Metoprolol vs Atenolol for Heart Rate Control

[Jerry_NJ]

I posted an update to my tread on "living with AFib", that touches on this subject.

I post here as I would like to draw specific attention to the difference I have learned mostly by the help of other patients who contribute to this Community and from web searches.  Strangely, in my mind, my Cardiologist never volunteered consideration of Atenolol even though I have complained to him for years (at least 10) that I suffer from dream problems, I call them trouble mares.  That is a subject for the "sleep disorders" Community to which I also contribute - so I'll I will not go into more detail here on that subject.

Following are my observations on day two of substituting Atenolol 25 mg twice a day for Metoprolol 25 mg twice a day.. both are regular, for Metoprolol it is called Tartrate, I think the Atenolol comes in only one normally longer lasting form.

Today in the early afternoon, following my third 25 mg dose of Atenolol at about 9 AM, I noticed some dizziness when I rose from a time sitting.  This is not unusual for me, but I checked my HR anyway (using my new Oximeter, subject of another post) and found even though I was then on my feet and had walked at least 10 feet my HR was in the mid 50s.  Prior to changing to Atenolol I rarely saw my resting HR below the low 70s.  I also note my resting HR yesterday and in the early hours of this morning were mostly 70s for resting, some 60s.  

I then went outside and did some physical work, spitting some Ash Hardwood for firewood.  Most of this splitting was done with a 4 ton electric splitter for which I had only to lift the rounds (upwards of 40 pounds I estimate) onto the splitter and then pull them splits apart and throw on a stack.  This went on for perhaps 40 minutes with me having to revert to an 8 pound maul (sledge hammer) and Wedge to split some rounds that stopped the light duty electric splitter.  I estimate I made no more than 30 swings with the heavy maul. This fairly strenuous exercise did make me a bit breathless and I found my HR only in the upper 90s.  Before Atenolol I recall a similar workout would have put my HR over 130, or near my maximum allowed rate.

Research on the web says that Atenolol is much longer lasting than Metoprolol and suggests that Metoprolol Tartrate has to be taken twice a day... Atenolol only once !  Strangle, again, my Cardiologist who issued a prescription for Atenolol upon my request to be allowed to try it is for 25 mg twice a day.

Given my unusual low HR I conclude that taking the Atenolol twice a day would be more comparable to taking the Metoprolol (same 25 mg) Slow Release twice a day - thus being equivalent to an increase in BB level, thus the lower HR.

I plan to skip my bedtime does, treating my morning Atenolol as a long lasting once a day. This will also cut my intake of BB from 50 mg a day to 25 mg.  I will keep a close watch on my HR and be sensitive to any unusual heart symptoms, the current unusual low HR going back to upper 60s or lower 70s at rest being considered normal, not unusual.   I look to with some hope that the reduced dose coupled with the lower brain side-effect of Atenolol will reduce the problem dreaming.  I fully expect to wake up in the early AM hours and will check my HR then, I keep my Oximeter (with HR meter) on my nightstand.

[updownleftright]

Atenolol works great for me. One cardiologist insisted I switch to bisporolol. I did, and it was terrible. Had to go to the hospital because my heart rate wouldn't come down. Switched back to atenolol and haven't had any problems since.

[Jerry_NJ]

Thanks, do you take Atenolol only once per 24 hours?  As read about it on the Web I understood Atenolol to be more equivalent to Metoprolol SR in terms of life, Atenolol is not metabolized by the liver as Metoprolol is.

Can you share what does you take?  

[DeltaDawn23]

Jerry -- My Rx for Atenolol is 2 25 mg. tablets per day.  I have gone from 1 to 1-1/2 per day to 2 tablets per day after my recent cardioversions.  I am weaning off of it now and am back to about one tablet a day.  I break the tablet in "large 1/4's" or just a bit less than half for each dose, every 8 hours.  My EP said I could do it however it wanted.  If I took an entire pill, my bp would plummet like a stone.  I keep a check on my hr and bp and if they are down too low, I delay my next dose.  My heart rates stays in the 50's.  If it drops to 55 or so, I delay the dose.  A 60 hr feels fast to me now.  I am having some fatigue since my Norpace was increased after my last afib episode.  My thyroid is low, so that may factor into the tiredness too.  You might want to try 1/2 tablet every 12 hours, rather than one tablet every 24.  For me, my bp and heart rate would be up if I didn't spread it out over the course of the day.  Keep us posted on how you do.  I hope it works out better for you.  Sounds like it is keeping your hr lower with less meds.

[updownleftright]

I only take 25mg once a day. If I were to take another dose at night it would lower my pulse too much, and I've also read that taking it at night can cause insomnia as well. I find on 25mg my heart rate sits around 60--75 for most of the day which is perfect for me since my heart rate is affected by my IST during the day time, and usually comes back down to a normal rate on its own at night time.

[tom_h]

Hi Jerry.  As a retired "double E", I imagine you already realize this but it bears mentioning:  You must consider that the effect seen for  a given weight of Metoprolol Tartrate cannot be compared to the same weight of Atenolol.  In other words, I don't think you can freely exchange drugs and use the same weight.

So if you were formerly on 25mg of Metoprolol 2X/day (which I know from experience is a fairly low dose), 25mg of Atenolol 2X/day may be huge in comparison.  I had been on Metoprolol dosages as high as 200mg/day (not fun), and my cardiologist said he has prescribed dosages as high as 400mg./day.

By the way, you can compare similar weights of Metoprolol Tartrate and the time release version called Metoprolol Succicate if you consider the longer half life of the latter version.

[tom_h]

One other thing.... I originally got on Metoprolol Succinate not for my SVT or to control blood pressure, but to use the side effect of slowing the heart rate.  I had complained about awakening in the middle of the night with an elevated sinus pulse.  Unfortunately, my physician never took into consideration that my elevated heart rate could have been caused by something.  It turned out that I had very severe obstructive sleep apnea which was diagnosed several years later by a new physician.  I continue to take it today at 75mg/day for bp and arrhythmia control, along with heart attack survivability.  At 62, that unpleasant thought must be taken into consideration.

[Jerry_NJ]

Thanks for your personal experience with the same drugs, that's what's great about this Community (blog) resource.  

HesAPooka:
Your experience with taking 25 mg Atenolol encourages me to continue my experiment with the same.

Tom:
I as mentioned many times, I am disappointed (as are others) with what I consider the Medicare shuffle, in-out in minimum time, in the USA - you'll be there in a couple of years yourself - if Obamacare doesn't replace it with something worse, I believe 2014 is the full-implementation date.  In truth I have to confess my Cardiologist is very kind and attentive and never gives me any direct indication he is trying to quickly finish with my check-up, but the fact that he never offers any experimentation to find a better approach leads me to conclude he's trying to minimize the time I take - good business practice in any business is get the job done right and quickly if you want to make some $$$ and I believe as long as my heart is holding up under the current treatment is good enough.  Still I believe the lower Medicare rate, which he accepts, plays a role.  Bad news, Obama keeps trying to lower the rates - make the doctors "pay their fare share".

I have lived in the same house for about 25 years so most of my doctors go back to when I was on private health insurance, and they all continue to care for me as a Medicare patient (read that to be lower pay than even the negotiated in-network insurance rates) but I believe, intentional or not, that each doctor tries to minimize the amount of time he spends on each (Medicare emphasis) patient.  Thus, when I asked (he didn't come up with the good idea, it came from me and my education here on his Community) him to write me a prescription for using Atenolol he wrote it to mirror the Metoprolol.  It took me only a day and a half to conclude the two drugs are not equivalent/equal in my body.

Is-Something-Wrong put me on to some important differences:
1) Atenolol is longer lasting, much longer half-life (forget what he gave, but for me it looks like a half-life of at least 12 hours)
2) Atenolol has less affect on brain function - I have complained for years to my Cardiologist about suffering from what I call trouble-mares. I have specifically asked about the dreaming being related to my BB.

Now with two days "under the belt" I will take my morning dose (and only dose) in the next hour.  My resting HR is in the low 70s, now 24 hours since the last dose of Atenolol.  When checked during the wee hours of the morning (I wake at least 3 times between midnight and 7 AM) my HR and O2 were good, HR in low 60s and O2 over 95%.  Thus I plan to continue with one 25 mg dose of Atenolol each morning and to monitor my HR and O2 saturation.

After heart surgery I was up to 100 mg Metoprolol twice a day for a few days, but I took my BP so low the nurses made me rest and get it back up after a work out in the cardio rehab I was taking.  It was somewhere along this time that the BB was lowered and CCB added.

DeltaDawn:
You mention cutting your Atenolol into parts.  My tablet (assume all are about the same regardless of the manufacturer) are about 1/8th inch in diameter, and would be difficult to cut in half, forget about fourths.  How are you cutting such a small tablet?  I have considered taking half in morning and have at night, but my experience/test so far suggests just taking it at 25 mg once a day in the morning may work for me.  I am keeping a close measure on what is happening to my HR as I pass the 12 hours mark from my morning dose.
-----

I have never had trouble with high blood pressure, and take the beta blocker (in combination with calcium channel blocker) to lower my HR, so called "rate control" treatment of AFib.  I will check my BP too, but doubt it will react badly to a lower dose of BB.  I take CCB at something like 240 mg twich a day - high dose, but guess at the number), The CCB is also a BP lowering drug.

[helyanna]

I have have been using atenolol (with Tenoblock, Tenoprin or other names) since the eighties. First I was using 50 mg for many years. Later, especially during AF, my daily dose has been the maximum, 100 mg. Some doctors have suggested to use the high dose, and when needed, I was allowed to increase it a bit over 100. I have the feeling that I should not use so high doses, they will decrease my blood pressure and heart rate too much. Recently, I have dropped the dose to 75 mg. Two doctors have agreed with me.

I think that atenolol is usually suggested as one daily dose in the morning. Before my AF episodes I was taking 50 mg in the morning, and it was OK. I took the daily dose 100 mg in two parts, 75 mg in the morning and 25 in the evening, or even in three parts. During AF, atenolol as a single dose was not wery good to keep my heart rate low enough throughout the day. And, possibly a single high dose caused some symptoms in the morning. The evening dose was because of periods of tachycardia at night. But, as early as during the year 2010 AF, I also had some bradycardia and pauses at night.

I think that my heart rate has had a slight tendency to be generally lower nowadays, maybe due to older age or some other, medication or metabolic factor (vitamin D, Thyroid etc). Now ( I have not AF now), I am using 50 mg in the morning and 12,5 mg in the evening.  I hope  this is enough to prevent a new AF episode.

Since the eighties I have tried to use many beta blockers. Atenolol has been selected as the best. I cannot tolerate eg. bisoprolol. Of calcium channel blockers Verapamil is forbidden, and Dilmin was not good, and maybe the other calcium channel blockers are not suitable either. It has to be noted that different beta blockers are very different in their effect, so their dosages can be very different.

Atenolol allows my heart rate to rise so much that I do not feel dizzy or weak when I am going up a hill or stairs. Other beta blockers cause my heart rate go mad (bisoprolol) or do not effect at all. Intravenous Seloken, in the emergency unit in 2010, had no effect on my heart rate, and Spesicor in this year did not affect either.

[Jerry_NJ]

Thanks, my situation is driven by permanent AFib and increasing age : )

I will continue to monitor my now one 25 mg in the morning.  I still intake some caffeine in the morning, two/three 8 oz (can't convert o ml in my head) and one 12 oz black tea.  In fact I'm a bit behind schedule this morning and am now drinking the tea. It is just past 12 noon here.

My 25 mg Atenolol was taken about 10 AM and was seeing a HR in the low 70s, it is now 60 at rest, as at rest one can be trying to type on a small travel laptop (true notebook) while looking through old eyes.

I remain optimistic that the move to Atenolol was the correct decision.

[DeltaDawn23]

Jerry -- my Atenolol is manufactured by Zydus Pharm and is 1/4" and is not scored, but breaks easily.  I did ask the pharmacy to keep ordering from this mfr. and refused a very small tablet as I could not break it.  They honored my request.  Glad the Atenolol is working well for you.  Take care.

[DeltaDawn23]

Just read your last post.  Does the caffeine have any effect on your heart rate or bp?  Or the afib?  I use none -- even chocolate, altho my EP says caffeine may be getting a bad rep.

[golfnfish51]

Jerry-I really appreciate your post.  I have been on atenolol for about a year.
The MD prescribed 50mg once a day.  My HR went to 45.  After a couple of days I decided to go to 25 mg twice a day.  My PAC's are pretty much gone (reason for the original scrip) and my resting HR is in the low 50's.  I am also considering and mentioned this to my Cardio (he isn't the greatest in the world.  He originally prescribed flecanide and I thought for 3-4 days that my heart was going to come out of my body) that I would like to cut back to the morning dose only.  He said try it (very encouraging).  I will be monitoring your posts.  Hopefully this will work for both of us.  I too drink tea early morning followed by a bit of coffee which doesn't seem to have a negative affect on my heart rate or bp.  

[Jerry_NJ]

Update, last night (early morning) my HR was a bit higher, no more 50s.  Even at 7 AM while still in bed my HR was in the low 70s, still very acceptable.  When I got up and had breakfast, up and down a flight of stairs a couple of time, a trip around the house to attend to a bird feeder and dog, and a couple of cups of coffee my HR never measured above 100.  I didn't notice much dizziness when I "jumped" up from seated to walk quickly across the room - a good 25 feet, to answer the telephone.  Yes, we still use a wire line phone and while the tele instrument is cordless, I never remember to take it with me when I retire to the living room, and this morning a seat before a fire in the fireplace insert.

Early conclusion:  25 mg once a day of Atenolol works, and spares me the dizziness I associate with the lower HR of 25 mg twice a day.  I have not taken my blood pressure, an error in this "test" plan, but that's were I am.

Trying to hurry up on the scientific principle that when doing an experiment with several known variables, change only one variable at a time - the assumption here being that the change has stabilized before making any other changes... I am considering two days and trend line on the reduction of Atenolol sufficiently stable to change something else.

Starting this morning I am cutting my Calcium Channel Blocker back to 1/2, my prescribed level of 120 mg twice a day. I broke my 120 mg dose of Diltiazem in half, and took half this morning, other half will be for this  evening.  I had misstated earlier I took 240 mg twice a day, 240 mg was the total per day, not dose.  

My reasoning on safe to try this is the CCB was added to get my Metoprolol down form 100 and more mg a day to lower my HR.  The Atenolol is doing such a good job I may be able to ask my Cardiologist to just drop the CCB all together.  

It seems I am pretty much on my own here, and while I consider the very helpful input  from my friends here on this Community, the decisions are all mine.  

My doctor may not be happy when I tell him after the fact I have done a study and from that here are my recommendations for my treatment.  Of course I'll have to be much more tactful and say in a way that fully recognizes I am a patient, not a doctor.  As noted earlier, as a senior using Medicare,  it may be difficult to find a doctor to treat me simply because of the low payment rate.  I don't want to offend any doctor willing to treat me, in the final analysis I plan to be on a plan the doctor has at least approved.  

[DeltaDawn23]

Congratulations on taking charge of your own health care.  Yes, we need the doctors, but in the end we are the ones who live with and pay for the medications and treatments they prescribe.  I hope you are wrong about doctors accepting medicare being scarce.  My doctor will surely be retiring soon and he is one in a million.  I don't even want to think about having to look for another who may not accept my insurance.

[Jerry_NJ]

Today is my 4th day of taking 25 mg of Atenolol only in the morning (none at night) and the 2nd day of taking 1/2 does morning and night of my Calcium Channel Blocker (60 mg each time).

Observations:
1) HR is in general higher, during sleeping period sample measurements of HR were in the upper 60s to low 70s range, none in the 50s.  This is the period more than 12 hours after my morning and only Atenolol.
2) HR during the day was in general higher, but still acceptable, I never saw a HR higher than the low 100s even with activity - need to check this further, say on a 1 mile or more walk.
3) Less dizziness, but I still get up from a seated position slowly.
4) Now about 10 minutes after my morning Atenolol and sitting typing my HR is in the mid 80s, doubt the BB has had a chance to "cut in".
5) Most troubling is my blood pressure measured yesterday at a local super market and at Walmart (measurements both in the afternoon, and about 2 hours apart) were slightly elevated, of course I had just walked several hundred feet before taking the measures. I am putting a new battery in my home BP device and will make measurements when truly at rest.
6) I continue to "suffer" from trouble mares - sleep disorder.


Conclusion, I suspect my body is adjusting to the Atenolol as I have less dizziness even after a "full" dose in the morning.  If the BP remains elevated I will first go back to full dose CCB and if that doesn't reduce BB I will try going back to morning/night Atenolol at 25 mg each.  I have not yet seen any reason to try taking 12.5 mg twice a day verses 25 mg only in the morning.  If I see an unacceptable elevation in HR during the sleeping period I may try the 12.5 twice a day.

The fact that my dreaming problems continue without any reductions I can detect leads me to believe my sleep/dream problems are not BB induced. The Atenolol has less impact on the brain, and my one dose in the morning means my BB level is at its low point during the sleep period.  My dream problem may be psychotic, but I am resisting seeing a Psychiatrist. Who would want another doctor appointment and another medication or two - next I'll have anxiety.  

I have to review again the good inputs posted here, and do recall some arguments made for not taking Atenolol before bed time.

I will continue to monitor my HR and dizziness throughout the day (trend only, not keeping a minute-by-minute record) and measure my BP at full rest.  My home BP measuring device will be checked against results at the local pharmacies.  

I will consider my situation in a steady-state after more than 5 days on a specific test dose level/regiment.  That means I will try to stay on the morning only BB and 1/2 morning, 1/2 evening on the CCB.until at least the middle of next week.

[Streetlite]

I live in Thailand. Last Fall I was visiting my home in  the USA and after a general checkup with the doctor discovered I had Atrial Fibulation. Had a medical procedure where they knocked me out, put something down my airway and "jumpstarted my heart back into rhythm. Prescribed 100 mg. of Metoprolol, 50mg of Lipitor and 300 mg. Aspirin each once a day. I have been attending a hospital in Bangkok and the Doc there kept me on the current meds now after 2 visits (3 months apart) and blood tests each visit. I live in a small Village 3 hours North of Bangkok. I ran out of Metoprolol and the Village pharmacist had Atenolol 50mg in stock. I bought it hoping it will do until I see the bangkok Doc at the end of this month. My question is "do I still stay on the 100mg dose or do I just take 1 50mg dose?  

[Jerry_NJ]

Good question, and I think the "Best" answer depends... on the individual.

In you place I'd take the same does and keep a watch on my heart rate and any new side effects.  If I saw a large decrease in HR, for me that would be below 60 at rest, I'd try 1/2 dose and  watch again.  

I believe taking every 12 hours is better than every 24, but I believe the total taken per 24 hours should be the same for either schedule.

As noted in this thread, I found Atenolol "stronger" in lowering my HR, but over a few months my body adjusted and I now take the same dose level as I had for Metoprolol, which I was using for several years.

Again, I am in permanent AFib, so I have to use BB to keep my heart rate at a healthy level, below 100 at rest.

I think you are taking BB to help your heart stay in normal sinus rhythm, so you may find the BB lowers you HR too much.  Discuss that with your pharmacist and doctor if you find you have a low HR.  Here too I note some people do fine with a resting HR as low as 50, but that is unusual and suggests a very strong cardiovascular system... lucky them.

[mosley89]

hello,
I'm  a 24 year old female and I just began taking atenolol 25mg prescribed at two times a day for rapid heart rate. I was originally only taking 10 mg tablets of propranolol as needed, but it was interfering with my asthma and wasn't really enough to control the HR without taking it 4 or more times a day. My cardio switched me to verapamil, which I swear is a demon. I ended up in the ER, who switched me to atenolol, twice a day at 25 mg. I'm on day three and feel as though my HR was too low for me at 64 bpm. I skipped this mornings dose and plan to try it at one a day, mid afternoon, but I've had a lot of anxiety surrounding it because I don't really know what to expect from missing a dose. Ive had every test (CBC, thyroid, 30 day holter, ekg's, echo, stress test etc) and they cant figure out why I have a pulse in the 120's for no apparent reason. (Not all day, just rises and falls) and a lot of PVC's (pre ventricular contraction) or skipping. anyways, I sure hope the one a day has me feeling better sometime soon, as a mother of small children and full time college student, I'm not sure how much more I can take. I'm headed to see an electro physiologist (or whatever he is lol) and hope we can figure this out. Good luck to anyone on this thread going through what I am or worse. I can definitely feel your pain!!!

[Jerry_NJ]

I think a resting HR of 64 is high enough for most of us...  lower normal is all, not too low.

Atenolol has a long half-life, so if you take it at least once a day, you have some active medication in you body even at the 24 hour point.  As I have already explained in the too many words above I find 25 mg every 12 hours keeps my HR at a reasonable level, assuming a rather sedimentary life style of a old guy.  

Not sure where I'm trying to go here, other than I don't see any reason to worry about a HR of 64 as being too low... if you are not dizzy or short of breath.

[DeltaDawn23]

It is my understanding that 60-90 or even under 100 is a normal range.  I was in the 50's while on Atenolol for my afib, taking 25 mg. divided (a.m. & p.m.) each day.  There were times when I took a little less or a little more, depending on what other issues were going on.  Good luck finding out what's going on.  Hang in there, rhythm problems can be knotty to unravel and take time, but in my experience can be managed.

[tom_h]

Atenolol's plasma half life is approximately 6 hours.  So in 6 hours, half the original dose remains in your blood, in 12 hours, in halves again, but you take another 25mg.  If you work it out on paper, your see this roller coaster effect, hills and valleys if you will, but every day the amount of Alenolol remaining in your blood increases slightly.  Compound this over days, and weeks, and slowly but surely you begin to feel like a zombie.  It come on imperceptibly slow, but it happens.  Personally, I take 75mg daily of Metoprolol.  It too builds slowly.  When I see my BP around 105/60, and I feel that it's taking too long for my heart to get up to speed when I work out, I stop a dose for a day, pehaps take half my normal dose the second day, then I go back on my maintenance dose.  When you stop, the drug is slashed in half after 6 hours, then is slashed in half again in 12 hours, etc.   At one time before my ablation I was on 200mg of Metoprolol for about a month and a half.  The build-up was so great that I couldn't walk up the driveway to get the mail without that cinderblock on the chest feeling.  I was a former athelete, so I knew somethng was wrong.  I called the physician who had me stop for a couple of days, then start again on a 100mg dose.  The results were remarkable.  I guess if you knew the actual plasma level, you could correct it with more precision, but this rough method works for me and quickly puts me back to feeling like myself again.. I often wonder if physicians take this buildup into consideration when prescribing larger quantities of a partiucular drug.

[Jerry_NJ]

Yep, I think we've had the discussion of the build up of medication that has an extended half live period (I'll say at least a large percentage of the period between taking doses) such as 6 hrs for Atenolol.  

I am unable to write the series for this accumulation, perhaps it has a "closed form" so one can easily calculate the maximum of the sum.  Unable to do that and to make things simple I offer the follow brief demonstration that the limit over extended periods of time is the doubling of the dose... never gets there, approaches asymptotically

I'll use a dose every 12 hours and a half life of 12 hours (6 hours half live would grow more slowly).  I will normalize to 1 dose, not 25 mg, and calculate for 10 periods (5 days):

Dose 1  (1)
Dose  2  (1.5)
Dose 3  (1.75)
Dose 4  (1.87..)
Dose 5  (1.94..)
Dose 6  (1.97..)
Dose 7  (1.985..)
Dose 8  (1.992..)
Dose 9  (1.996..)
Dose 10 ( 1.998..)

So in 5 days the patient starts each period with approximately twice the level of one dose taken in isolation.  Of course a 6 hour half-life grows more slowly, but I'll suggest (not doing the arithmetic) the 6 hour half-life will hit the double level in less than a month.

As we have also discussed, I manage to forget to take one of my 25 mg doses at least once a month.  That said I have found my body has adjusted to Atenolol sufficiently that I no longer can directly associate taking a does with feeling dizzy or very low HR.  Checking when just lying in bed, after waking from a sleep that usually is fraught with dreams I usually find a HR in the 60s, some upper 50s and some lower 70s.  When I first started Antenolol I had some dizzy periods and low HR and BP... both of these are near normal now, but the low exercise tolerance remains, but then my atrium chambers are non functional.

[mum418]

Hi Jerry.  I have had pvc's for many yrs. but as I get older they seem to be getting worse.  Upon a prep for a colonoscopy they really got bad the day of the procedure, but the doctor decided to go ahead anyway and I guess because of pvcs he did not give me pain med. or anything else.  Had a holter monitor (24 Hr.) which showed 10,000 pvcs in that 1 day period, which is according to my cardiologist is just short of max.  He changed my med. from 25 mg. of atenonol twice a day to 25 mg. of Metoprolol twice a day. Have noticed an increase in heart rate when I wake up to about 80-85 and with Atenonol mid 60's.
I believe I also have sleep apnea but after going in for a sleep study I could not get to sleep so don't know what to do.  I to get nightmares, headaches and shortness of breath.  Do you have any thoughts on this.

[Jerry_NJ]

I have not further comment on the Atenolol verses Metoprolol beyond I now have about the same result.  Seems my body has adjusted to the Antenolol to a degree that makes its effectiveness about the same as Metoprolol.

On the PVCs, I don't suffer but 10,000 is high to my recollection but not unusual for sufferers.  The "normal" range rates must be available on a search for same.

I suffer from trouble mares, not nightmares.  These dreams are every time I sleep, even a nap, and are indeed troubling, more depression than fear.  This has been going on for years, I can't remember how long.  I don't think the beta blocker is the driver, but the BB doesn't help stop them either, of that I am sure.

I was diagnosed with mild obstructive sleep (OSA) apnea and here's the way that diagnosis developed.

First I was troubled by waking up, sometimes from right at the onset of sleep, with the feeling I was suffocating.  I talked with my wife (with whom I still sleep after over 55 years of marriage) and she has enough trouble sleeping to no put up with any unusual kicking or snoring on my part.  She has complained some, but not often and so there was nothing there to suggest OSA.   But, I was concerned enough I purchased a real time (not recording) Oximeter and put it on my night stand.  I had a couple of reasons for the purchase, not expensive about $25, one being concerns about apnea the other about my heart rate.  The device quickly (maybe 2 or 3 seconds) give a oxygen saturation level and hear rate.  In fact one reason I purchased it was the Antenolol - I was concerned about it's affect on my HR being too high - maybe I could reduce the dose level.  That didn't "pan out".

My Oxygen saturation level was normal to good:  95% to 98% most of the time, but I found when I woke up with the suffocation sensation clipping on the meter showed a O2 saturation as low as the mid 80s %.  I had a scheduled physical exam so I mentioned my experiment with my Primary Care doctor.  He prescribed an overnight recording Oximeter test. That was easy, and natural I did it at home, albeit I had to tape a detector on my finger which was wired to a recorder on my night stand.  I woke up a couple of times that night (as usual - have to pee more at night it seems) and looked at the recorder, which had a display.  I saw low readings there too when accompanied by the suffocation sensation.  The results were reported back to my doctor recommending I purchase and use supplemental oxygen - in fact the company tried to get approval form me to send oxygen, my readings were bad enough they said I qualify under Medicare requirements for supplemental O2.  I told them to hold on the O2, I'd talk with my doctor first.  He prescribed a Sleep study. That got me an appointment with a sleep study center and the Pulmonary specialists - wow,  Good news/bad news, the first test were x-ray and physical exams which resulted in a diagnosis that I did NOT have emphysema or other serious lung problems, the bad news (not all that bad) was because I am (now was) Obsess  (come on, 250 pounds yes, but 6' 5" + to put it on) and that had reduced my air passage size in my throat.  I asked would weight loss help that, the answer was YES, what else could they say.  In any case this led to an overnight sleep study at the sleep center in my local hospital.  I did a near normal sleep and the results confirmed "mild" OSA.  It also showed I still got almost the normal required REM sleep (all the dreaming I think) to get rest, and that I can confirm as I did not suffer from day-time sleep problems.  Hey, where am I going?  Hope I haven't lost the question, or made too may typos to be understood.  The doctor suggested I could benefit from a CPAP sleeping aid, and I said how about losing weight? He said it was worth a try.  I lost 25 pounds and I no longer wake up feeling like I am suffocating.  I need to confirm with another overnight recording oximeter test..here's my bottom line for you:  do a recording overnight O2 test at home, and so it until you can do one with what you consider an overnight sleep.

As for the bad dreams, try reading up on Lucid Dreaming, I like the work by Dr. Stephen LaBerge at Stanford.  I checked his book on the subject out of the library and listened to the audio CD many times.  It didn't solve my problem, but I gave/give it only a cursory try as my dreams and not full of terror.  The book also covers night terror I think.  The point is to try to engage you conscious mind in your dreams, take control  My solution to nightmares was similar, and I came up with it at the age of 12 or there about where I trained my mind to wake myself up when the terror scene was just starting to develop... it worked, I have a nightmare that I remember no more that a couple of times a year, it that often.

Good luck, I didn't proof read, already put too much time in.  My typo rate is troubling, but most are easy to figure out.