Does anyone else experience waking with rapid heart rate?

[icipher]

Long story short,

--Diagnosed with unexplainable CSA last summer. No other health conditions. During sleep study they noted i have bradycardia while asleep(resting pulse below 60, mine got down to low 40's)
--MRI and Echo-stress test came back normal.
--Been on ASV since fall. AHI averages 1-2 with almost all hypopnea.

What I am experiencing...

I OCCASIONALLY, as in once a month, wake up, tear my mask off, in panic and my heart is beating really fast. This sends me into a bit of a panic which then just amplifies the severity of the event, but after a minute or so my heart settles which then alleviates my panic. I have checked my data the next morning in Encore and see nothing abnormal in my waveforms before i woke up.

When I go to bed i am not anxious and my stress level isn't all that bad. I have had so many tests done on my heart and all come back fine. I get palpitations sometimes and occasionally while awake my heart goes off rhythm for a few seconds, but that's about it.

Anyone else deal with this?

[Julie]

How well are you doing with Cpap - do you track progress on your computer? You need to see what's going on just prior to waking - at least it might help explain things.

[old dude]

Yes, I do.

It's worth pointing out that first I have arial flutter, which was likely caused in large part by untreated sleep apnea. I've had a cardioversion once already, and may have to have an ablation done.

Secondly I'm a long standing acute and chronic anxiety patient, if you'll pardon the redundancy. Had it since age 13 and I'm almost 65. That can also be a cause.

I have also heard it said that this can occur from awakening rapidly from a deep sleep with dreaming.

[icipher]

How well are you doing with Cpap - do you track progress on your computer? You need to see what's going on just prior to waking - at least it might help explain things.

Doing great with CPAP. Most nights I put it on, fall asleep, and wake up 8 hours later feeling OKAY.

I did look at my date prior to the wake up, there was nothing going on.

[icipher]

Yes, I do.

It's worth pointing out that first I have arial flutter, which was likely caused in large part by untreated sleep apnea. I've had a cardioversion once already, and may have to have an ablation done.

Secondly I'm a long standing acute and chronic anxiety patient, if you'll pardon the redundancy. Had it since age 13 and I'm almost 65. That can also be a cause.

I have also heard it said that this can occur from awakening rapidly from a deep sleep with dreaming.

How were you diagnosed with atrial flutter, and what does it feel like?

[LSAT]

Long story short,

--Diagnosed with unexplainable CSA last summer. No other health conditions. During sleep study they noted i have bradycardia while askeep(resting pulse below 60, mine got down to low 40's)
--MRI and Echo-stress test came back normal.
--Been on ASV since fall. AHI averages 1-2 with almost all hypopnea.

What I am experiencing...

I OCCASIONALLY, as in once a month, wake up, tear my mask off, in panic and my heart is beating really fast. This sends me into a bit of a panic which then just amplifies the severity of the event, but after a minute or so my heart settles which then alleviates my panic. I have checked my data the next morning in Encore and see nothing abnormal in my waveforms before i woke up.

When I go to bed i am not anxious and my stress level isn't all that bad. I have had so many tests done on my heart and all come back fine. I get palpitations sometimes and occasionally while awake my heart goes off rhythm for a few seconds, but that's about it.

Anyone else deal with this?

I can relate my personal experience. I have been on CPAP for over 5 years and on occasion I would wake up with what "feels like" a racing heart. The first few times that it happened I panicked. Like you I went to the doctor and had testing done...all normal. I went out and purchased an inexpensive puls ox. When I woke with the racing heart feeling I immediately checked my pulse and it was normal. I then went to my DME and they lent me an overnight puls ox which I wore for 2 nights and everything showed normal. The overnight puls ox also showed that my pulse rate was as low as 45 but never got higher than 88. My cardiologist could not explain it and insists that it is not a racing heart that I was feeling.

[Todzo]

Long story short,

--Diagnosed with unexplainable CSA last summer. No other health conditions. During sleep study they noted i have bradycardia while asleep(resting pulse below 60, mine got down to low 40's)

Next time you see your doctor ask them if your CSA is hypercapnic or hypocapnic.

--MRI and Echo-stress test came back normal.

That is quite a work up.

--Been on ASV since fall. AHI averages 1-2 with almost all hypopnea.

I am gonna bet hypocapnic CSA.

What I am experiencing...

I OCCASIONALLY, as in once a month, wake up, tear my mask off, in panic and my heart is beating really fast. This sends me into a bit of a panic which then just amplifies the severity of the event, but after a minute or so my heart settles which then alleviates my panic.

I have experienced this during times of stress. Specifically near the anniversary of a severe assault and robbery upon my person.

I believe that my issue relates directly to stress adding to my respiratory control loop gain[1,2] which when added to the pressure of CPAP facilitates long term hyperventilation the respiratory effort of which awakens me.

I find that when I wake up doing this eucapnic breathing techniques quiet things down fairly fast (about 90 seconds) and can be done mask on so I can continue sleep.

I have checked my data the next morning in Encore and see nothing abnormal in my waveforms before i woke up.

Wow, not even increased breathing levels?

I think you might do well to obtain a recording pulse oximeter or work with your doctor to obtain a Holter monitor for a time. It would be nice to “catch” one of these incidents with more information available.

When I go to bed i am not anxious and my stress level isn't all that bad. I have had so many tests done on my heart and all come back fine. I get palpitations sometimes and occasionally while awake my heart goes off rhythm for a few seconds, but that's about it.

Anyone else deal with this?

With no changes in breathing I am not sure what I have experienced is what you are experiencing.

[1] Danny J. Eckert, David P. White, Amy S. Jordan, Atul Malhotra, and Andrew Wellman "Defining Phenotypic Causes of Obstructive Sleep Apnea. Identification of Novel Therapeutic Targets", American Journal of Respiratory and Critical Care Medicine, Vol. 188, No. 8 (2013), pp. 996-1004. doi: 10.1164/rccm.201303-0448OC

[2] Sairam Parthasarathy M.D., Emergence of Obstructive Sleep Apnea Phenotyping. From Weak to Strong! American Journal of Respitory and Critical Care Medicine VOL 188 2013
-- critical closing pressure [Pcrit] - Arousal Threshold - ventilatory control Loop gain - and genioglossal Muscle responsiveness. Pcrit, Loop, Arousal, Muscle (PALM)--

[Todzo]

If your CSA is hypercapnic then a leak while using your ASV could be a real problem.

I think I would make checking mask fit every night part of the ritual.

[old dude]

Yes, I do.

It's worth pointing out that first I have arial flutter, which was likely caused in large part by untreated sleep apnea. I've had a cardioversion once already, and may have to have an ablation done.

Secondly I'm a long standing acute and chronic anxiety patient, if you'll pardon the redundancy. Had it since age 13 and I'm almost 65. That can also be a cause.

I have also heard it said that this can occur from awakening rapidly from a deep sleep with dreaming.

How were you diagnosed with atrial flutter, and what does it feel like?

I was taking my BP one morning about a year ago and the meter said my pulse was 188. I felt perfectly fine, nothing abnormal at all so I got another meter out and tried again with the same result. Tried a third time with my pulse ox, again ~190. No feelings of palpitations at all. (Which I have had all my life, including PVCs which I can definitely feel.) Went straight to the ER where I was diagnosed and sent to a cardiologist. Even at a HR of 190-200 I was not short of breath or in any visible distress. Surprised the docs too.

[Rob108]

I've had just about every heart related procedure & test my two cardiologists could think of.
I even had an implanted loop recorder for 2 years. I was initially diagnosed with tachy/Brady arrhythmia, but after the loop recorder "caught" my heart rate going from 70bpm to 240bpm almost instantaneously I had my first ablation procedure. After 2 more ablation procedures I had the loop recorder removed. I still have svt's recorded on my numerous ekg's but haven't passed out since the 2nd ablation procedure. If your heart rate is racing it will be recorded on the Holter monitor and then your pcp & cardiologist can determine what, if anything, needs to be addressed.
My Untreated ahi is 108.5 and my treated ahi is 1 - 3

[The Latinist]

Without being on an EKG when this occurs, it's going to be pretty hard to tell whether this is a panic attack or an arrhythmia. I've experienced something similar off and on for over a decade, but was only diagnosed last spring when I managed to get to the ER before my rhythm spontaneously converted: Supraventricular Tachycardia (SVT), a relatively benign arrhythmia where the ventricle is stimulated to contract twice per heartbeat. My pulmonologist thinks it's possible that my sleep apnea is a trigger, though it's impossible to say for sure. Have you asked your doctor about it?

[HoseCrusher]

You may want to consider buying or borrowing a recording pulse oximeter. A few nights of data may help understand what is going on.

[icipher]

All,

Thank you for your input.

Todzo,

I will check about the hypocapnic thing with my doctor.

I have a pulse ox and have used it occasionally. I see it go down to 92% at the lowest, but only for a short while. Seems to average around 95% while I am asleep.

If I have any arrhythmia, which I pray I do not at my age of 30, i would think it would be tachycardia. My heart doesn't seem to beat off rhythm, mostly just really fast.

[Julie]

Just curious - have you taken any particular meds over a long time, and ever gone off them - with what results?

[icipher]

Just curious - have you taken any particular meds over a long time, and ever gone off them - with what results?

No, no meds. I took antibiotics for a severe case of bacterial pneumonia back in 2012, but that's the only medication I can think of. Other than that I take a multivitamin, fish oil, vitamin D and magnesium.