How Strange

3/24 - Afib - 1:30 AM to 5 AM

4/25 - Afib - 1:28 AM TO 3 AM

5/9 - Afib - 1:30 AM - 5 AM

5/11 - Afib - 1:15 AM ....??? fell asleep

What’s going on, do you suppose. Not with the Afib, necessarily, but with the time it starts.

Coincidence?

Lights out usually between 10:30 and 11:30 PM.

Pretty common for afibbers with a vagal trigger to have early morning episodes. Among other things, I think it is a diurnal low for potassium <[www.afibbers.org] , also could be night time hypoglycemia, apnea, overbreathing during sleep...

Over breathing while sleeping?

Catherine - As George mentions, hypoglycemia can be the culprit. It was for me until my MD at the time told me to eat a protein snack about an hour before bedtime to help prevent low blood glucose during those hours. I also took Omega 3 fish oil at bedtime - about 2 teaspoons and often, a generous spoonful of organic, expeller pressed coconut oil. That helped stabilize the hypoglycemic trend. However, it didn't totally prevent Afib... since it then just came at various times in during the day, but at least I was able to sleep a good 8 hours without interruption. I also always took a dose of magnesium and potassium at bedtime...still do, but without knowing continually what the IC levels are, difficult to know if that was an additional contributor... probably so.

Jackie

That’s like me. About three hours into sleep. Mine never happened when I am awake and not ever triggered by any food. It could be vagal or caused by other things like other people said.

Jackie, tonight I will drink a 5.5 oz. can of V-8 juice with a magnesium capsule and try to stay awake until midnight.

I know I sleep with my mouth open as sonetimes I awake with parched lips and very dry tongue.

George, I take my BP medicine (Triamterene-HCTZ) in the evening resulting in many bathroom visits throughout the night, most likely depleting my potassium levels, even though Triamterene is potassium sparring. Unfortunately I have already taken this evening’s dose. I will drink my V8 juice with a Magnesium capsule.

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lizzie
Over breathing while sleeping?

Yep, pretty common. Patrick McKeown has worked with thousands of people on this. Here is an interview of him that is a reasonable intro <[blog.bulletproof.com] Or you can just read the transcript here <[blog.bulletproof.com]

There is lots more, Patrick has a lot of interviews, books, videos & etc. and there are others in this space, too.

If you want an idea how well you are doing, there is a simple test. First thing in the morning, do a "Control Pause" test. This is described on the page numbered 19 in this pdf <[buteykoclinic.com] The idea is you are resting, taking small breaths in through your nose and out through your nose. On a normal outbreath (not a complete exhalation) you hold your breath out till you feel your first urge to breathe (not a maximum breath hold). You time the length of this. If your breaths after are normal and you don't need to "catch up," you've done this correctly. The time is your control pause (CP). The longer the CP, the better. 60 seconds is outstanding, 40 seconds is excellent, 30 seconds is OK, below 20 seconds is very suboptimal. This tests at what CO2 level your breathing centers tell you to breathe.

This is based on the Bohr effect <[en.wikipedia.org] . Hemoglobin binds tightly to oxygen. It needs CO2 to release O2 to the cells. The interesting part is the more CO2 you have the more O2 your cells get. See the oxygen hemoglobin disassociation curve <[en.wikipedia.org]. In your breathing center, the out of air feeling comes from the CO2 sensor. The idea of training is to reset level this triggers at. For endpoints, think of very fit free divers, they hardly breathe. Think of people who are very unwell, they typically breathe deeply and frequently and many times through their mouth.

There are some people who have had apnea for a long time and can have a high CP, this is a different issue and I'm not talking about that here.

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Catherine
3/24 - Afib - 1:30 AM to 5 AM

4/25 - Afib - 1:28 AM TO 3 AM

5/9 - Afib - 1:30 AM - 5 AM

5/11 - Afib - 1:15 AM ....??? fell asleep

What’s going on, do you suppose. Not with the Afib, necessarily, but with the time it starts.

Coincidence?

Lights out usually between 10:30 and 11:30 PM.

Catherine, I totally agree it's strange. I'd even say it's crazy.
.
Here's my recent data:

May, 7 / 2:30AM to 2:50AM: afib
May, 10 / 2:15AM to 2:40AM: afib
May, 12 / 2:15AM to 2:50AM: no afib but lots of PACs(50?) and PVCs(150?)
May,13 / 2:25AM to 2:45AM: afib

Jackie, George,

I was wondering if blood sugar level might be involved in this recurrent phenomenon, and I got an answer early this morning. If there's a coincidence, I'd like to know which one.
Let me explain...

I consider there are "ordinary" and "extraordinary" days, the former being when there's nothing special in my food, drink, meds and complements. No alcohol, only 2 cups of coffee with my breakfast, last meal between 6:00 and 6:30pm, in bed around 10:00pm, flecainide and dabigatran around 6:00 am+pm, bisoprolol around 6:00am. Mg bisglycinate and K citrate 3x/day.

So, if I've afib in the early morning, there should have been something "wrong" with food or drink in the hours leading to this.

From May 6 to 12, all days were "ordinary" except for the 7th and 12th.

May 7 was a stressfull day, I went to a 28 y.o. niece's funeral. No midday meal, only pastries and two beers in the afternoon; evening meal and meds between 7:30 and 8:00. I expected afib in the early hours of May, 8; but all went fine. No afib, no PACs nor PVCs.

Yesterday (May 12) was "extraordinary", because I spent the evening with friends. Heavy looong and late meal (from 6:00 to 10:30), three glasses of wine, meds around 9:00pm, in bed around 11:30.
Given my big late meal and alcohol consumption, I expected having afib in a different way but, surprisingly, it comes as usually. If blood sugar level was involved, wouldn't had afib appear later?

I've tried finding a link between "extraordinary days" and afib attacks, but it's still a mystery.

I've already tried to find a relation between afib and activities (work, exercise...) but it all went the same: no obvious correlation between a "very active" day and afib.

I wrote it in another thread: the only obvious reason to get afib is I'm afib free for at least 48h.

If someone has a good explanation, I'll take it.

George thank you very much for that information. Breathing has always been a problem for me when I'm nervous, I get that feeling I'm just not filling up my lungs, so I end up over breathing, never really thought it could trigger afib while I'm sleeping.

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Pompon
Jackie, George,

I was wondering if blood sugar level might be involved in this recurrent phenomenon, and I got an answer early this morning. If there's a coincidence, I'd like to know which one.
Let me explain...

I wrote it in another thread: the only obvious reason to get afib is I'm afib free for at least 48h.

If someone has a good explanation, I'll take it.

Back in the day, people used to talk about "cyclic afib." The cycle time might vary between people, but many did seem to experience a time that after which afib was very probable. I experienced this in the first two months of my afib career, 14 years ago. Then I had an episode that would not convert and lasted 2 1/2 months. After that I started playing with my electrolytes which changed this for me.

There were discussions about this in the Conference Room <[www.afibbers.org]. Hans wrote a piece in CR 2 <[www.afibbers.org]

I can certainly empathize with the difficulty of figuring out triggers. Carey posted recently that it was pointless. I'm not sure this is true for everybody, but it may well be for quite a few. In my case, I think that nighttime hypoglycemia might have been an issue I was unaware of. I would wake up hot and sweaty when in afib. Didn't correlate this to the hypos till much later (and afib wasn't that common after I changed my electrolyte balance).

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lizzie
George thank you very much for that information. Breathing has always been a problem for me when I'm nervous, I get that feeling I'm just not filling up my lungs, so I end up over breathing, never really thought it could trigger afib while I'm sleeping.

Not saying it will trigger afib, but it is possible (and can also lead to apnea). I've been taping my mouth shut at night now for a number of years, as it is harder to overbreathe as much, though still possilbe, breathing through your nose. I worked hard at increasing my control pause and was able to get it near 30 seconds. Then I got out of the habit of paying as much attention and it dropped to 17 seconds. Most of the problem with the low CP was my breathing at night as I can ski hard at 12,000' breathing only through my nose.

Thank you, George, for the links. There are lots of interesting articles there, and I've still so many instructive writings to discover! I couldn't imagine the explanations under the title "LAF and the hormone connection" would bring such a lighting on the "infernal cycle" I'm so frequently grappling with!

"Many afibbers, myself included, have noticed that it feels like something is building up in the body
that is eventually released by an afib episode. Some, again myself included, have also noticed
an increase in PACs and/or PVCs in the days prior to an episode and a total lack of ectopic beats
in the first few days following an episode. I believe this observation is crucial to discovering what
terminates an episode."



Edited 1 time(s). Last edit at 05/13/2018 12:36PM by Pompon.

Catherine - Sorry I failed to also add the connection of impaired glucose homeostasis and afib.

Magnesium balance may be a suitable indicator of magnesium depletion under experimental conditions. Magnesium deficiency resulting from feeding a diet that would not be considered having an atypical menu induces heart arrhythmias, impairs glucose homeostasis, and alters cholesterol and oxidative metabolism in post menopausal women. A dietary intake of about 4.12 mmol (100 mg) Mg/8.4 MJ is inadequate for healthy adults and may result in compromised cardiovascular health and glycemic control in post menopausal women.
Source: [www.ncbi.nlm.nih.gov]

The V8 juice is good if it's organic and consumed during the day but since it's low protein, it would not be helpful if your problem is the hypoglycemia during sleep. The generous protein snack a hour before bed was what reversed my hypoglycemia-related Afib in the wee hours of the morning. My pattern was very similar to yours. Then, when it stopped during sleep and yet continued during the day, it was not consistent... maybe once a week or once every 3 weeks... again ...because I was getting enough protein and healthy fat during the daytime to avoid low glucose.

Pompon - this relates to what you've documented here as well. When you go a long time from a 6:30 pm meal, it's very plausible that you are also becoming hypoglycemic during those hours. A lot depends on several types of food intake... the higher protein and fat...either healthy or non, will be sustaining and less likely to provoke an event... yet often, alcohol and sugary foods act as triggers when there isn't enough protein and fat to slow down the metabolism.
Again... everyone is different in how they metabolize.

Alcohol isn't a nutrient and it does deplete magnesium and other nutrients. It can be a trigger for some and not for others and probably depends on the extent of their magnesium deficiency. Some afibbers find they can drink moderate amounts of alcohol as long as they have a balanced meal with protein and fat. It's been noted that problems typically come up with large amounts of alcoholic beverages are consumed with little or no food. I believe I recall one of Shannon's posts saying that a wine spritzer with meal was relatively innocuous.

Thanks George for elaborating on the Buteyko breathing technique. That can be very helpful. It makes sense to give it a try.

Jackie