Sleep > bradycardia > tachycardia episode > wake up

[Off-beat]

Anyone have experience with sleep-induced slow heart rate (bradycardia) that in turn triggers tachycardia episodes?  I'm currently on metoprolol to stabilize my heart rate, and it's been working pretty well to suppress the tachy episodes that were waking me up multiple times every night.  Since then, I've realized that I feel much more alert and rested in the morning.  I think the sleep-bradycardia must've been gradually getting worse over time, but I didn't notice it until it got so severe that it started triggering tachy episodes.  But recently the metoprolol isn't working as well anymore.  I'm wondering what's next.

My theory is that, when I sleep, my heart rate is dropping very low (possibly related to a central sleep apnea?), and when it drops too low, the ventricle starts firing independently as the electric potential builds too high, leading to a temporary "loop" tachy arrhythmia. So, the solution would seem to be to prevent the slow heart rate in the first place, but direct treatments for CSA/bradycardia seem pretty crude to non-existent - cloddish breathing apparatus, or pacemakers - I'm hoping for something less invasive.

I also have PVCs - have had for years.  

I've been through full battery of heart tests including EP study - they told me I just have a 'benign arrythmia'.

Anyone who's found a good treatment for sleep-induced bradycardia, I'd love to hear it.

[Tawnian77]

I have been suffering with the same issues. I recently had a 24 hr halter monitor Because I feel my heart skip, palpitations, heart racing and flutters. I am always very fatigued and light headed. The results showed that I had a resting heart rate of 137 and while I was sleeping it dropped to 40 Beats per minute. The nurse really wouldnt tell me much, but she said that she will discuss this with my cardiologist and get back to me. I am so scared because I also have been waking up, or right as I am falling asleep, feeling very short of breath and when I feel my pulse it seems like my heart is hardly beating. Does anyone know anything about these numbers. I had an echo and everything came up fine. I just am so impatient to hear what the doctor will say. My health has declined so much in the past few months. I am just so tired, and I gained a lot of weight. If anyone with answers, Id appreciate it. Thanks and good luck everyone else.  

[Off-beat]

I posted the first entry on this page three years ago, and I'm still doing fine on Metoprolol.  I still get the "episodes" when I don't take the drug.  The episodes consist of waking up in the middle of the night feeling like my whole body is heavy and lethargic, and within the next 30 seconds or so, I feel a surge of warmth flowing out to my arms and legs, like it feels when you regain circulation after your leg falls asleep.  I don't know exactly what my heart is doing just before I wake up (beating slowly or with some other dysfunctional rhythm), but the result is inadequate circulation and interrupted sleep.

I have found one link to a research article that seems to describe the syndrome, but it seems to be a fairly rare problem that has had very little research.  
"REM sleep-related brady-arrhythmia syndrome"   - http://www.ncbi.nlm.nih.gov/pubmed/17375344 .  I did not buy the whole article, but the abstract starts out, "Rapid eye movement (REM) sleep-related brady-arrhythmia syndrome is a cardiac rhythm disorder characterised by asystoles lasting several seconds during REM sleep in otherwise healthy individuals. In contrast to arrhythmias associated with obstructive sleep apnea, REM sleep-related sinus arrests and atrioventricular (AV) blocks are not associated with episodes of apnea or hypopnea. In literature, only few cases have been published, suggesting that the prevalence of this nighttime rhythm disorder is very rare."  So, there ya go, for what it's worth.

Good luck and God bless.

[mandalin3]

I myself have similar problems, I have tachycaridia when im awake about 160 to 170 for several hours and when i sleep it goes as low as 50 which is very low for me. I have been on several meds and 160mg of inderal worked the best for me. I have been through several tests over 13 years now and the doctors still don't know what causes it. I have been off my meds for about 2yrs. now and I feel like it has taken a tole on my health, very fatigue all the time and my heart skips a lot and I am having alot of PVC's. I just wish someone could give me some advice on what to do.

[mtgirl1]

I'm not certain about the med terms here, but I really never had any palpations that scared me, until I had a hysterectomy, I kept waking up in the hospital catching my breathe, this continued for a while, then seemed to subside. Now for the past week I have been waking up to what feels like I am breathing out and then there will be a "pause", I will do this over and over when I try to see what my pulse feels like this there is no beat just fluttering?  So far it seems better when I get up.
I have become terrified to go to sleep, anybody have any clue about this?? I have been to the ER, they hooked me up and said everything was fine, my doc pats me on the back and tells me I'm fine...........I am really disgusted with the med community!! Any thoughts or anyone with the same symptom would be appreciated!!!!!

[bobad]

I don't have any answers yet, but I have a simlar problem.

I'm currently investingating whether my (probably) sleep-related brady-tachy has been going on for years, slowly damaging my heart. It did get severe enough to require a pacemaker to prevent the low rate from going too low, and toperol to keep the high rate down. I'm still new to the PM and meds, but so far I am sleeping better than I have in many years.

[maggiemag]

How low is very low?  It would all depend on the rate.  Have you actually been diagnosed with central sleep apnea?  If you have, and don't use the prescribed treatment, no matter how cumbersome, you are seriously compromising your health and could develop more arrhythmias, high blood pressure with resultant cardiomyopathy etc., etc.  What kind of tachycardia was found on Holter?  Many times the doctors have said that nighttime sinus tach is anxiety related.