Have any Vagal Afibbers tried exercising before bed?

[OzRob]

As I have Vagal Afib I can switch it off early on in an episode with a Valsalva maneuver.

A few nights ago I could not stop the Afib as it did not wake me immediately, so I could not stop it the usual way. I had read that some people exercise during Afib, so rather than pop another Flecainide pill I decided to jog on the spot on the bathroom mat for 5 minutes.

Afib resolved which is good to know as I can add it to my repertoire of techniques.

I have searched the forum and can't find anyone who exercises just before bed. My theory is that if you have been winding down for 4 hours before bed then some exercise just before sleep may stimulate the vagal nerve to lesson the Afib episodes/burden during the night.

I have a device for my road bicycle that converts it into a training bike, I plan to jump on it each night, get my heart rate up to 120bpm for 10 minutes and then go to sleep.

Would love to hear what others think.

[secondtry]

I have vagally mediated Lone PAF. My theory is I encouraged my Vagus Nerve to misbehave by my lifestyle of too much stress/activity in the day and then collapsing into bed ie the contrast between the two parts of the day was too wide. The solution I adopted was to reduce day time stress/activities and slowly wind down in the evening before bed. Over several years, I believe this plan has helped keep my AF episodes at zero.

I also think your plan of evening exercise if it is light is helpful, particularly if accompanied by a lighter daytime schedule. The main point with a sensitive Vagus Nerve is IMHO that your lifestyle has to change, which in most cases will include more attention to your gastric health/diet/eating times as well as stress.

[OzRob in reply to secondtry]

Yes, lifestyle and stress has much to do with Afib. Another thing is inflammation and the vagal nerve, be it to do with the digestive system or the respiratory system.

My Afib was dormant for 5 months, the after a few episodes another 8 months of nothing. The beast awoke during a really bad cold followed by a bout of Covid 19 four months ago . This spike in Afib resulted in poor sleep which then left me exposed to a head cold virus which is almost gone. Improving immunity towards colds etc. are also very important.

I have thought of bring retirement forward, or at least working less in my business to improve the work/life balance. Yoga is also on my radar.

In the meantime I won't become reliant on medications in order to test many different things to try and unlock my own Afib. Will post more here on the nightly exercise regime once I have completed a few weeks.

[secondtry in reply to OzRob]

I think you are pretty much right in your approach. Just a thought on your experience.... if a bad could brings AF on, what it tells me is that your level of inflammation or whatever else is way to high. With better lifestyle choices, I would say you should be able to weather a cold without triggering AF unless there are indirect effects eg a blocked nose exacerbating sleep apnoea. Best wishes.

[OzRob in reply to secondtry]

Lack of sleep caused the recent head cold, which I believe was brought on by my Afib recording device, a watch that detects Afib.

I am convinced these types of devices where you physically need to participate in getting a recording are bad for people with Vagal (nightime) Afib.

I was in stealth mode when going to bed ready to catch any unusual heartbeats, so I woke up often. Then I was suffering from insomnia when going to bed which is the first time in my life.

I now have a chest monitor that records the whole night and I am sleeping again knowing that I don't need to worry about being part of the recording.

[Tux18 in reply to OzRob]

After scrolling on down through more comments I found the utube of Dr. Sanjay Gupta which explained and sneered some e of my questions. His information is so helpful!

[Tux18 in reply to secondtry]

All of the posts concerning vagal nerve effecting afib is interesting. I think my afib is very much brought on by varies life events I.e. getting too stressed/anxious or physically tired, or doing strenuous work/exercise.

However, when i daily do my meditation, tapping(which may or may not help), don’t over eat or eat slump over when I eat I don’t have as many episodes.

Yet at times it seems for no reason at all I may go into afib.

No doctor has ever said I have vagal afib….wondering if doctors EP believe that the vagal nerve is the cause of some afib?

[OzJames]

hi OzRob

I’ve used exercise to convert to Sinus on each of my AF episodes. I first got PAF 29 years ago and on average an episode every 4 years. Though in August just before a trip to Bali I was back in AF.

Due to the trip being a few days away the Cardio said let’s try Flec/Metro/Apixaban combo. A month later and he cardioverted me into Sinus. He wants me to carry the pills in the event of recurrence and he’s happy for me to try exercise to get back into Sinus as well. Each person is different and what works for one may not for another. Also before exercise it would be advisable to ask your doctors whether this may work for you and what the risks might be. They may discuss ChadVasc scores amongst other things before you go out and do any vigorous exercise

[OzRob in reply to OzJames]

My ChadVasc score is zero, I have no other conditions other than Afib. I was in Bali 3 weeks ago with my family and my reasonably new friend Afib!

Is your Afib vagal? Occurred at night?

[OzJames in reply to OzRob]

good question…. I didn’t ask the doctor, I’m not sure and I’ve only heard the term Vagal nerve when I joined this community back in August

[OzRob in reply to OzJames]

Check this out, richardbogle.com/blog/vagal...

That article plus this video from Sanjay Gupta at York Cardiology youtu.be/ivof8UUKW3M(Not working as expected?) will help you work out what you have.

[ozziebob in reply to OzJames]

James,

Can I ask about your use of the three medications you mentioned. I understand you used these meds everyday on holiday and up until your cardioversion? Did you continue any meds after the cardioversion? and for how long?

Then you mention carrying these meds in case of a recurrence. What advice did you get re the meds in the instance of a recurrence? Would you be taking the meds daily or only as required (PIP approach)? And most importantly for my concerns, did your Cardio authorise your use of Apixaban as a PIP? starting Apixaban when an AF event begins and continuing Apixaban for a specified period after the AF stops?

I realise my questions are off-topic, but your replies are of vital importance to my anticoagulation journey. I have noticed medical authorities and EPs and Cardiologists in different countries have different approaches in this area, and it's important for me to understand the differences. Thanks.

bob.

[OzJames in reply to ozziebob]

hi Rob the Cardiologist initially had hoped the Flecainide, Metropolol would get me back into Sinus….which it can but he suggested it needs to be done at the time you go into AF or soon after. At the time I got to appointment it was about 7 days with AF. The strategy was then to do Cardioversion 4 weeks later, the thinking is that a Cardioversion is risky if you have a clot so the Apixaban has time to dissolve it. They also did a TOE which looks at heart to check if there is a clot just before CVersion. After CV he wanted to keep me on drugs for 4 weeks to mitigate risk of flipping back into AF. He did reduce Flec from 100mg to 50mg post CVersion.. So now we are approx 9 weeks from first visit and we have started to taper off all drugs over the next 2 weeks. He did say stop overnight but I said I’d prefer to wean off. He tells me I have a ChadVasc score of zero and will start me on low dose aspirin after.

PIP was suggested as soon as I know I’m in AF….. all 3 drugs as per original script for a month. The thinking is as before in case a clot forms. I’m then required to see him as soon as I go into AF. I’ve got new Apple Watch with arrhythmia and ECG ability and it works.

By the way I asked if it would be advisable to have a 12.5mg tab of Metropolol the night before and morning of any days that I do more strenuous training, eg…. a 10km ocean ski paddle. He said I may not get much saturation of the beta blocker but I would get some which would lower heart rate and may reduce risk of getting heart too excited. He’s ok with it… whether it helps is speculative.

[ozziebob in reply to OzJames]

James,

Thanks for your helpful and informative reply. I understand from your reply that your Cardio is supportive of the use of Apixaban as a PIP, as is also reported by some Forum members who live in USA. Sadly, not my experience in UK.

Perhaps your ChadVasc of zero, because of being under 65 and no comorbidities, is part of the consideration of allowing you a PIP approach. I'm 75, also with no comorbidities, but my age alone gives me a ChadVasc of 2, so daily Apixaban was recommended. But I also have a HasBled score of 2 (1 for age + 1 for previous acute bilateral subdural haematomas), and because of the latter my preference is for a PIP approach to Apixaban.

But I've no contact with either Cardiology or EP, so I would have to decide for myself the risks involved. And this is what I am trying to do now before asking for the recommended Apixaban, or not. And I have yet to take any doses of the Flecainide and Bisoprolol I have just received to be used as PIPs (no AF recently).

Interestingly Northwestern University in Chicago is just starting a 7 year trial (React AF) of using Apixaban as a PIP in conjunction with patients self detecting AF events with watches supplied by Apple, and all monitored via an App. 7 years too late for me unfortuntely, but I think this will be the future of anticoagulation.

Happy paddling,

bob.

PS. I see now why you mistakenly addressed me as "Rob". You previously replied to OzRob.

[OzJames in reply to ozziebob]

sorry mate thanks for pointing out your correct name my apologies. Yes actually being able to sit in front of the Cardiologist helps. You need to understand the percentage risk of not being on full time Coagulation and that’s what they can help you with. I’m not familiar with Hasbled scores and does having the previous bleed mean full time Apixaban increases chances of another bleed? These are questions they need to answer for you. Maybe draft an email and send it through to them

[AFCyclist]

I am a keen cyclist and have been using the exercise trick many times over the past 10 years to convert back to NSR when I get AF. Normaly a short spell going up a hill will work the next morning.

[OzRob in reply to AFCyclist]

Do you get Afib at night when sleeping? If so do you exercise then?

[AFCyclist in reply to OzRob]

AF often starts when I relax in the evening after a ride or a stressful situation. Exercise straight away does not work for me but the next morning normaly works every time.

[AMcG17]

Hi,

Sounds familiar, I have lone vagal AF. I have tried many ways to stop my AF. Valsalva maneuver works sometimes but (not always) and recently I have discovered exercising can stop an attack (walking up 10 flights of stairs and exercise bike).

All my episodes happen at night while sleeping. I have noticed a link between my daily activity and AF. If I 'over do' things during the day and don't go to bed early it can trigger an episode. There may be a link to long drives too but that could be coincidence. I think I might go into a deeper sleep because I am mentally and physically tired or maybe I roll onto my left side.

I have a relatively low resting heart rate (low 40s). I have been advised to de-train. So far the jury is out on whether it's helping.

Let us know how you get on with the exercise before bed.

[KiwiBlake in reply to AMcG17]

Hi. I'm just curious in your comment about laying on your left side while sleeping. Personally I don't like sleeping on my left side, I feel like I'm squashing my heart. Is that me being paranoid, or is there something in that? Not sure in my case if it is linked to AF. My preference is to sleep on my back.

Thanks Blake

[AMcG17 in reply to KiwiBlake]

Hi Blake,

I don't feel comfortable lying on my left side, sometimes I get a pulse in my ears. I try to avoid lying on my left side now as a precaution. During my early internet research I did see some references to sleeping position, there was mostly anecdotal evidence that people preferred to lying on their right side or back.

You can search this forum for more info:

healthunlocked.com/afassoci...

All the best

Alan

[KiwiBlake in reply to AMcG17]

Thanks Alan. I too am able to hear my pulse, quite often while sitting quietly, or laying in bed. I wonder if it's to do with variation in blood pressure. My regular Dr measured it at 124/80, I'm 51 years old.

[AMcG17 in reply to KiwiBlake]

Hi Blake, I think you can become over sensitive to your own heart beat especially with AF. I'm 50 with a BP of around 120/80 and a resting heart rate in the low 40s. Still trying to work it out.

[Hylda2 in reply to AMcG17]

hearing your heart beat is called pulsatile tinnitus. Just had pacemaker fitted and having Ablate part in two weeks. Just wondering if I will hear it then!

[AMcG17 in reply to Hylda2]

Fingers crossed it goes well for you!

[Hylda2 in reply to AMcG17]

Many thanks

[Jajarunner]

if it works for you why not. Keep us posted.

[ChasMartin]

Interesting. I have never managed to get the Valsalva maneuvers to work, in fact I was told by my EP that they could worsen my vagal afib should I try them. I tried them anyway a few times in desperation and I don't think they made it worse, but they had absolutely no effect whatsoever, barring one time in which I was having quite a severe episode and doing it made me feel suddenly very light headed and strange. I actually haven't tried it again since that time because it was a bit of a frightening feeling.

As for exercise before bed, often do some yoga before bed as I feel it helps me sleep more comfortably. I also feel sometimes I can do some yoga when I feel an episode looming and it seems to help some.

I also tried vigorous exercise as many here have mentioned, to try to abort an episode, but it also definitely did not work for me. Perhaps that is due to having Afib with RVR, and it is different for those with lower AF rates.

[KiwiBlake]

Hi OzRob

Re your comments about the benefits of a quick bout of exercise before going to bed. I wonder if this drops your blood glucose levels. Going to bed with a full stomach is a known trigger, so while you are sleeping your blood glucose levels will be increasing as the food is digested in the stomach as absorbed through the small intestine. Is there a link between high blood glucose levels and AF?

Are there any Type 1 diabetics out there with AF that monitor their blood glucose levels and are able to correlate blood glucose levels with AF occurrence? - that would be interesting to know.

For me, when I go into AF, a brisk walk, or a light jog quickens the time to return to normal rhythm. I normally do this in conjunction with taking a Diltiazem capsule, but these take time for your stomach to break down the plastic capsule releasing the Diltiazem for absorption. So, I don't know if it's the exercise or the medication (or a combination of both) which is returning me to normal rhythm.

Cheers Blake

[OzRob in reply to KiwiBlake]

Hi Blake,

Good to see you joined this forum, very proactive group of people.

Yes, I think the gut has a lot do do with Afib.

I did not exercise on the bike last night before bed, my Afib kicked in about 30 mins after lying down, I switched it of about 5 times with Valsalva maneuvers over about an hour, but the Afib just kept coming back.

I decided to jump on the bike whilst in Afib at 11:45pm Was at 126bpm when in Afib getting on the bike, started peddling and saw it drop quite quickly to 70bpm, then got it up to 110bpm through exercise for 5 minutes. Settled down to 65bpm and I went to bed.

When I woke at 6am I downloaded the data from my 24 hour monitor and discovered that I also went into Afib when I was asleep for less than a minute at 1:13am, again at 1:22am for 5 minutes and one more time at 2:14am for less than 4 minutes.

What this shows me is that one small exercise seems to work better than performing multiple Valsalva maneuvers to terminate episodes.

I did have a chicken curry last night which may have contributed to a greater Afib burden than usual.

What is also interesting is I wore my monitor to work today and I took the same leftover chicken curry for lunch, about 30 minutes after eating I went into afib for about 40 seconds. I have had Afib during the day on about 10 occasions since Afib began 18 months ago so that is another interesting observation.

[KiwiBlake in reply to OzRob]

Do you get any bloating? I think I may have already mentioned, but highly processed foods give me bloating , which is a trigger. Things like sausages, curry in a jar that you add the meat to, canned ingredients. I reckon it's one of the preservatives. You don't know what's put in to extend the shelf life. Eating freshly prepared as possible. Also lentils and beans sets me off.

[OzRob in reply to KiwiBlake]

No noticeable bloating.

Last night I lay down and I felt the start of Afib immediately, 114bpm, so jumped on the bike for 5 minutes followed by a great nights sleep with minimal Afib through the night.

Over the next 5 nights before my next cardiologist appointment, I will get on the bike just before bedtime and record more results.

[JOY2THEWORLD49]

Hi

No ant-co.agulant!

I have rapid persistent H/R day and low H/R night.

I dont feel it unless exercising and using exertion.

Nation Cardiac asked me the specific ? what exertion exercise

did I do.

I said walking up my elevated road and more in getting back to the top of the start of my road. Sometimes with groceries which puts me under more exertion and I need to stop twice.

Dr told me it was the AF and enlarged chamber waiting for more blood to circulate.

So exertion for me in small spikes is good for me heart.

My thyroxin intake is at the right level of TSH2.0. (Ca Thyroidectomy)

cheri JOY. 73 (NZ)