Waking up every night during REM atrial fibrillation and anxiety

[ZigZag]

Hi, I have had nocturnal disturbances for 8 years or so where I wake every night roughly at the same time and always during REM (dreaming) sleep. In the last month my symptoms have got a lot worse, I have been taken into A&E twice via ambulance as my pulse was over 200 bpm and very irregular. I get chest pains, nausea, feel as though I am going to pass out, sweating, dizziness and sometimes tingling in my left arm. It is so terrifying and it happens to me every night. I have been put on beta-blockers but they are not making much difference.
I have been feeling suicidal as it is so traumatic and frightening. I dread going to bed now. I have no life anymore, I just exist. I have no problem falling asleep as I am so exhausted but wake around 2am and/or 5am. Dreams are always interesting or pleasant, never nightmares. I am going crazy with this. I have a wave of heat over me and feel sweaty, my stomach starts making noise and twitches as if it is full of snakes, I feel sick and my heart goes crazy. I have a Kardia monitor and can see me pulse go irregular and rapid. It feels like I am going to die every night.
I have no worries in life (apart from this), no stresses whatsoever.
Please, please if you have had similar symptoms can you reply?!

[RJJones]

I dread going to sleep every night waiting for Anxiety attacks to happen. I was in a routine there for a while of going to sleep and waking up having some sort of panic attack. Heat rush over my head and body like i was going to pass out with dizziness, the shakes, sweaty. It was all happening around 3am every night. My routine was take a tiny bit of seroquel for sleep, go outside and have a coffee and a sig and then go back to bed. Probably wasn't the best thing to do, but i had nothing better to do at 3am. It was either that or go up the hosy and get told to go home and take a few Valium. My pulse wasn't a real issue at the time, but my blood pressure would go sky high which freaked me out. I reckon this has gone off and on for like 15 years. I really HATE night times for this reason, like you, i think im going to die or i just don't want anxiety to happen. I started taking my Xanax just before bed which actually helped me sleep past 3am. Although it has died off again, i still freak when night time hits. Like when everyone goes to bed im like, here we go again!

What is your pulse usually when you don't have a panic attack mate?
Is it normal throughout the day?

Im not suggesting taking any tablets like im on, im just saying what helps me out with the approval of my DR.

[ZigZag]

Hi, thanks for your reply. I'm sorry you are having awful symptoms too, you have my sympathy. It would be bad enough not being able to sleep without any symptoms as well, but waking up feeling terror on a regular basis is horrific. I don't think anyone who hasn't experienced this understands at all. I feel that people think I'm being a bit silly and just need to pull myself together but I don't believe my symptoms are purely psychological but it is really hard not to feel anxiety when you anticipate the thing that scares you the most, ie. going to bed and facing your demons every night. What I wouldn't give just to be able to sleep in peace for one night!!!

I hear about all the interesting things that people are doing in their lives - having holidays, days out, hobbies etc.etc. and compare it to my own life, which just revolves around pain, exhaustion, obsessing over lack of sleep, heart problems, and fear!

In answer to your question, my pulse is normal throughout the day and my blood pressure is normally quite low - typically 100 / 70. During these night time episodes my blood pressure rockets up. I've always had some palpitations at the same time but it's only in the last month that my pulse has gone really high and irregular for long periods of time.

I don't drink, smoke, take drugs, I eat a healthy diet and have no stress (apart from what these symptoms give me). Don't drink coffee/tea, don't eat chocolate - ie. all the things that doctors tell you can make sleeping worse.

I have been considering asking my doctor for some medication that will basically knock me out during the night so I don't have to endure this traumatic nightmare anymore, but as I don't yet know if there's something wrong with my heart i am reluctant to take medication that might make my heart symptoms worse - irrational I know but I am so exhausted with it all that I can hardly think straight anymore. I am frightened that if i take some kind of tranquillisers, my heart will stop.

I phoned a private hospital yesterday to see if I could arrange to have a sleep study. I can't really afford it but I am desperate now. Anyway, they said no, because I was already being seen in the NHS. What crazy world do we live in - I mean, I am offering to pay in full for it but it's denied me. Than I rang my local NHS neurological hospital as I am overdue for an appointment there. They said they can't make any appointments until January so ring back again. It's like there is no help out there.

I don't think that anyone who suffers from anxiety related symptoms is taken seriously by the medical profession or by non-sufferers. It's like a slap in the face that we just don't deserve.

[Aaahhfreakout]

Hi,

Sorry to hear you're having these problems. I too used to wake at night with a racing heart but in my case it actually was psychological. It was nowhere near as bad as what you're experiencing, anyway.

Your case sounds tricky. As you know so well, it's hard to tell what could be physical or not.

Is atrial fibrillation an actual diagnosis by a doctor? If it is, then vagally-mediated atrial fibrillation may be what's going on as that can be triggered by sleep. I once triggered it myself by drinking a half-litre of ice cold water very quickly. Not fun.

Anyhow, you need to get it recorded and diagnosed, whatever it is.

The doctors should have given you a portable Holter monitor for a few days or longer to record what's going on by now. That's pretty standard. I'll be disappointed in them if they haven't.

If they haven't yet, can the Kardia monitor record what it's displaying so you can show doctors? You could use a second device to film or photograph what it's showing if it doesn't.

Also, are the irregular beats you saw a normal shape or big, a bit weird and possibly upsidedown? That can tell us a lot. If they're normal shaped then that's a good sign as that does indeed suggest an atrial origin of some kind, and that is rarely dangerous.

Edit: oh, just noticed in another thread I was reading that you'd posted too and talked about the Kardia and the Holter.

[ZigZag]

Hi, thanks for posting. I have an appointment to have a holter monitor next week for a few days. The Kardia device has been very useful as I can record the episodes and send them to the arrhythmia clinic. During normal sinus rhythm I can see a regular looking graph but during my nocturnal episodes the graph shows a different pattern - what to me looks like a longer QT interval plus lots of irregular beats.

No, there are no upside down bits really, the main peak becomes smaller as my pulse becomes rapid but still regular, albeit faster, and the two pulses between each peak become close together then there are lots of little pulses. Sometimes it's just like spaghetti. I can see my stomach rapidly pulsing with the beats. I get churning stomach and lots of gurgling noises in my stomach too. It's like the nerves are hyperactive and everything starts twitching.


It seems accepted that I have some issue and have been prescribed a low dose of beta blocker which I have only had for a week so it's a bit early to say whether they are making any difference - I still wake every night at least once and have similar symptoms, although since taking the medication my pulse has not gone over 200bpm as before. I don't understand why I keep waking up during dreams then my heart goes nuts. Anyway, I shall have to endure it for a bit longer and hope I get a positive diagnosis following the holter monitor testing.

I am just scared I will die suddenly. Especially during an episode. I try to think rationally but it's like being a spectator and watching my body go crazy and there's nothing I can do to stop it. It comes in waves. I bear it and try to breathe slow and deeply, eventually it stops and my stomach goes still, then I get wave after wave of it until eventually it stops and I manage to get to sleep. I am usually awake for an hour and a half for each episode in total.

[Aaahhfreakout]

Very interesting. What you see on your monitor suggests it's not ventricular as that typically has large and very distinctive shapes on an ECG and it's often inverted. So it's very probably atrial.

Does your heart slow down gradually or instantly drop back to normal?

A gradual slow down would suggest it's not arrhythmia like atrial fibrillation, atrial tachycardia, etc. but is instead series of very frequent atrial premature beats.

This would be very good news as atrial causes are usually harmless, even if they have distressing symptoms. And atrial premature beats are the most harmless of all.

[ZigZag]

My pulse changes quite rapidly, i.e. it will suddenly start racing from a low rate. Also it can go back down to normal quite quickly. I wouldn't say the changes are gradual, although they're not exactly instant either.

There have been times when the changes seem very rapid, as if a switch has been flicked.

I have other symptoms that are probably not connected but might be. They are now bothering me too. I have a feeling of very localised pain and tightness in my left hand side just behind my lower rib which wraps around to the front left hand side, as if I have a tight band around me. I have a numb patch on my skin just under the left front ribs which also itches frequently, plus pins and needles. It seems like I have a nerve issue. Maybe that is what's causing the heart problems and stomach twitching/nausea. I have no idea and whenever I mention these symptoms to the doctors they make notes but never say anything. I wish they would say something, anything!

Overall anxiety is undoubtedly making me feel worse, but what more can I do? I am getting the holter monitor on wednesday so not long to go now. It will probably take weeks before I get an appointment with the results so I shall just have to endure it and hope I survive long enough to get a diagnosis!

[WiredIncorrectly]

For as long as I can remember I have had problems where I will wake up within the first hour of sleeping in a state of terrifying fear. 100x worse than what a panic attack feels like. I struggle to breath (or at least it feels that way), and there's a feeling of impending doom for a good hour after the "attack". Sometimes my heart races, and I have caught it at 180bpm.

Do you have confirmed AF? I'm asking because irregular beats can also just be regular palpitations but they happen so often during anxiety that they the heart can appear irregular. I can confirm I've had palpitations non stop for weeks sometimes.

I'm always told it's anxiety related. I also fear sleep because when I stress over the nocturnal attacks they get worse :(

I feel your pain though.

[ZigZag]

Hi, yes it does seem much worse than a 'regular' panic attack. It's so crazy having these attacks every night.

My throat gets really dry, not so much my mouth, but I feel as though my tongue has swollen up and I feel as though I am choking. I'm sure it is just a high state of fear but boy, is it hard to rationalise during an attack, and I've had years of exposure. You'd think we'd get used to it.

Yes, I get that impending doom. My episodes come one after the other with breaks in between. As soon as I start to feel more relaxed and getting closer to sleep - boom! It all starts again, over and over until rest is impossible. Sometimes I can wake at 1am then feel completely wired for the rest of the night, eyes on stalks, heart pounding, boom, boom, boom all night long.

Of course the next day I am totally shattered.

I haven't had a confirmed diagnosis yet. All I can see from my Kardia monitor is that during an attack my pulse takes on a different pattern then becomes very irregular. Sometimes I feel like my heart stops for a couple of seconds then sometimes I get an incredibly powerful beat. I get very acute episodes of strong nausea and a hot flush just before an episode starts. Feelings of incredible doom. Chest pain, dizziness and absolute terror.

I am wondering whether I am having a huge surge of adrenaline during these episodes, perhaps triggered off by low blood sugar during the night, plus a change in brain waves.

Last night was bad. I wanted to scream out and lose it completely. Not because of the fear but because I feel like I am at breaking point. I am beyond exhausted with it all. I am angry. I am desperate. Why am I suffering so much? I don't know how to bear it anymore.

I know we are all suffering, it's crazy. I just don't understand why.

One strange thing - my symptoms always get worse in October. My neurologist told me that it's quite common for migraine sufferers to feel better in the brighter, summer months. I wonder if the darker days have caused a change in my brain chemistry which has an effect on my symptoms. There have been suggestions that I am having atypical sleep induced migraines (without the headache although I do often get a little bit of pain in the left hand side of my head and neck during attacks).

Do your symptoms get better in the summer?