Still sleepy

I've been going over some old posts about fatigue & have come to the conclusion that my extreme sleepiness is related to medication. I say this because the other major cause seems to be arrhythmia, and my last remote report showed 0% afib & no unusual incidents at all. When I say extreme sleepiness I mean I can get out of bed at 9 & be ready for a 2-hour nap by 11, then go through the rest of the day craving even more sleep! I found out that metoprolol (I take 50mg x 2) and other beta blockers have the nickname "slug drug", and boy, did that hit home! It was suggested that a lower dose might be helpful, but I was taking half the amount & still having some afib. Now I'm wondering if it was better to put up with occasional arrhythmia & not be so tired?  Some folks said taking their beta blocker at night helped a bit, but mine is taken twice a day--could I take the full amont all at once in the evening? I have a dr visit coming in March, but I'm interested in hearing others' experiences with the slug drug :)   Of course, I would never make medication changes without checking with my doctor!




by AgentX86 - 2021-12-15 14:07:17

I'd not heard the term "slug drug" before but it's fitting.

Talk to your doctor. People react differently to metoprolol.  It dosn't affect me too badly, though 200 mg was getting to me.  I'm on 25/25 now without problems. There are other beta blockers that may not affect you so badly.  There are also calcium channel blockers that may work just as well.  Talk to your doctor, there has to be an alternative that won't make you a zombie.



by MinimeJer05 - 2021-12-15 15:39:40


I find it interesting that you are taking 50mg x2 of the Metoprolol as that is what I am taking too! I take 50mg at 6:30ish am and one at 6pm. I also take Amlidopine Besylate, which I think is a beta blocker (it does something to my BP).

I would say that I am generally a little tired during the day and I find myself wanting to go to bed pretty early, but I also think it's my lack of activity (I've been having issues that are keeping me from exercising at my gym and essentially driving I have started to adapt to the "lazy" life). But I wouldn't think about taking a nap during the day or anything like that.

You are smart to consult the doctors to see if there are ways to move around the medication. I've been told that there are different forms of the same meds that have different release schedules (slowly over day, all up front, etc) -- maybe that will come into play?

I'm not sure if your arrhythmia's are bad enough to warrant changing the meds vs being sleepy all the time. I am still learning about what those are and can't comment.

Of course, we are all different and different conditions and meds effect us all in our own way.

I hope that you find your balance and what works for YOU very soon.

Take care


A price too high?

by Gemita - 2021-12-15 16:07:39

Dear TLee,

It seems to me that you are paying too high a price to keep AFib at bay.  AFib needs to be controlled only and you have complete control now and should be able to gently look at reducing some of your meds.  

I have always believed and I continue to believe that immediately following your implant your heart reacted adversely to the trauma of the procedure (as indeed did mine).  This was when you needed maximum control with medication to calm your AFib.  I believe now that your AFib has settled, you are no longer in need of high dosages of meds.  In fact if they are causing your fatigue and preventing you from living normally, this will be detrimental to your well being in the long run.

Of course there are other reasons for chronic fatigue so severe that it prevents us from living normally and my question to you is have you had a few checks on your general health to see whether there might be a related cause?  Have you for example had Covid and could this be long Covid symptoms, or is there evidence of any infection, anaemia, auto immune condition, thyroid condition.  In other words, have you had a word with your general doctor for some blood checks?  They can also check liver and renal function and check whether blood levels of any of your meds are perhaps building up and not being adequately cleared.  There are so many possibilities TLee.

The slug drug?  Oh yes, I am on a slug drug called Bisoprolol, which is also a “cardio selective” beta blocker like Metoprolol which at low doses should only target the heart.  Perhaps your dose of Metoprolol is too high and targets other organs and so you will be prone to more side effects.   Bisoprolol at a low dose does not cause any problems at all for me and in fact the low dose keeps my arrhythmias at bay and when they do occur, they are short lived and the heart rate is well controlled.  What more could I wish?    Maybe a change in beta blocker is all that you need or as AgentX86 suggests, a Calcium Channel Blocker can be tried instead.  But you need to fight back, since you don't have to live this way.  By the way my EP said I can take my beta blocker morning or night in one dose.  I find taking it with lunch suits me best and I have got it down to half a dose without any ill effect.  In fact I found the more meds I took, the worse my arrhythmias.  It really is trial and error as we have always said


by Gemita - 2021-12-15 16:39:17

Amlodipine is a Calcium Channel Blocker used to control both BP and heart rate

LOL "Slug Drug"....

by Marybird - 2021-12-15 17:01:03

I know it well. I have taken metoprolol for many years to control my heart rate ( long history of SVT) and know well of the sleepiness, or lightheadedness the drug can cause. Fortunately for me it seems the side effects have worn off over the years.

Currently I take 75 mg metoprolol twice a day ( total 150 mg) along with 180 mg diltiazem ( total of 360 mg/day) twice a day to control the heart rate ( diagnosed with afib about 8 months ago) and high blood pressure. I still get breakthrough episodes of afib, but find for me the combination of the beta blocker and calcium channel blocker seem to work better together than each does separately to minimize those breakthrough afib episodes. 

I don't feel tired after the morning meds anymore- in fact often feel better as those breakthrough episodes tend to occur as its time to take the next dose of meds, but I often start feeling tired in the late afternoons or early evening.  And the PM doses ( which also include losartan not taken in the AM) of the meds pretty much wipe me out, but at bedtime that's a plus.

TLee, I guess like you I'd be tempted to see about cutting back on your beta blocker with the side effects you describe, and thinking maybe your afib is kept at bay, but unfortunately ( as you already know), that's a trial and error type thing till you hit on a combination that works for you. I think in your shoes, though, I'd explore your options with you doctor for different dosages, different drugs,,whatever is out there, and as Gemita suggested, maybe checking out other medical reasons for your tiredness, because like you I wouldn't want to live that way. Anyway, I wish you the best with this and hope you can find something that's able to beat back your afib with a minimim of side effects.

Jer, I just wanted to mention that Amlodipine is a calcium channel blocker, in the same category as diltiazem. Amlodipine is generally prescribed to control high blood pressure ( as diltiazem is also), but I'd guess it can be used to control the heart rate when that is indicated? 

Thanks for Clarification

by MinimeJer05 - 2021-12-15 17:26:01

Gemita & Marybird -- Thanks for the clarification on Amlodipine -- it probably sounds terrible that I don't even fully understand what the drugs even do to me, but I always just assumed that the doctors know what's best and give me what "I need". They didn't really explain the Amlodipine that much when they gave it, they just said it would help with lowering the blood pressure. I wasn't sure what the differences between that and Metoprolol (which is also something I've been taking ever since I got my mechanical valve installed). I was also once on Lisinopril, but stopped that probably 6 months after the valve surgery. 

I never knew if I would always need metoprolol, but I am going to assume yes since I now have the PM in addition to the valve.

Sorry to side-track the convo, but wanted to thank you two for the clarification (and for making me Google the difference between beta blockers and calcium channel blockers).




by Gemita - 2021-12-15 19:54:56

Don’t worry, I was just the same.  I couldn’t take everything in at first and always came away with more questions than answers.

All those meds:  Lisinopril (Ace Inhibitor), Metoprolol (Beta Blocker) and Amlodipine (Calcium Channel Blocker) are used to lower BP, heart rate and to support the heart.  The problem is that once we start certain heart meds, we may end up staying on them for long periods or indefinitely unless we ask specifically whether we still need all of them.  At least that has been my experience, although we cannot play around with heart meds and stopping them suddenly can be dangerous.  

The Metoprolol can be used to treat anxiety as well as for controlling BP and heart rate.  It can also be used to calm down an arrhythmia, help with chest pain and heart failure.  You could ask specifically why you are on it when you have Amlodipine to control your blood pressure?  However often two meds work more effectively “together” than one alone, but still a good question to ask your cardiologist/EP when you see him in a few days.


by AgentX86 - 2021-12-15 23:19:48


Just as a reference, drugs ending in 'olol' are beta blockers. I don't know of any beta blockers that don't (but there may be).

Metoprolol settles the nervous system.  It's often used by snipers to steady their hands. Beta blockers are a banned substance from several Olympic sports, including shooting events.

Bang bang

by Griddlebone - 2021-12-16 05:19:48

These forums are a font of learning. If I decide to become a sniper, I'll be sure to remember the metoprolol, ha!

No chance of me making the Olympics........

sleepy all day

by new to pace.... - 2021-12-16 11:25:41

I found i had that problem after eating Bananas . Once i stopped eating them that problem went away.  Became a morning person.  Of course also have that sleepiness after eating wheat, beans, chia seeds, almonds. Of course there is turkey.   You might get tested to see if you have allergies or food sensitives.  I used the  ALCAt test, which you have to pay for.

new to pace

Carb loading is a known cause of sleepiness

by crustyg - 2021-12-16 12:38:14

IIRC, the mechanism is significant carbohydrate intake (e.g bananas) => provokes insulin secretion => provokes serotonin production in brain => sleepiness.  Lots of bread or pasta will also do it, but not slow release carbs like porridge oats.

It seems to be *much* more of an issue for those who already score highly on the Epworth sleepiness score.

Daytime sleepiness is a complex area...


by AgentX86 - 2021-12-16 14:01:28

Daytime sleepiness can also be explained by a lack of sleep at night.  ;-) Seriously, sleep apnea can be a cause, as well as a number of other sleep disturbances.

In my case, I'm a night person and unless I have to get up for work the next day, I'll stay up very late.  I still have to force myself to go to bed.  I also walk all morning before breakfast (noonish).  I know that I don't get enough sleep.  I do eat a lot of carbs (walking for three hours makes one crave carbs), so there may be something there too.

Interestingly, using the computer makes me very sleepy.  I often drift off while typing here, even.

Are we any closer to a diagnosis I wonder ?

by Gemita - 2021-12-16 14:50:54

Well to get onto the subject of sleep TLee, may I ask whether you sleep well at night.  I mean do you sleep through the night or is your sleep broken?  It clearly isn’t restorative because you want to nap during the day.  Sleep hygiene is very important.  The more we nap during the day, the less likely we will sleep well at night.  

Beta blockers are renowned for upsetting sleep, since they can decrease melatonin levels, the sleep hormone.  Google beta blockers and sleep.  Beta blockers may also cause nightmares.  Is your sleep disrupted TLee or are you sleeping soundly, deeply during the night?  Maybe an in hospital sleep study can determine this?

And going to bed and getting up at the same time is important too.   But if you sleep well all the time and still want more, could this be something like Chronic Fatigue Syndrome caused by a virus or something like this?  That is the other possibility.  Or perhaps you are still suffering from the trauma of going through pacemaker surgery, having to deal with AF and the treatment for AF.  It certainly exhausted me.  You need to get down to your doctor for a nice long chat in my opinion to see what is going on.  It is miserable feeling tired all the time and it will quickly become worse unless it can be controlled.  

More info

by TLee - 2021-12-16 18:57:45

I'm enjoying the discussion--I didn't realize that so many things can cause sleepiness. It is certainly a difficult thing to deal with but it may be equally difficult to get answers. Especially for me, because:

I have been diagnosed with fairly mild sleep apnea & rejected sleeping strapped into a CPAP mask. This displeased my pulmonologist, but she did convince me to at least use O2 at night, as my levels occasionally dropped pretty signifacantly. I want to say that I do sleep better, as I no longer wake up gasping for air. I can't even tell that I have the nasal cannula in place, sometimes reaching to put it on when it is already there(!) so it is no bother.

My last blood work 6 months ago showed a vitamin B12 deficiency, while everything else looked fine. I have been taking the supplement since.

I take Cymbalta for both mild depression and arthritis pain. Drowsiness is listed as a side effect, but I've been told that it is normally temporary & could not be causing problems after this long--not sure how true that actually is though. Oh, and either it has lost some of its pain relieving effect or my hips & back have gotten worse, because the pain is pretty awful. Now that probably does interrupt my sleep somewhat.

I try to eat a balanced diet & I don't splurge on carbs too much. I do have 2 cups of coffee in the morning, no caffiene after around 11am. I also get fresh air & exercise by walking most every day for about an hour., 

I have an appointment with my primary next week, probably for more blood work & I'll discuss my other (pain) issues with him. Then in March, when I see my cardiologist, I will probably ask about a lower dose of metoprolol. If memory serves, I felt better when I was started on half my current dose. In fact, I was surprised to be told that I needed to increase it. It seems that my doctors are of the opinion that any afib at all is not acceptable. I wish I knew why, so maybe I'll ask! Time to get more involved in my own care. For an ironic twist, I remember I often warned my elderly mother about just blindly doing whatever her doctor told her to do. Uh-huh.

Blindly doing...

by AgentX86 - 2021-12-17 14:49:48

Lol! So true. That's why we need to understand what they're doing to us and why.

Afib:  If you don't care about Afib, I don't see why your cardiologist should, assuming rate control and anticoagulation.  He can see any tachycardia on your pacemaker record which could be the reason for his concern of Afib and metoptolol (rate control).

Otherwise, "any Afib" is only a quality of life issue. Mind-over-matter (if you don't mind, it doesn't matter).  Many asymptomatic people go through life in AF.

That's what I thought

by TLee - 2021-12-20 20:02:55

I remember asking about living with afib way back when all I'd experienced was a failed cardioversion & an ablation (also not effective). I sort of felt that maybe this was my new normal & I could just deal with it--just like it said in the pamphlet that I was handed at some point, the one with all the smiling, active people with afib! My cardiologist told me that I was "too young" to think that way, which I kind of understood to mean it could either severely limit or shorten my next 20 years or so. Now I wonder if it was more that it was a challenge to him--it wasn't that he didn't want ME to give up, but that HE didn't want to give up. I'll have a bit more of a discussion with him when I see him in March.

I did see my primary care dr today, and he has suggested vitamin B12 injections for 6 mos or so, to see if they do more for me than the oral supplement. It would sure be nice if that is the answer to a lot of my fatigue. He also made me an appointment to see the orthopedist about my worsening arthritis pain, hoping they can help me feel better overall. Just a note: I use a clinic that uses med school residents as primary care physicians, and I find them to be enthusiastic & thorough--highly recommend!  

What to do about AF

by Gemita - 2021-12-21 06:09:09

TLee yes I agree, for some of us to go down the route of hitting our AF into total submission (impossible in my opinion) may come at an extremely heavy cost to our general well being, which can often worsen our AF rather than improve.  If only we could all get to the root cause of our AF that would make all the difference to how we would treat it.  But as we know, AF is usually the result of many health conditions, trauma, lifestyle and stresses in life, so that is why it is easier to treat the symptoms and risks of AF rather than to look for the cause.  

I can remember when my cardiologist first told me I had had a 3 hour episode of AF, hitting a maximum heart rate of over 200 bpm, I was shocked, although not unaware of the episode since I was symptomatic at the time.  But even so, they didn’t want to rush in with an ablation or anti arrhythmic meds immediately, preferring instead a gentle beta blocker and anticoagulation.  It was a good start for me and my pacemaker was the ideal treatment too for the bradycardia part of my Sick Sinus Syndrome (tachy/brady + syncope).  I wonder what would have happened if I had treated my AF more aggressively at that time?  Perhaps I would have been in a worse position now?

I hope your fatigue can be treated and don't forget to also discuss your need for Apixaban when you see your cardiologist.  Although generally well tolerated and one of the best, Apixaban caused some joint pain for me and gastric distress so I switched to low dose Edoxaban because of low body weight (under 60 kgs).

b-12 and etc

by new to pace.... - 2021-12-26 19:42:28

I also take B-12 shots about every 6 weeks.  does perk me up some.

You might try Accupucnture  for your tiredness.

When you see the orthopedist you might ask about Osteprosis  and get a bone denisty test.

I've gone fromOstepiana to full Osteroprosis.  Now taking supplements suggested by my accupucnutrist. to Grow bone.  Giving me some energy.

new to pace


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I am 100% pacemaker dependant and have been all my life. I try not to think about how a little metal box keeps me alive - it would drive me crazy. So I lead a very active life.