Heart pounding during the night

[TINYdes]

I am 70 years old and have sleep apnea and PMR. I started on 15 mg of prednisone on Nov 22,2019 and am now on 6mg per day. Most nights I wake up between 3 and 4 A.M. feeling like my heart is pounding out of my chest. Does this happen to anyone else.

[PMRpro Ambassador]

Palpitations are a listed side effect of pred - but has this started recently? As opposed to having been a problem at higher doses? I have atrial fibrillation which is linked to the autoimmune part of PMR - if it flares, so does the a/f. When I am on too low a dose of pred I also wake in the early morning experiencing various symptoms,

[TINYdes in reply to PMRpro]

This started when I got to 11mg. I am having a very hard time every time I cut back. My Dr. Wants me to get off prednisone as soon as I can.

[PMRpro Ambassador in reply to TINYdes]

I'm sure your doctor DOES want you off pred asap - and actually, so do all we patients. The key is "as soon as you can" - unfortunately he isn't in charge, the PMR is, and my suggestion would be to seek a doctor who actually understands PMR, how it works and how management with steroids works. Above all, the fact that now you are well below 10mg means you must reduce slowly and in small steps to allow your adrenal function to return which happens best with a slow and steady tortoise rather than a speedy hares approach.

But you won't get off pred altogether until the underlying autoimmune disorder that causes the symptoms has burned out and gone into remission. After only 9 months, to be at 6mg is very good progress. PMR requires a median duration of just under 6 years of management with steroids - only 1 in 5 are able to get off pred in a year or less. And a median time to 5mg is 18 months - you are way ahead of the curve.

practicalpainmanagement.com...

medpagetoday.org/rheumatolo...

are two articles about the same research quoting those figures and the link to the original work is at the bottom of the articles.

[piglette in reply to TINYdes]

It is very easy for doctors to say they want us off pred as quickly as possible, they do not have PMR.

[Marilyn1959]

I had palpitations for months and put it all down to pred / PMR, so it became my norm. One night it kept me awake and the following day felt a bit heady, spaced out, dizzy and faint. Took my blood pressure and heart rate was 180. Ended up in Resus with heart rate of 190+ bpm. Fortunately all is well however, having learnt the scary way, I would get it checked out. If nothing else to give you peace of mind.

[PMRpro Ambassador in reply to Marilyn1959]

Thank you for saying this - that was my next thing to say.

[Yellowbluebell]

Your doctor needs lessons on how to taper. Purely as an example I started on 15mg Oct 2018 and only got to 6mg about 4 weeks ago!! You are bound to feel unwell.

[TINYdes in reply to Yellowbluebell]

Thank u for the help. Yes I feel

Unwell all the time. No quality of life at all.

[PMRpro Ambassador in reply to TINYdes]

Which, as my rheumatologist agreed on Friday, is not the idea at all! I am lucky in having 4 doctors, a GP, a rheumy, a cardiologist and a pain management specialist, who all believe that quality of life is all. It would be nice if I could get them all to sit down together but that isn't likely. Nevertheless, my needs and wants are always the priority.

But the question is, are you feeling unwell all the time because your PMR is no longer under control? Or is there something else - a cardiac arrythmia problem for example, that is also contributing? Some of the effects are similar - fatigue and just feeling rubbish - and the underlying causes may also be similar. That must be investigated.

[TINYdes in reply to PMRpro]

Have seen a cardiologist and was told it was premature beats and nothing to worry about. Did wear a halter monitor for 24 hr. He said if it became much worse he would treat it.

[Suffererc]

Yes. But it is also happening in the day time as well now

[Hidden]

Hi,

I have limited knowledge of the effects of prednisilone on sleep other than the dose I currently take prevents me from sleeping for much of the night.

Apart from prednisilone you mention sleep apnoea, which by its very nature can cause the symptoms you describe.

My default source for research and a good starting place is the NHS website. No it isn’t specifically targeted at people like us, but the content is well balanced and is in mainly plain speak.

Take a look here nhs.uk/conditions/heart-pal... sometimes lifestyle can be altered and it may be that a few minor adjustments will answer your questions and more importantly sort your problem.

As an aside, did you know that eating Chinese food late at night may result in similar symptoms? Sleeping soon after eating MSG, which used extensively in Chinese take away cooking, results in people sometimes experiencing “flutters”. Not researched but this article may help

healthline.com/health/heart...

[TINYdes in reply to Hidden]

I do have a machine for the sleep apnea. Thank u all for the help.

[RoadTrip]

If concerned about heart rate or AF suggest think about an Apple Watch 4 or higher. It does a 1 point AF trace ( docs do 12 point), and has warning for continuous low or high heart rates. A relative of mine got one to monitor their AF.

I got one as heart rate was a bit low!

[cranberryt]

I got an apple watch when I started having heart palpitations (prior to pmr). It gave me peace of mind. So when I did go on prednisone and had thwm during the night, it didn’t worry me because I could check that my heart rate was actually normal. For me, it went away after about a month. That said, it’s always best to get checked out when it comes to the heart.

[TINYdes in reply to cranberryt]

I have a Fitbit. It also shows the heart rate and oxygen level. Helps put my mind at rest. Thank u.

[Noosat]

All that worrying is adding to possible flare up. I know it is not easy to not worry, but please do your best, meditate, get interested in something else. Just try to relieve the tension.

[gaqke10]

Another possibility is Graves Disease, autoimmune hyperthyroidism. If you have one autoimmune disease, you are at higher risk of developing another one. You can have your thyroid checked with a simple blood test.

[TINYdes in reply to gaqke10]

Thank u. It has been five months since I had it tested.

[gaqke10]

If your palpitations started more recently than five months ago, you could be tested again, just to be sure.

[TINYdes in reply to gaqke10]

Thank u I will do that.