Palpitations at night

[bugswhiskers]

I had a third ablation nearly three weeks ago and am in sinus rhythm, but I'm having trouble sleeping because of an uncomfortable thumping heart when I go to bed, that keeps me awake for a while, though it's OK in the mornings. After the ablation my consultant told me to halve my Bisoprolol dose, which was 2.5mg morning and evening, and to just take 2.5mg in the evenings.

The arrhythmia nurse said I could go back on Bisoprolol twice a day as before, but I don't feel I should go against the consultant, but should persevere with the single dose and see what happens.

At the same time I feel a bit fed up and am not wanting to go to bed as I know what will happen!

Has anyone had a similar experience, and what do you think I should do?

[Teresa156]

Hi Bugswhiskers,

I can’t advise you what best to do, as I haven’t had an ablation, but I do take bisoprolol once a day in the mornings. Please can I just ask, did you just go from 5 mg one day to 2.5 the following day? I am only asking as that is quite a jump if you did as your body has got used to the 5 mg, presumably for a while. If you did ( as it looks like this from your post) It might have been better to have reduced a bit slower as withdrawal symptoms can occur, especially with bisoprolol and it might be why you are having problems around evening time - perhaps? This is only a thought, I’m not medically trained but reactions when reducing bisoprolol quickly is a common experience. Your consultant told you what to do and you followed their direction, so you did what they told you, but some don’t seem to realise the effects reduction of bisoprolol can have on some people. Hopefully it may settle down but to me, it does sound like a reaction to your adjustment. The heart rate will increase ( if you halved so quickly) but hopefully it will settle, but may take a while.

It might be worth getting more advice from either the Nurse or the consultant if you can about that?

Teresa

[bugswhiskers in reply to Teresa156]

Thanks for your reply Teresa156. I did think it was a bit drastic to suddenly reduce the Bisoprolol dose from 5mg a day to 2.5mg, especially when it's not yet known if the ablation will be successful, but that's what I was told to do from the day of the ablation. I get a lot of ectopics during the day as well, but I always did. I think sometimes doctors don't understand how difficult it is to cope with heart problems, it's not like having a sore toe!

[honey1958 in reply to bugswhiskers]

It may be better to reduce the dosage gradually perhaps go to 3.75 for a week or two and then down to 2.5 if you are ok? You can buy a pill splitter from the pharmacy if necessary.

I had bisoprolol reduced from 7.5 to 2.5 in one go and had a bad increase in symptoms

[Teresa156 in reply to bugswhiskers]

Hi Bugswhiskers,

I’m glad you are taking it well, as I didn’t want to alarm you in any way with what I have said. No they don’t realise at all. I’ve already tried to come off bisoprolol completely and I was on 2.5 last year and I failed, as I came off over a week so slower than you with a smaller amount. I’ve since reduced from 2.5 to 1.25 and after learning my lesson, I did this over 4 months. Some would say this was overkill, ( and it was a right palava) but my heart didn’t really notice it at all. I’m now ok on 1.25 only but if I ever decided to come off, I’d do it over months again 😳 I know you haven’t come off completely, but your body has got used to two doses a day spread 12 hours apart and now it’s lost one. Ideally they say that bisoprolol lasts 24 hrs, but there are many who take this twice a day like you. I can only imagine ( and I’m totally guessing) that come the evening, your body missed your morning dose and desperately wants that dose of bisoprolol that you then give it in the evening, then it takes a while to kick in while you’re trying to get to sleep? I might be wrong, but then it works eventually which is why, come the morning, you are feeling better.

You may have been better to have taken a bit off one of the doses, bit by bit, or even reduced slowly both doses to 1.25 over a few weeks, but hindsight is a wonderful thing and they really should have suggested this to you. However, as we said, they don’t take this themselves and they don’t realise. I bought some jewellery scales from Amazon so I could get my doses cut more correctly ( pill cutters aren’t that precise unfortunately and every mg counts with bisoprolol 😳)

If you can, try and speak to your nurse ( easier said than done, I know) do you take any supplements? Ie magnesium? Magnesium is quite calming for some and a lot of us find magnesium can benefit the heart and it also can calm heart rates. I take magnesium every day and I know it’s helped me enormously.

How many days ago did you stop one of your doses?

[bugswhiskers in reply to Teresa156]

It's three weeks since I had to halve my Bisoprolol dose and my heart seems a bit calmer at night, so I'll carry on unless it gets worse. I have been taking Magnesium for a week, so I'll see what happens. Thanks for your advice.

[mav7]

I have experienced and read of others that notice a heart rate increase when you first lie down.

Would not be concerned if it goes away within a short time.

[bugswhiskers in reply to mav7]

Sometimes it does and sometimes it goes on and on, but I know anxiety makes it worse and breathing exercises help so it is what it is. Whatever it is!

[DIB69]

I had an ablation in 2013 which has been reasonably successful other than two bouts of paroxysmal AF which I strongly suspect as being vagal related. I do get ectopics which aren't too troublesome but like you when I lie down in bed at night some bumping and thumping starts. It calms down quite quickly, I go to sleep and then not a trace of it when I wake up. I wonder if the change in position from upright to lying down has any bearing on it. I take magnesium taurate daily which definitely seems to have helped with the AF overall.

[bugswhiskers in reply to DIB69]

I've started to take magnesium citrate daily and hope it will help, but I only take 200mg and I wonder if that's enough. The tablets are huge and take quite a bit of swallowing.

[Jmc43]

I hope you are doing better. I too have the occasional bout of irregular heartbeats in the middle of the night. Deep breathing and walking help, but still irritating…and produces anxiety. I notice a couple of comments about magnesium taurate in the responses. I have a couple of questions: 1) Is this effective at reducing irregular heart beats and 2) Do physicians seem to recognize this? I have the feeling if I asked my EP, he would just say my magnesium is fine, and these don’t add much value.

[bugswhiskers in reply to Jmc43]

I wish we were given more advice. The arrhythmia nurses are very helpful but it's hard to get to see anyone since Covid.

[WildIris]

I'm also very aware of my heartbeat when I go to bed. For one thing, when you lie down, your heart rate slows way down, which can let in confusing ectopic beats. I wiggle my legs and wave my arms around to speed up my heart a bit for a few minutes so it can slow down more slowly, which works for me. Also, anxiety can make your heart thump, so deep breathing is helpful.

[bugswhiskers in reply to WildIris]

I do try deep breathing and it does help, but can't help feeling anxious. The trouble is, it's every night, after about twenty minutes, one strong thump, an interval, and then another powerful thump, and so on. It keeps me awake, but I do eventually sleep, and when I wake in the morning it's all right.

[WildIris in reply to bugswhiskers]

If it happens within three or four minutes of lying down (or sitting down after being active during the day) it just a normal response of your heart of suddenly not being assisted by large muscle motion, especially walking, and suddenly not having so much work to do, especially if you're taking beta-blockers or similar. In my case, the really slow beats can lead to an ectopic rhythm, like a-fib. That's why I do some large muscle motion while lying down. I realize it probably looks stupid, but I'm alone when I go to bed, and it usually works for me. Ectopic rhythms make me anxious too. I practice deep relaxation and feeling cheerful for no reason during the daytime which also helps. Good luck.