AF Only at Night

[RAS54]

Anyone Know why AF only occurs when I'm asleep?

[BobD Volunteer]

Probably vagally mediated. Beta blockers would make this type of AF worse.

[TopsyJones in reply to BobD]

I agree , it did for me because it was taking the heart rate too low at night. I was put on Flecainide instead and have had no episodes for 6 months.

[RAS54]

67year old male, diagnosed with paroxysmal AF six months ago. Can walk about 6 miles without getting short of breath, resting heart rate 50bpm. Meds Flecanide, Apixiban, Ramipril. 7 day ECG monitor found 5 episodes of AF longest lasting 5minutes. I'm using a Garmin Vivosmart watch to measure heart rate. This is showing an irregular heart rate of greater than 110bpm for more than 10minutes whilst sleeping, happens about 3 days a week. I think this is all information about myself.

[Hidden in reply to RAS54]

Mine always were at night, never on exertion lasted 8 hours approximately. My EP said my heart rate drops especially if I had even small amount of alcohol, heart goes out of rhythm and tries badly to normalise. Beta blockers counter indicated. I avoided alcohol but also had a successful ablation, not sure I would have done if AF very brief but 8 hours or more at up to 200 BPM was unpleasant and unhealthy. No sleep apnea or overweight issues in my case. But elderly! Good luck

[CDreamer]

Mine turned out to be bradycardia at night which triggered AF along with Sleep Apnea. Treated for both and nocturnal AF disappeared.

Do you monitor HR at night?Has GP assessed you for Sleep Apnea.

Other reasons - Dysautomnia = vagal nerve

Gastric - do you eat large meal after 6pm?

Alcohol consumption

Spinal misalignment due to poor mattress or how you lie

I could go on…….

[AussieHeart in reply to CDreamer]

Go on please

[CDreamer in reply to AussieHeart]

Those are the most usual/obvious ones and those the easiest to check.

Other reasons are those that may apply to all AF eg: ill controlled co-morbidities

Mouth breathing, at night especially - taping up the mouth and breathing practice helps

Indicator of Magnesium Deficiency

Circadian rhythms

Now I got mocked when I posted about this but I tracked my nocturnal activity very carefully and found that my sleep deteriated and AF increased at certain times of the month - in conjunction with phases of the moon. I hope I’m not a Lunatic, but lunar activity was a factor for me.

PubMed has numerous articles on nocturnal AF but nearly all but the Sleep Apnea involve Circadian Rhythm disruption and Autonomic dysfunction ie: the part of the nervous system which controls all none thinking functions such as Digestion/Heart Rate/Breathing (semi-automatic). Research has shown that prior to AF starting, many people with nocturnal AF have what’s called ‘cyclial variation in Heart Rate’ and a difference in the electrical activity in the heart varies

The prevalence of cyclical variation in HR was significantly greater in the nighttime AF episodes than in the daytime AF episodes (Chi=5.34, p<0.05). The mean frequency of cyclical variation in HR was 0.015±0.003 Hz. The mean power of the VLF (very low frequency) component (0.008-0.04 Hz) before the onset of AF was significantly greater in the nighttime AF episodes than in the daytime AF episodes. Among the nighttime AF episodes, the power of the HF (high frequency), LF (low frequency) and very low frequency (VLF) components increased significantly just before the onset of AF compared with that observed 40 minutes before onset.

The authors conclude that that this is probably down to sleep apnea but as it was observed in 60% of the study participants, not 100% there is obviously something else at play as well.

My own experience and self-research led me to observe that stress played a huge part in how our heart’s behave and going to bed excited or stressed would often result in lighter sleep and much more body movement. This disruption prevents repair of damaged cells. Psychological and Physiological stress are as a result of inflammation.

I don’t think this has been studied nearly enough and it’s too simplistic to say ‘vagal AF’ - although it’s often true!

[pottypete1 in reply to CDreamer]

If I taped up my mouth I think I would suffocate. I have had two operations on my nose to help my breathing and they didn’t resolve my problem.

Sadly I am told I snore very loudly 🤭

I have Bradycardia and borderline sleep apnea.

I did a study on my incidence of AF some years ago and and I remember that 54% of all my episodes started on waking. I also used to wake at night with a very fast heart rate.

As you are no doubt aware my AF has reduced significantly since the last of numerous ablations that I had.

Pete

[CDreamer in reply to pottypete1]

I use Myotape - it doesn’t keep your closed completely, that’s not the idea. It’s to promote nasal breathing so you don’t have SA. Used along with breathing exercises it really improves sleep quality. Improve your sleep - less AF.

[pottypete1 in reply to CDreamer]

Never heard of Myotape. I'll have to think about it🤐

[captainKFF in reply to CDreamer]

Can you please share how were you treated for bradycardia?

[CDreamer in reply to captainKFF]

My conditions are somewhat unusual so it wasn’t straightforward Brady. Pacemaker is usual and I had resynchronisation therapy Pacemaker which improved my QOL overnight.

[Spiritji]

Start off sleeping on the right side.........after an hour or so you can maybe switch to the left........but if you start on the right side there is less of a chance of the afib starting up. This is the kind of thing online people know but cardiologists do not for some reason......when I think "what the heck I am starting on the left side",,,,,,,,hmmmmm .....does not work so have to switch to the right side when first going to sleep.........at least for a while.........

[Paulalexander in reply to Spiritji]

Funny that you mention this, I have had AF bouts since I was around 27, but I am certain earlier because I had a GP check at 20 because as I was hitting sleep I would often wake up and take huge breaths and be shaky but they found nothing wrong.

For the most part (aside from some small blips) each episode of AF I had happened when I was asleep and I woke up with it.

Through trial and error I found that when I sleep on my left side it is much more likely to start, I still do not know why. I would also wake often with pins and needles in my left arm and side and think I was having a heart attack.

I have also found that cutting out alcohol completely and drinking water before bed both help, as dehydration also seems to be a factor for me.

[Griffin9 in reply to Spiritji]

The safest position for me is on my back, but I get very uncomfortable that way. My AF started on either side right and left.

[Hidden]

Hi! My case - 69 of age, male, middle weight category (72 kg), resting HR 50, capable to work without any limitations, during the day AF free, at night regular bouts, for the whole night. Almost no symptoms apart from an uneasy feeling in the chest and sometimes tingling hands/fingers. In the past months testing my friends and relatives about arrhythmia - almost all are "infected", many having no clear idea what's going on. Arrhythmia, in our age, seems to be kinda normal, like baby boomer disease, lol.

[Paulalexander in reply to Hidden]

Interesting that you and the original poster both have low resting heart rate, mine is also very low, normally around 50-55 but sometimes as a low as 45.

Not sure if this is a pattern or not but I always found my heart rate to be way lower than my level of fitness should indicate.

[Hidden in reply to Paulalexander]

My HR was during my whole life at about 48 (very fit and fighting to remain fit), what should be a sign of a well trained heart. In the past years, my resting HR rocketed to about 52, sometimes 54, lol. In my humble opinion, arrhythmia problems have to do with wearing off of the nervous system, including the primitive basic function regulating nervous centers, so the result always the same... If so, it is very just, lol.

[secondtry]

I am 68yo with vagally mediated PAF in remission for 7 years. Suggest you try the easiest and quickest first before seeking medical advice, all of the following have helped me when I had nighttime AF and a sleep test showing low sleep apnea: an extra pillow under your head, 2 extra on the left side to stop you turning that way, nasal strip and thumbnail sized mouth strip (across the middle of the lips). Lastly, cut daily stress and in the evening spend an hour winding down before bed - I do a couple of yoga exercises, Mindfullness & prayer.

[Rubymurray25]

My bedtime AF episodes turned out to be undiagnosed severe Sleep Apnoea , wasn't considered for years as I was not overweight and reasonable fit.

[LouBrig]

Mine starts in sleep and appears to be when my heart rate drops particularly low. My resting heart is about 58 but in sleep can do to 38.

[RAS54]

Thank you everybody who has replied. Lot of things to try and I will try them all but one by one to see what helps the most. I feel a lot better for all your replies

[Tryfan]

Interesting comments. My Cardiologist also stated that a slow heart rate was a contributing factor in Afib. As mentioned by many of you in these posts. It may also be one of the reasons why those of us who have been marathon, hard cyclists seem adversely affected.

[Griffin9]

Mine was usually once a month, after 11:00pm and lasted 5 hours (before my ablation). Nearly always ended before 6:00am.

[Sustainedvtach270]

It is similar for me. Resting heart rate 50, I am very fit, walk 10000 steps daily, changed my diet and started taping my mouth at night( got a special tape from Patrick Mckeown). That really helps me to sleep better and desat less. I was feeling so well that I progressively stopped my anti arrhythmia Sotalol... Two nights ago, at 5 am, I woke up suddenly with the urge to urinate, while standing in the bathroom, my defibrilator shocked me. I had no palpitations. Painful and very scary, my HR was at 190... I am back on Sotalol.

[RAS54]

One further item I forgot to mention is that I have had a bout of sinusitis, could this have a similar effect to sleep apnea?

[Madscientist16]

You could have sleep apnea. Ask your doctor for a sleep study.