intersting and is the first time anyone (even cardiologists) has offered any sort of explanation. I generally eat around 6.00/6.30 and go to bed around 10.30 (although a bit earlier on Sunday evening 'cos I was knackered), so I hope that this was a long enough interval. However, I have always had a pretty low heart rate (resting heart rate of around 50bpm), so I guess there's a lot of adjustment going on.
In my earlier days of AF (14 yrs ago), it was triggered by intensive exercise and/or adrenalin - both usually available because of my rock climbing habits. I still climb but seldom get Af as a result nowadays.
Hi Kent, are you on anti-coagulation? Asking because when I went on those I stopped all climbing. Was too worried about a basic fall causing bleeding and lumbering my partner with a horrible situation. I would love to be able to resume.
Sean - I'm just going back through discussions prompted by my post, in preparation for a consultation with a cardiologist next week. I am sure the question of anti-coagulants will crop up. I shall ask his views about risks from climbing (and mountain biking). But, I spent this morning at the climbing wall, and often go climbing on bolted routes, especially on overseas trips. Plus, there's always top-roping and bouldering. Still plenty to scratch that itch if you still have it.
I only have a hunch. It is based on reading and speaking with medically trained people. You may be going into a very deep sleep and your heart rate has dropped low too low following the exertions of the day. Could it be Vagus. Unqualified to say but I'd try Vagus stimulation. Nothing to loose. Another thought. Make your bedroom less welcoming on sleep hygiene. So you sleep but not so deep. Keep a light on or something like that. Just some thoughts.
• in reply toTryfan
Agree vagal, what is vagal nerve stimulation?
Tryfan• in reply to
If you search posts on my name. I hope you will find several on deep breathing exercises. Also, accupressure massage around the inner ear and neck. Fee to be going on with.
Box breathing for relaxation breath in counting to 4. Hold breath count to 4 exhale slowly count to 5. Hold for count of 4 and repeat. In and out through nose.
Sounds strange, gargle or sing loudly. Might get you locked up but shock sometimes works as well.
Foot massage on web between big and next toe. You will feel the place as you will feel it as either slight pain or tingle
Massage inner ear inside the cartilage above ear canal, then just inside ear canal.
Cold water. Fill bowl and plunge head into cold water. No surprises that you see in Westerns throwing cold water on unconscious people.
Laugh if you can.
All above good for vague stimulation.
As AF is often described as a 'mongrel' condition, I treat it with a mongrel solution. In other words I 'throw the kitchen sink at it' rather than seek one answer. e.g. Half you usual exercise, eat light with minimal meat evening meal at 5.30pm, no alcohol or caffeine after 12pm, no carbonated drinks particularly tonic water (quinine), 3 pillows under head, 2 on left side to stop you turning that way, nasal strip and lip strip to enforce nose breathing (if that sounds weird check out James Nestor's book Breath).
I have no clue of course which if any work all I can say is I'm fine, my sleeps are much better and the changed routine causes me no problems.
Me too! If I get Afib it is always at night, about 4-6 am. Then the dreaded dccv to correct it. Please keep us posted on your research. Good luck and enjoy your mountain adventures x
My cardiologist reckoned that the Bisoprolol was taking my heart rate down too low at night, which was allowing too many ectopic beats through ,which then triggered the AF. He took me off the Bisoprolol and gave me 50 mg of Flecainide twice a day. I have had no episodes since. Worth asking your cardiologist. ?
YouTube Dr. Gupta. Vagal AFib
Completely agree with mikeharrymac. I have PAF which only ever happens during the night, I wake up and heart rate is all over the place, I take 3 Flecainide and in 15/20 minutes or so it's back to normal. Following a subsequent endoscopy and colonoscopy, it was discovered that a) my bowel was longer than the M25 (and then some!) and b) I also have a sliding hiatus hernia both of which could be pushing up onto the vagus nerve when I'm in bed asleep. Worth getting checked out in those areas? Here's a link to Sanjay's video on youtube and there are plenty others he's done on the same topic. Good luck,,,,
Mine acted in much the same way. Usually when at rest after a day of ‘healthy’ activity. I seem to have a strong relationship between my stomach and heart activity, so would also guess my Afib was vagally influenced. Had an ablation 2 years ago, episodes are down to minutes per year.
…sleep apnea? Ever had a sleep study?
Because the comedown always happens after the show? That'd be my interpretation. Your body responds when you push it - in my case it's if I'm responding to a shock or stressful situation - you refuel and relax and off you with the boom-diddy-boom! Feels unfair doesn't it? My only advice anecdotally would be to push yourself less and find more of a balance. Not to stop the walking, but maybe shorter trips and longer rest times?
Thanks are due to everyone who has responded to my post. Since I started with this (2007), I have kept a diary of my episodes. I can feel my irregular beats fairly clearly, especially at night, so I record start time, duration, possible cause, my response in terms of additional medication (PIP style). Over the last two years, 81% of my AF and 83% of episodes that never progressed beyond ectopics occurred between 6.00pm and 6.00am, probably nearer to 95% if I narrow that to 9.00pm and 3.00am. Obviosuly, there is more uncertainty over possible trigger, but I estimate that around 65-70% of cases relate to fatigue after a long day's exercise (hill walking or cycling) or heavy meal and alcohol (I rarely drink more than a couple of pints or half a bottle of wine). From what people have said, and further internet searching, I am inclined to think that my condition is vagally mediated.I think I shall try to consult a cardiologist for an opinion and possible change in medication by time of day (less bisoprolol and more flecainide at night, for example).
That's impressive diarising! From what I understand Bisoprolol or similar is not the best medication for vagally mediated AF.
I'm a male in my mid-50’s, fit and healthy, regular exercise, etc… and have suffered from nighttime vagal AF since I was about 40 years old. My symptoms were* similar to what you’ve described.
A year ago I read “Breath, The New Science of a Lost Art” by James Nestor. It talks about nose breathing and the impact on sleeping patterns.
For the decade+ before reading the book I would typically suffer AF about 1 week each month (ie a few ‘bad’ nights in the bad week). I would take 2x 100mg Flecainide daily, sometimes up to 3x. I also had 2 pulmonary vein ablations.
After reading Breathe and focusing on the nose breathing technics described in the book my AF has almost disappeared. I had a few episodes about 3 months ago when I got overly tired. Other than that nothing in the past year.
The book is a fascinating read anyway, and in my case it has had a profoundly positive impact on reducing and nearly eliminating my vagal AF. Obviously I highly recommend it.
Night time af here too. Now I'm on Flecanide 50 x 2 instead of pill in pocket, there are no daytime episodes but a one can occur or try to occur between midnight and 3 am.
Fortunately, an impending episode gives me a bit of warning. I wake up still in NSR or I am still awake but feeling "nervous"; my pulse rate begins to climb.
I no longer wait to see what happens. I sit up, reach to bedside drawer and pull out meds. First is 1/2 a 5mg tab of diazepam (valium) to quickly shut down the adrenalin rush, followed by an extra Flecainide. Then I pop up out of bed and walk at a quick pace around my house, go up and down the stairs, do jumping jacks, practice my golf swing....whatever it takes to get my still NSR heart rate up to at least 90. I want to "wake up" the right atrium pacemaker. And that has been thwarting episodes,
My theory is: at a low resting rate, wicked rogue cells in the left atrium that ablation seeks to destroy, takes the opportunity to take control while the right atrium mechanism is sleepy. So lying down and doing slow breathing etc, is counterproductive and never worked for me.
Maybe this approach will help some of you nighttimers.
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