Wife's Crazy Sleeping Heart Rate, Ideas?

[Apnea23]

Hello everyone,

I'm a 2 year CPAP user and my wife of a healthy weight has been having issues with awake POTS like symptoms which are being investigated.

She is not currently diagnosed and has never been tested for any sleep disorder yet.

However I tell her often she is definitely suffering from some sort of sleep disordered breathing as she goes to sleep before me and I see and hear the choking off and arousals.

Anyway - while she waits for an ECG to check her heart and the months long NHS process of investigating, I wondered what some of the experts make of her sleeping heart rate - it really is ridiculous and beyond anything I see even if I'm not using my CPAP.

She is constantly way *above* her resting heart rate and significantly all through the night with a peculiar pattern.

Take a look at these recent nights and please let me know your thoughts.

She takes no medication and does not drink alcoholic. None smoker. 35 years old. Healthy BMI.

[Jeff8356]

Apnea23,

I'm not sure what you mean by "crazy", but the typical resting heart rate for an adult is 60-100 BPM as listed on the American Heart Association website: https://www.heart.org/en/health-topics/h...rate-pulse

Those quick spikes could just be sensor anomalies, meaning the sensor was bumped or had poor contact momentarily. You didn't mention what type of device she was using to record her heart rate. Oximeter, smart watch???

[cmpman1974]

I don't see anything crazy at all here. I'm confused. I was expecting to open the chart and see a 150 BPM rate.

[nauticalnomad]

Looks fine to me.. 
I bought a Samsung galaxy watch 5 pro and i ended up in ER as i started to panic about my heart rate dropping to 30bpm and then shooting to 180 bpm whilst sleeping. 
Turns out the medical grade samsung sensors arent so reliable, even though Samsung loosely market them so but back them up with not for medical useage bla bla bla.. 
Her rates looks fine and within resting as the others have said. Sure the spikes etc might be from some sort of mild apneas taking place. 
But id not be panicking until she gets tested. Sew a tennis ball into the back of a t shirt and make her wear that to bed so she sleeps on her side all night and see what sort of readings she gets from that? 
Obstructive breathing is mostly taking place when sleeping on the back..

[Apnea23]

Sorry I'm not sure everyone is understanding - her daily resting rate is the darker blue number (60-62) and during the night she is above that for anything up to 97% of the time.

That's not what happens during sleep - typically we spend the significant majority of the time under our daily resting heart rate. For example I spend over 90% of the night under my resting heart rate, and she spends 90% above hers.

That is extremely abnormal and crazy.

I hope this makes sense.

I'm assuming it's POTS and her heart is required to be elevated throughout the night to keep the blood circulating properly (elevating the bed at one end seems to help a little) but I wonder if there's a sleep disordered component to it as well, or perhaps that's just a coincidence she seems to be struggling respiratory wise.

When she gets up from laying down the next morning her heart rate shoots up 40-50bpm higher within 10-15 seconds and she's breathless and has to sit/lay down as she feels like she will pass out.

I just wondered if any experts of sleep disordered breathing and possibly with knowledge of POTS or similar had any knowledge to share, given she seems to be having breathing related arousals during the night as well.

[Jay51]

It sounds like your wife might have POTS.  Does she see a Cardiologist?  I agree with everyone else that her numbers do not look too terribly bad, but I am taking Propafenone (Rhythmol) to stop any POTS or tachycardia. 

When she rises and her pulse shoots up, those are POTS symptoms.  During my sleep study, my resting heart rate was around 40, and shot up to 155 when I sat up in bed.  If blood pressure is lower, the body responds by increasing pulse rapidly so a person does not pass out.  I fainted after my angiogram for the same reason (I am very grateful a nurse caught me before I hit the floor).  Watch her carefully and encourage her to very slowly sit up and transition to standing (so no falls or fainting). 

At minimum have her see PCP and hopefully Cardiologist (If she is not seeing one already and maybe they will prescribe medication to combat this tachycardia component).

[mesenteria]

What I see is a possibility of atrial flutter and/or atrial fibrillation. Many people who have AF report having their most frequent events when they are in bed, often to the point where it awakens them.

A 12 point lead ECG at a local ER or cardiologist's offices will show this, but a polysomnography will also reveal this possibility.

What gives AF away are two main characteristics in an ECG:

The absence of a P wave (the small blip just before the large QRS complex (the big spike), and the obvious variation in time between the S and R waves. The numerous small jagged profile between the T wave (the blip to the right of the high spike QRS complex) and the next QRS indicates a high probability of atrial flutter. A wearable with ECG should be able to show you a representation of the PQRST waves and what happens to the intervals...if they vary considerably.

Atrial fibrillation won't kill the patient, but over a prolonged period, many months, with the AF left untreated or uncontrolled, it will result in cardiomyopathy and eventually heart failure. It can be controlled with anti-arrhythmic drugs, several kinds, and the rate of the beats can be reduced with a beta-blocker such as the very commonly prescribed metoprolol, which has been around for decades and is quite safe.

If this turns out to be the case, your wife should seek out an electrophysiologist as soon as a definitive diagnosis if AF is rendered. An EP can map out the defective electrical pathways and isolate them using radio frequency catheter ablation around the pulmonary vein outlets where they return oxygenated blood from the lungs to the left atrium. It is atrial endothelial tissue that has migrated into the pulmonary veins' ostia (mouths) and begun to transmit electrical impulses sent out by the sino-atrial node in the right atrium which is the 'clock' that gives off the electrical beat signals. The pulmonary vein path is an extra new one that mistimes the regular signal, and the atrium begins to contract chaotically because it is being told to by compound signals when there should only be the one from the SA node.

Yes, it's complicated, she and you have a lot to learn, but the big thing is that approximately 8% of all humans life with AF, and that it can be controlled. It can be mitigated very positively by catheter ablation, which a competent (busy and popular) electrophysiologist can do for you. Also, the sooner the better. AF responds best when it is 'paroxysmal' in nature, meaning it comes and goes on its own for no apparent reason. If it progresses, AND IT ALWAYS DOES, it becomes much harder to treat. Get on this right away.

[Apnea23]

Wow thank you so much, I appreciate the lengthy reply and gives us something to look in to while waiting for the ECG due within the next few weeks to rule out anything heart related before a referral is given to a cardiologist to investigate her symptoms further.

Her father has a leaky heart valve, and her grandad has had a triple heart bypass, with his brother dieing in his 50s suddenly of a heart issue while doing manual labour.

I have a lot to research tonight. Thank you once again. I thought there must be someone on here who would see something interesting in those patterns and the fact she's above her resting rate for the majority of the night.

All the best,
Pete

[Apnea23]

Sorry, just one last thing - she has wore a Fitbit with Afib detection enabled for some time which I understand is FDA Approved. Would you expect this to pick up Afib/Aflutter in all cases? She has  not had one single notification.

I'm wondering if I should purchase another device in the meantime or just wait out the proper ECG at the doctors office.

Many thanks,

[mesenteria]

Those devices, including my Galaxy 4 smart watch, will detect AF if they are designed (and approved) to do so.  However, not all devices will nudge you, or provide an alert.  They'll simply detect the arrhythmia if it is underway, AND if you tell the watch to run an ECG.  I don't know about your FitBit, but my Galaxy watch does this.  It even keeps a record and you can download the ECG to your health app that controls the monitoring device.  I used the ECG, looking just like the ones a hospital would print out, to send electronically to my electrophysiologist who took one look and agreed that his first attempt at isolating my pulmonary veins (by a process called radio frequency catheter ablation) had not worked completely.

So, get into the manual for that device, on line downloadable at FitBit's site, and see if it can give notifications of arrhythmia.  In my Galaxy watch case, I have to set it to continuous readings, which runs down the batter inside of five hours, or use the applet on the watch to run a 60 second ECG.  That will be kept in memory, and I can use the app on my phone to do a bluetooth download from the watch and keep it as a record on the phone.

One other consideration, now that I get a better view of your wife's report: the whole night has many spikes, and these might be rises in heart response to low oxygen levels, and those might be due to her sleep position causing apnea/flow limits. The heart will beat more dramatically when it gets a shot of adrenaline or when the body senses that it might be in trouble...during low oxygen.  Maybe she sleeps on her back and her head tilts forward on one or two pillows (what's with women and pillows anyway?!?!? My wife is the same.) This supine sleeping causes the most problems across populations of sleep apnea sufferers.  If this turns out to be the case, she needs a soft foam cervical collar, available at department stores and medical supplies outlets, including at the Big Market.