Can not sleep

I’m 6 days into living with my pacemaker.  It was diagnosed with Bradycardia and sinus node sickness.  I’m an avid cyclist, hiker, swimmer etc so I always have had a very low pulse so definitely a shocker that I need a Pacemaker.  My pulse rate is now set at 60 (prior to pacer night pulse in low 40s).  Last night my heart went crazy and I could not sleep.  It felt like it was racing, pounding would not stop and settle. I need to sleep!



by AgentX86 - 2019-11-13 11:57:50

Tell your EP.  Better, if you have a remote monitor,  it would have been a perfect time to use it. This is why we get them.

After my PM implant,  I had a lot of problems with bigeminal PVCs. My PM wouldn't capture them, so little could be done but once I was able to record them on the remote monitor, they could easily see what was going on and help. There was nothing dangerous but it sure was uncomfortable. They upped my PM to 80bpm, which helped. In time they've all but disappeared. Because, like you, I was used to sleeping with a slow heart rate,they set my night time rate to 50bpm. This risks the bigeminy but it was a good tradeoff. As my heart has become used to being paced,  the problem has gotten better but it's still a good tradeoff.

Anxiety makes PVCs much worse

by crustyg - 2019-11-13 12:12:29

Hi: it's a shock and commonly the mental adjustment takes longer than the physical healing. Having a lower HR of 60 shouldn't feel that different from what you're used to, so as AgentX86 suggests you may be getting a lot of premature beats, which is commonly due to anxiety soon after PM implantation.

There's not a lot of information in your bio: if you have SSS + chronotropic incompetence (== you can't get your HR up to an appropriate level) then you're *probably* not on any medication.  If you have a lot of extra beats it won't be long before someone suggests a beta-blocker which probably won't be great for an athlete like you.

Lying on your left side at night will make it much easier to feel each heartbeat, which you may not have noticed before => you worry => your extra beats get worse.

My BostonSci unit was implanted in May for SSS+brady/incomp as you, and we started on 50/130 (quite a big increase from 38, but much gentler beats as I'm atrial paced), and after tuning on a static bike I'm at 50/160 and cycling up the mountains.  I *wanted* the PM.

It sounds as though you *feel* that the PM was inflicted on you: until you're happy that there are things that you can do now, with the PM, that you couldn't do before, you're not going to relax and get on with your life!

If I've missed the point and there's something else going on, then sing out!

Have the lower rate set to 50

by ar_vin - 2019-11-13 12:44:02

Start with the simplest fix - lower the HR to 50.

I had the same issue; at the one week appointment I had it adjusted down to 50 from 60. It made all the difference.

You've been used to a lower HR at rest and during sleep so the higher rate feels uncomfortable.

If that doesn't work go digging deeper.

Occam is your friend.

six days

by dwelch - 2019-11-14 08:05:07

by six days I wouldnt be expecting to sleep through the night, certainly not able to sleep on the pacer side. It is part of the process and is normal.  

I also had a low resting heart rate in the 40s and in the 30s when sleeping and was bumped to 50 I think on my first device.  It took a while to learn to sleep with a normal heart rate.  It will happen.  But pain from the surgery alone sleeping through the night takes a while, give it a couple of weeks from the pain perspective alone, then it can take weeks or months to learn how to sleep again due to the new heart rate.  

it will definitely happen though.  focus on the bright side.  1) I am alive, and will live much longer 2) I am alive and will live much longer  3) I am alive and will live much longer 4) I have more hours in the day to do stuff, like binge watch all the shows I am behind on.

You have to give this time, some parts of the recovery take days, some parts weeks, and some parts months.  Being an active person, the physical should take less time to happen, but the mental, thats on you, if you fight it it will take longer, if you understand it and go with it it will take less time.  have to let the leads grow into your body, the scar tissue you cannot rush, then at the few week/months visits they can tune the device, ideally by that months later visit getting it dialed in, although as an athlete you might want another few month or 6 month visit if you dont feel they have it.  They are likely not going to lower your lower limit too much, maybe down to 50, talk to them at the few week visit about that.  Really there is no reason for them to do that, these things make us or try to make us normal, so we should all be able to live with normal heart rates like everyone else around us.  difference is we have this step change that happened.  

give it time, work it dont fight it, conquering this is no different than conqeuering an athletic goal, there is a mental and physical challenge to that faster time, bigger hill, longer race.


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