I am 67 years old with paroxysmal AF since 2012 , currently on beta blocker (metoprolol 50 mg twice a day ) . No symptomatic A fib and only two possible a fib in last 13 years. No other medical issues except mild left shoulder arthritis and GERD. In January, my heart rate started episodically hitting 100 -105 but no A fib seen on Karida or EKG or on the 14-day ZIO recorder . Keeping a careful log of events, it seems these bouts of tachycardia were associated with episodic migraine headache, which intermittently came and went lasting 3 days each time. My baseline heart rate is usually in the 65-72 but with the headache hangs out around 85-90. So, my meds were increased from 25 mg bid to 50 bid . I am off caffeine including chocolate and alcohol.For the past 4 months I have been having difficulty staying asleep . I can fall asleep pretty easily but Ibwake up after 3 hours . Typically, the cycle is: after 2 sleepless nights , on the third night I finally get a decent stretch of sleep ( about 6 hrs.) simply because I am so exhausted and sleep deprived. However, on the 4th night , the cycle starts all over again . When I wake up, I am not symptomatic, and my tracing shows no arrythmias.
I recently saw the following blurb “Beta blockers have long been associated with sleep disturbances such as difficulty falling asleep, staying asleep, and insomnia. They have been shown to reduce the production of melatonin via specific inhibition of beta-1 adrenergic receptors”.
I don’t want to lower the metoprolol for fear it might triggers an A fib episode and with the recent heat wave my HA frequency has increased .
Does anyone else experience this while on beta blockers? Anyone with experience with natural insomnia remedies : Valerian or Melatonin with regards to the AF.
Regards Sleepless in NY
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Aegean56
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metoprolol 50 mg twice a day ) . No symptomatic A fib and only two possible a fib in last 13 years.
That's a very high dose of a beta blocker for a very low AF burden.
When I had a similar afib burden, I was not on any beta blockers. Also keep in mind beta blockers are mainly for rate control and are a very weak anti-arhythmic. So the fact you've been on beta blockers without a fib episodes doesn't mean there's a cause-and-effect here.
Given your side effects, and even if they were none, I would speak to your doctor about a trial completely off of beta blockers after a gradual weaning period.
Thanks Jim for your thoughtful insight . There has been quite a bit of discussion about my low A fib burden . Hence the 14 day recording. With that not showing any A fib only a few ectopics, I feel pretty certain that the episodes of tachycardia were HA ( possibly a bit dehydrated) related . To your point when I am absolutely HA free my heart rate on this new increased dosing has on occasion dipped into the low 50s when I am lying down or sitting for a while . I think after so long with no A fib and two eiposdes of Tachycardia (which were unsettling) without a clear explanation, the cardiologist decided to increase the dose . My thinking is to see the cardiologist again and have a discussion about a PIP approach. But I'm still curious about a natural remedies to help me sleep better.
Aegean56 I have persistent afib, take .75mg Metoprolol daily (split dose). Does well controlling my heart rate. My insomnia exactly mirrors yours waking and having difficulty returning to sleep.
My primary doctor prescribed Mirtazapine stating it is safe with Metoprolol, Lipitor, and 2 other medications I take for other issues. It is classified as an antidepressant and after research I decided to refrain. I have an appt with my doctor next week and will further discuss.
You may want to consult with your doctor about reducing the dosage of Metoprolol and taking only in the morning. As jean states, do consult with your doctor about medications. If you research Melatonin you will find it can limit the effectiveness of anticoagulants and possibly other medications. And keep in mind, many sleep medications are not intended for long term use, but do consult with your doctor.
Keep in mind some find the side effects of beta blockers to be much. Each has to compare the side effects to the result and most important consult with their doctor. They are commonly prescribed due to generally being well tolerated. Though rhythm control is the preferred method, some are not eligible for rhythm control drugs due to other issues.
And we afibbers sometimes forget other issues (anxiety, exertion, etc) can cause an increased heart rate like you experienced in January. The key is the increased rate should not continue like with afib.
Mav7 thanks. I am not interested or considering any prescribed sleeping aids for a host of reasons particularly sides effect which increases fall risk. At my next appt will have a chat about lowering the dose of the beta blocker which is the most likely culprit given the temporal relationship to the onset of the insomnia.
Dec/Jan was quite stressful: holidays and a big move, etc. Now in the process of reducing my workload and hrs and figuringout what retirement will feel like. So stress is definitely a factor. .... so working on that too. Thanks again
I was reading online about magnesium glycinate this morning and have just found you the part re it helping us to sleep. Here it is:
How much magnesium for sleep?
For sleep improvement, typical elemental magnesium doses range from 200 mg to 400 mg of magnesium, taken about 30 minutes before bedtime. The most popular form of magnesium for sleep is magnesium glycinate, because it’s rapidly absorbed and the glycine that makes up the remainder of the molecule also has benefits: it helps build the neurotransmitters we need to fall and stay asleep.
How much magnesium glycinate do I need for sleep?
For sleep improvement, typical magnesium glycinate doses are up to 2,900 mg for men (giving 350 mg of elemental magnesium) and 2500 mg for women (giving 300mg of elemental magnesium). These are based on UK recommended dosages from the EFSA. For sleep, it’s usually recommended to take magnesium glycinate around 30 minutes before bedtime.
Please do your own research and check with your GP before taking any magnesium glycinate supplements.
Beta Blockers are either Lipophilic or Hydrophillic, i.e lipid soluble or water soluble.Lipophilic beta blockers such as metoprolol pass the blood brain barrier and may cause sleep problems.It may be helpful to use a water soluble beta blocker such as Bisoprolol or Nebivolol.
Nebivolol is considered to be the most selective beta blocker and the one which is considered the best tolerated.However people differ in their tolerability.Are you sure that Nebivolol caused you insomnia ?
James DiNicolantonio, can just google him, recommends a sleep stack of
- Magnesium, as suggested above, a cornerstone for many functions including sleep
- Glycine
- Inositol
- Theanine
I also take melatonin, again as mentioned above this and other substances can interact with prescription meds, on the flip side melatonin is also heart protective.
Biggest difference I’d say is prescription sleep drugs will knock you out (quality of sleep debatable), natural are much gentler hence most needing a stack rather than a single pill solution.
If you look at combo products out there for sleep you will often see things like valerian, passionflower or gaba/5-htp etc.
A case of a bit of personal trial an error.
For me right now I’m happy with magnesium, glycine, inositol and melatonin.
On occasion I take a low dose old school antihistamine as well (like Promethazine hydrochloride 10mg) if I’m traveling or something.
FYI—I am on metoprolol succ 25 mg once a day before bed and also take magnesium glycinate by liguid before bed ( as well as flecainide and eliquis), for PAF which is now well managed. I was on metoprolol 2 x day but was able to lower to 1x as I was overly fatigued. I found like many metoprolol can help me fall asleep but not STAY Asleep. I think the magnesium helps with that part. I am usually now getting about 5 1/2 to 6 hours sleep. If I do wake in middle of night and can’t get back to sleep I sometimes take another dose of magnesium and it seems to help me get back to sleep.
There are certain foods which can trigger migraines and insomnia. Free glutamates which includes msg and amines. Avoid Chinese takeaways, flavoured crisps, peas, tomatoes, mushrooms, soy, aged foods such as cheese, wines, vinegar, sourdough, Asian sauces. These food are stimulants. You would notice a difference within a few days if trying if these are the culprits exacerbating your symptoms - there are lists online of all the foods to avoid.
Magnesium supplements that some have mentioned help insomnia but can also lower blood pressure and heart rate. Taking supplements in high doses can help a symptom but put other systems out of whack.
I am in the UK and in permanent AF (for over 5 years now). I have been plagued with insomnia but may be due to an over active brain and worry about said condition as well as other things!!
I was taken off Metoprolol because it became "unavailable" during covid lockdown here. Been on Bisoprolol ever since. I hated Meto...it made me like a snail and i get on better with Biso, but many don't.
I was prescribed a course (only) of Melatonin when I became desperate after trying other meds (mostly histamine based!!! the ingredient beginning with D, that I can't spell). It helped and seemed to reset my "clock" but unfortunately 3 days after finishing the course i got a UTI which totally messed up my sleep pattern again.
I have some Zopliclone (zimovane) that I was prescribed to fall back on, but again I only take it when I am desperate for a decent nights sleep (i.e. before a long journey the next day). It works really well...BUT...I think is quite addictive...and stops working after a while like everything else.
Yes, I've been on Bisoprolol for years and it does the same to me as well as drive weight gain - its a real problem but seems to be the only thing that slows my heart rate when in rapid AF or tachycardia. You have my sympathies. I havent found a way around this problem so just tend to listen to audiobooks when I'm struggling to get back to sleep until I finally drop off again. I'm usually OK falling asleep but wake up and struggle soon after.
I have not . A friend cardiologist suggested that as a possible root of my a fib. But my own cardio has not brought it up. Now with the insomnia, definitely, something I thought about and will bring up with my doc. Thank you.
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