is there a source for programs.

I hope someone can advise me. I have a Medtronic adapta pacemaker installed December 11, 2012. I was having a problem sleeping and so a few days ago they programmed the sleep mode. I don't know the technical name, something like hysterical which I am beginning to be after many failed attempts on various sites especially the many medtronic sites. Don't they want you to know? My understanding, mainly from reading posts on this site is that the PM would be set at 11:30pm (my choice for bedtime) to adapt my heartbeat by whatever means to 50BPM and keep it at that rate until 8:30 am, my wakeup time. If I am correct in my assumptions, it sure ain't doing that! I wake up during the night with a much higher rate than that. At midnight, my HR was going so fast I couldn't count beats. Again I am going to assume that was the self check function happening. And nowhere except here can I get confirmation that this indeed exists. First night after mode turned on, it didn't happen but perhaps because it had already been checked that day during interrogation. I know I can wait a few days and see what happens but regardless, I sure would like to know the answers. Many thanks for any help you might be able to give me,

4 Comments

Sorry, it does NOT exist!

by donr - 2013-01-25 09:01:51

You said you want your PM to KEEP your HR at 50 BPM all night. That implies that you expect your PM to act as a brake, as well as an accelerator. The PM has NO capability to act as a brake pedal on HR. The 50 BPM is a MINIMUM below which it will not permit your heart to drop. If, for some reason, your heart's natural pace controlling feature (the sinus node) increases the HR, the PM just follows along w/ it.

Unless you were having a bad dream that increased your HR & woke you up, you have no way of telling why your HR increases while you are asleep. The self check feature does not run your HR up to a speed that is so fast that you cannot count the beats - it might get to about 100 BPM, but that does not fall into the fast category you mentioned.

Hope this helped. More questions, ask away.

Don

I'm asking away!

by magenniskeith - 2013-01-26 10:01:54

Thank you so much Don. Yes I did expect the PM to control the fast heartrate. So then if I have a consistently high HR when asleep, the doubling of the atenolol is the means by which that rate would be slowed down? It is discouraging when I read about so many people feeling so great after having their PM installed and then I realize I actually feel worse. My HR when sleeping would go to low 30s and have pauses but I didn't know it. During the day I felt fine but would get winded and tired climbing stairs or hills or carrying groceries but chores around the house, watching tv or reading I felt fine. The Holter was put on to see why that was happening there, and the sleep bradychardia was discovered. Now when I am watching TV or shopping. I just don't feel right. The only time I feel decent is when I am doing household chores. Do you think that a setting of the rate control or lowest rate is too high or low. I am sorry but the only numbers I remember are 50, 90 and 110. Don't know to what function each is attached. The medtronic person who put in the sleep mode said that it I was not feeling better, she would turn off rate response. I am at the point where I would just like that lower limit thingamajiggy activated and go back to where I was and not climb hills and take elevators and order groceries delivered. I know I am not giving you much to work with but I truly feel crazed, that there is something that might be tweaked or tried that would allow me to feel as good as you and so many others. Thank you from the bottom of my paced heart. Don't know where you are or how young you are but I am an 82 year old Californian transplanted from Boston.Would you believe, I truly feel better right now because I just have a feeling you will be able to help.

WOW

by magenniskeith - 2013-01-29 04:01:06

Now to print this out and study it in between studying for written drivers renewal license, reading The Paris Wife for bookclub and watching NBA games. You see I am mentally active, not so much physically. So much pacemaker wisdom! The rate response was something I requested because prior to PM, HR would not increase on hill climbing etc making me fatigued.Will definitely check out HR when watching TV, but not a Lakers game. Too much adrenalin flows whether they are winning or losing.
You had said if the HR is high during sleep, the PM will not lower it and maybe a bad dream caused it. I believe that and too I firmly believe that digestive upset causes it. I have a tortuous upper colon and I believe that when food is attempting to make its way through that either the effort or contact makes the heart beat faster. My cardiologist and my blessed GP have not heard of this but I know we are all unique and if I have taken note of this over the years, I believe it is so. What is that saying about horses and zebras? The nights I have slept well since PM, no digestive problems. I know maybe the fast HR causes it but I don't think so.
Please keep in touch. You are delightful. And I have scoffed about the social media craze talking over the world, but this is different, we are a pacemaker club.

Wow! That's a Bookfull!

by donr - 2013-01-29 11:01:32

Second try - had three long paragraphs written & they were suddenly erased by the computer!

Sorry I have taken so long to get back to you.

Last question first - it's the easiest. I'm 76 & live in the foothills of North GA, about 60 miles from Atlanta. I've had my PM since Feb 2003 - ten yrs next week. You are not alone - at 82, there are 2 or 3 of your age group in the population. ElectricFrank is the most prominent.

First question: Yes, the only way to slow the HR is via drugs & Atenolol is a Beta Blocker & can slow the HR, in addition to lowering BP. The Beta Blockers create an artificial Bradycardia that is then corrected for by your PM. In your case, they hopefully reduce your HR 24 hrs per day, then run your heart at TWO different BASE rates - one for your waking hours & another for your bedtime hours. The bedtime base rate will naturally be slower than the daytime rate.

Actually, I'm kinda surprised that they doubled the Atenolol. Since you have a natural Brady while asleep, it seems to me all they would have to do is take advantage of that & give you a lower base rate for sleeping hours, since you naturally had a slower HR while asleep. Perhaps you did NOT have the sleep Brady often enough to use that option. The PM would have taken care of the pauses in heart beat. Also, they may have programmed your daytime rate higher than you could comfortably tolerate while sleeping.

At this point, DO NOT get discouraged! A LOT of us take some PM setting tweaking before we lapse into PM heaven, feeling like new people.

Your description of problems w/ daytime activities tells me you really do need the PM! Although, the cause of your daytime problems may be incorrectly diagnosed. You obviously have a problem w/ heart output under heavier physical activity - like climbing stairs & lugging groceries. Yet - just puttering round, you felt fine. Your heart was able to supply oxygen to your body under lower activity levels.

From your description it sounds like your daytime base rate & upper limit rates may be set WRONG! Here's why. You say that while shopping & choring around (New term - I just made it up) you feel fine, yet while watching TV you feel poor. With a base rate TOO HIGH, you would be taken care of under light/medium activity because the body NEEDS the greater rate to sustain itself. But sid down & now the heart runs faster than you need it to run & you feel a sense of anxiety/urgency of unknown origin, making you feel like you want to climb the walls to swat flies. You are restless & fidgety. (This is a guess on my part - I went through exactly such a situation about 3 weeks post op.)

I'm not sure of the three numbers you mentioned. The 50 sounds like a base rate, MOST likely your daytime base. The sleep function would be another number, perhaps not even mentioned. 90 is far too low for an upper limit. 110is likewise too low. Good grief - I hover around 115 during any exertion at all. My upper limit is set at 130 BPM.

I'll bet that if you ask, they'll tell you that the 110 is, indeed, your upper limit. I think you are a woman fro your description of your lifestyle. At 82, the cretins who adjust your PM settings may well not want to believe that you need a higher setting for the upper limit, & intentionally set it at 110, not thinking that you may need a higher limit because you are active more than the average 82 yr old bear. You need to challenge them on this point.

At least the Medtronics lady gave you an opening for further change - take her up on it. Ask he specifically what each of your settings is. BTW - the Rate Response function is a little thingy in the PM that senses movement of your body, assumes that you need more HR & gives it to you. That function is only needed IF your heart rate does NOT increase under the load of increased activity. You need to ask them WHY they turned it on. Its level of sensitivity is also adjustable. Here's where you have to help out. Next time you are sitting watching TV, check your pulse & see what it is. Is it way higher than your base rate? If so, that could cause you to feel bad? That's an indication that your base rate is incorrect or the Rate Response is mal-functioning.

I'll also tell you this - the mental aspects of PM hosting are extremely important. If you have hope, you will feel better - despair will drive you into feeling lousy.

We are here to give hope.

Don

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