Why do I wake up every night around 3 AM with my heart racing? It lasts until about mid-morning and then my heart quiets down. I have not yet turned on the light to take my BP, but instead try to ride it out.,hoping to get back to sleep..

I have moderately high blood pressure (about 147 over 80 and take a single low dose Carvedilol (Coreg) at breakfast and one at about 9:30 PM. I have not been able to tolerate other BP drugs. I have had two ablations, the last in 2007, but recently broke through with a bout of Afib and Flutter after a stressful day followed by a meal that probably had MSG and lots of salt. I have not been in Afib since and according to a recent EKG the flutter was minimal.

(Prior to my last ablation with Natale, my BP was always within normal limits (120/ 80).

My previous cardiologist who was very attentive, retired, and the cardiologist I see in Worcester, MA, although considered "excellent" seems to be processing patients in a production line and limits them to about 20 minutes a visit. Subsequently, I am handed off to Nurse Practitioners, who seem to know less them I do. I am kept on hold on the phone waiting for answers, and when they say they will call back they often don't. I have to wait weeks to get in to see them.

Is this what has become of the quality of our health care system?

I would appreciate hearing from you about the problem of the racing heart at night.

How fast is racing? It's common for afib episodes to start in the early morning hours so are you 100% sure it's a normal rhythm?

Note that it begins near the end of your last dose of carvedilol and ends shortly after you take the next dose. Carvedilol is a beta blocker, so it slows your heart rate. The timing seems like a pretty big coincidence.

The rhythm or beat seems strong (pounding), fast and steady, not erratic like Afib. It is more like tachycardia, I think.,.

As you said, it may be drug or carvedilol related.

I am going to try taking Coreg the minute I go to bed and hope that my heart does not take off in the middle of the night. .

Years ago, when I first developed afib, it almost always came on the minute I lay down to sleep - especially when sleeping on my left side.(My doctor says that it is set off by my heart moving on my rib cage) I think that it was also related to acid reflux irritating my esophagus and adjacent vagus nerve. This is different, occurring at about 3 AM..

Could also be hypoglycemia (low blood sugar). When is your last meal of the day?

About 6 PM. I have to eat supper early to prevent acid reflux, which can be a trigger for Afib- Aflutter.

So, if low blood sugar is setting off tachycardia, flutter or whatever...what can I do?.

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Carola
The rhythm or beat seems strong (pounding), fast and steady, not erratic like Afib. It is more like tachycardia, I think.,.

Atrial flutter is fast and steady too, not erratic like afib.

It's impossible to distinguish flutter from atrial tachycardia or sinus tachycardia by how it feels, by feeling your pulse, or even by using a Kardia or Apple watch. You can get some clues, but no proof. For example, is the rate near 150 bpm? If so, that's highly suggestive of flutter.

I think you should ask for a monitor to wear for a week or two. If it takes weeks to get in to see your local guy and you're not happy with him then find another local guy. You don't need Natale's skills here, you just need a cardiologist who can prescribe a monitor and interpret the results.

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Carola
About 6 PM. I have to eat supper early to prevent acid reflux, which can be a trigger for Afib- Aflutter.

So, if low blood sugar is setting off tachycardia, flutter or whatever...what can I do?.

Experiment.

Just eat something sugary before bed, but not so much that you’ll get reflux.

Yes, I am often woken up or have trouble getting to sleep with a raving or pounding heart. It usually comes with an assortment of ectopics as well.

I often wake up in the morning with my heart pounding as well.

Unfortunately, I have no idea what the cause is. I have many candidates to point the finger at though.

(The following post is split into two windows to hopefully result in easier reading of a more in-depth discussion on this frequently asked issue)

One common cause of waking up around 3am with a pounding heart and often accompanied by a sudden waking up startled reflex ... can even feel like a panic feeling for some folks is connected to a sudden drop in both blood sugar and can also include a rapid drop in BP.

Very often such a late nocturnal timing of these constellation of symptoms are triggered fundamentally by an adrenal dysfunction, or a temporary imbalance, in which one's circadian rhythm of essential cortisol production is thrown out of whack by various more proximal 'causes' or triggers.

Cortisol is the single most important hormones contributing to core steady energy production (along with stable thyroid function an ATP) as well as being essential as a key cog for both blood sugar and blood pressure regulation in addition to immune function modulation and as our core endogenous anti-inflammatory/anti-stress agent, along with the above mentioned stable energy production.

Basically, the key evidence of adequate cortisol's paramount importance in support of healthy human life is underscored by the fact that it is the only hormone whose lack of sufficient daily production will lead to a rather quick death ... often with roughly 36 hours or so of cessation of any effective cortisol production at all.

Severe Addison's disease an autoimmune destruction of the adrenals ability to produce sufficient daily cortisol, typically is fatal with out continuous replacement dosing of normal levels of cortisol through daily hydrocortisone doses (which, BTW, is 100% bio-identical cortisol no different in structure and biochemistry than our natural cortisol produced by ones healthy adrenal glands) that try to mimic in daily dosing the same circadian rhythm that is more or less ideal for healthy cortisol production if your adrenal glands were working properly.

A healthy hormonal rhythm of critical daily cortisol production will see peak daily levels between roughly 7am to 8 am ... and from there a steady gradually decline in a pulsatile fashion (meaning a gradually decline in peak cortisol levels punctuated by steadily declining peak pulses of cortisol release within a broad descending curve from the 7am to 8am peak to the eventual nadir (or lowest ebb) of cortisol production occurring from around 11pm to roughly 2:30am in a generally optimum circadian rhythm.

Cortisol is the only hormone our bodies produce that we can't live without. All other major hormones we can limp along with minimal to no production, you likely won't feel great or function optimally, but you'll likely survive. Not so without regular cortisol.

Since cortisol reaches its natural daily low limits of protection in those wee hours from 11pm to 2:30am to 3:00am, it's not at all surprising that a sudden or gradual additional suppression of already naturally very low levels of nocturnal cortisol might bring on such unwanted and disturbingly abrupt symptoms as described above by both Carola and DavrosT. .... (Post continues in following window) ....

Shannon

(This is part two of the discussion above on the original thread topic regarding waking with a pounding heart at 3AM)

(continued) .... One 'bandaid' response to such a nocturnal 'cortisol mini-crash' can be to swallow something sweet and sugary upon being startled awake, often with a pounding heart plus sweating, and that can lead to AFIB in those so prone. Taking a sugar blast at 3am may help just a bit to temporarily blunt a cortisol crash, which is generally similar to a drop into hypoglycemia.

However, if you are prone to such nocturnal low cortisol-induced startle responses happening and early waking, then a more effective 'bandaid' is to try instead a dollop (a tablespoon full but no more) of almond butter right before bed in which the combination of both the longer 'sticking to the ribs' protein as well as good fats can give a modest but often more sustainable boost to blood sugar when needed than just a quick shot of sugar.

However, even the almond butter dose is not a more durable solution and obviously doesn't begin to even address the likely underlying cause(s) of these distressing symptoms once they have become a common occurrence in one's life with on-going interruption of precious sleep.

If such is happening to you, and it started relatively recently, my first question is; "have you recently, or in the last year, started taking night time Melatonin doses to help you get to sleep?

If so, it's possible you might now be building up an overdose of this vital anabolic hormone melatonin that you may have been deficient in which likely inspired your experiments in night time dosing of Melatonin to begin with.

Fortunately, there are no known dangerous contraindications, or long term serious health risks, from consuming typically available and reasonable melatonin doses in otherwise healthy adults. Nevertheless, an inadvertent gradual overdose can definitely lead to very unpleasant symptoms, much as described above!

This is a common problem when people just start self-dosing melatonin based on the readily available over the counter formulas, without ever getting a comprehensive hormone labs work up by a well-trained MD in hormone therapy ... and that includes testing for a key melatonin metabolite in urine called '6-Sulfatoxy-melatonin' to make sure you are not getting way too much of an otherwise good thing.

These common over the counter melatonin formulas range from 3mg to 5mg of sublingual melatonin. For a person taking these for sleep problems, they might indeed need these larger doses in the early months of attempting to restore more optimal natural levels of nocturnal melatonin ... (keep in mind that sublingual dosing is more concentrated than oral dosing). Such significantly deficient folks can take several months to six months to replete their melatonin stores to a more solid and sustainable functional sufficiency.

But once their stores have been sufficiently restored, to continue taking what, by then, could well be much too large dose of regular nightly consumption can relatively quickly lead to a melatonin overdose. Excess melatonin directly has a suppressive effect on cortisol ... and because people taking melatonin for sleep often continue to take the same larger doses of melatonin they started with, such folks too often wind up pushing an already low nocturnal level of cortisol to critically low levels .... hence the possibility of triggering an unwanted mini-cortisol crash defined by just the very symptoms both Carola and DavrosT shared above.

Another contributing factor to such an unpleasant and abrupt startled wake-up call at 3am, is that the strong pounding heart beat, including a possible AFIB episode from excess melatonin, can get an added boost from such an overdose's negative impact on thyroid function by suddenly converting the weakly active T4 thyroid hormone into very active T3 after an intake of excessive melatonin 3 to 4 hours earlier. And thus, causing a temporary sudden burst of hyperthyroid function.

Such excessive melatonin can be a double-whammy for triggering just this kind of 3am wake up with a pounding heart, and thus us Afibbers should be aware of this potential interaction.

If you find treatment with night-time melatonin helpful for a long restful sleep that is fine, just make sure you are not gradually overdoing it. And if any such symptom appear for such Afibbers, then reduce your nightly melatonin dose to between 0.1mg and 0.4 mg, and no higher. That should reduce your odds of experiencing abrupt awakening with such a harsh pounding heart in the early morning hours. Assuming, of course, that your problem really is caused by a melatonin excess.

Cheers!
Shannon



Edited 4 time(s). Last edit at 01/05/2020 07:07PM by Shannon.

Carola - Just FYI

In the early years of my Afib saga, I had exactly what you are describing. The Internist I had at the time told me to eat a protein and healthy fat snack about an hour before I went to bed. Apparently, my problem was also low blood sugar (glucose) ... especially, if I ate something too sugary or carby at dinner which helped set up the predicted crash later on. . Adding healthy fat to protein was an almost instant 'fix' for the AF during sleep. As Shannon notes, almond butter would be appropriate. Eventually, I relied on organic coconut oil which was very sustaining.

However, that didn't stop the AF entirely...just moved it to another time of day as I'd have it during the day at work ...especially if it was was high stress, packed scheduling day and I didn't eat enough 'sustaining' food for breakfast or lunch. Eventually, I learned that my adrenal function was substandard and followed a program to help with that as well since the cortisol issue was definitely a detrimental factor.

I hope you find that the sustaining snack is helpful. Best to you,
Jackie

Would pure peanut butter be a option?