Any Article Or Response Or Crazy Theory

[Jordan5815]

By the pots symptoms I mean the faster heart rate upon standing.......

I've been looking all around the web for that...

If you can find anything towards the hyperadrenergic form of it that would be cool too.

Not really interested in hearing about blood pressure normalizing towards the end of the night and that is why heart rate slows down. More of What chemicals cause the regulation or slight regulation. Because POTS symptoms are worse in the morning then at night time. Again when I'm talking about POTS symptoms I'm not talking about "Episodes" I'm talking about blood pressure rising/falling and heart rate going up upon standing.

[Guest tearose]

Do a search on a thread here called "time of day".

My first sense is fluid volume retention. We become depleted while sleeping and it takes all day to slowly get the fluid in and keep it in. Often those with Hyperadrenergic POTS like me, spend alot of day time voiding. Also, for me, with an additional issue of lymphedema, I can not take high doses of salt to retain the fluids as some others can.

I think it may also be blood volume regulation. With someone who has anemia or an abnormality in their blood cells it would further make it worse. Look at this...http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1501099

I find this an interesting question, I think I will look into it more to. Let me know what you discover.

best regards,

tearose

[firewatcher]

John,

Also look into Circadian Rhythms. Most heart attacks happen in the morning, due to Circadian factors. When you have dysautonomia, it screws with your circadian rhythms. You may be a night owl to begin with, so your circadian clock is out of whack already (like I am.) Some of us, if we are allowed to keep our own schedules (not what society says, ie. 9-5) do not have such extreme POTS symptoms. If I can sleep when I want, and wake when I want, I am not as fatigued and the HR does not spike like it does at 6:30 in the morning. Good luck!

[ajw4790]

I don't know of any evidence, but I too feel better at night. I think Circadian Rhythm is part of it, along with decreased temp. and humidity at night. Blood and fluid volume is also likely part of it. I have always been a night owl. Interesting to know if there is much evidence.

[Jordan5815]

I don't know of any evidence, but I too feel better at night. I think Circadian Rhythm is part of it, along with decreased temp. and humidity at night. Blood and fluid volume is also likely part of it. I have always been a night owl. Interesting to know if there is much evidence.

I'm up at night time more then I am during the day, my schedule is so out of whack that is does not matter what time i wake up it's how long I've been up..... After being up for a while my symptoms go away...... The fluid I think holds more weight then the other but I just may be tired right now since I woke up at 9pm and am now righting this. lol.

Definately want to know more theories as crazy as they sound does not matter to me......

[yogini]

I agree with tearose. You don't drink anything all night and wind up losing fluids. You start drinking in the morning and at some point the fluid builds up and increases your blood volume.

[jump]

I'm sure fluid is a big part of it, but I don't think it's the whole picture. I wake up every 1-2 hours because of polyuria, and for a while I experimented with drinking a lot of water every time I woke up to see if I would feel better in the morning, and even drinking all through the night didn't seem to help with my morning symptoms.

Also, I've found that if I go to bed at 9 pm and wake up at 6 am, I feel just as sick as if I went to bed at 1 am and got up at 6; whereas if I go to bed at 3 am and wake up at 10 am I feel much much better than either 6-am scenerio. In other words, the hour that I get out of bed seems to affect my symptoms more than the total hours of sleep I get.

I find it all very mysterious.

jump

[Katja]

I haven't had a chance to watch it, but here's a link that may be interesting:

"Morning heart rate surge in postural tachycardia syndrome" (audio/video presentation)

http://www.scienceondemand.org/sessions200...archQ=undefined

[pat57]

So we conclude from this that orthostatic tachycardia is greater in the morning than in the evening and that this is a generalized physiologic phenomenon, but one that is exaggerated in our pace group of patients with postural tachycardia syndrome. There are several possible reasons for this diurnal variability. One explanation is that blood volume may rightly be lower in the morning.

We do not have data to support that, but certainly the morning assessments were done with patients who were NPO and so they had gone several hours without consuming any liquid. I do not know that the evening, the patients, you know, consume much liquid in the evening, but I can only assume that they ate supper and drank fluid at that time.Other possibilities though include circadian variability in one of many central regulatory neurohormones.

Specifically, we found that there are two times as many positive diagnoses of POTS based on heart rate criterion alone, in the morning as compared with the evening.

the above is some of the transcript

http://www.scienceondemand.org/sessions200...archQ=undefined

[mom4cem]

All I know is that when I wake up in the morning, no matter what time, as soon as I get up my hr is way up. If I get up in the middle of the night, say after going to bed at 11:00 and I get up at 1:00 or 2:00 for the bathroom, my heartrate goes way up and I have a heck of a time getting it back down so I can get back to sleep!

[Kathy_Ireland]

I have always noticed that I felt much better at night than in the morning...at around 6pm things tend to start looking up a little bit for me symptom wise. I've always presumd it's to do with blood volume too and sometimes wondered if it's related to the fact that I eat a meal with alot of salt at around 5pm whereas my salt intake is less earlier in the day. That said I find I have more palpitations etc if I eat a meal at all earlier in the day so maybe that theory is just potty as opposed to POTSy!

I was just reading the health section of Time and came across an article explaining the frequency of morning heart attacks. While it doesn't address our issues at all it does give some insight into how the heart functions in the morning as opposed to the evening so it might of interest to you . Of most interest to me was a part that said that cortisol and catacholomine production peak in the morning. Perhaps that may go somewhere to explaining our increased symptoms. Also the article states that during REM(dream time) sleep the autonomic nervous system goes through a large peak of activity, even more than when we are awake. During very active dreams in which you're running your heart apparently behaves like it is running! (That would explain why I'm usually so wrecked in the morning! )Maybe we have a harder time than others shutting this response down.

That may be of no interest to ye but I thought I'd share anyway.At least the fact that it happens with so many of us means we aren't crazy .There must be a reason for it out there somewhere.

Here is the link to the article: http://www.time.com/time/health/article/0,...-full-healthsci

This is the most insightful excert from our perspective :

The cardiovascular system follows a daily pattern that is oscillatory in nature: most cardiovascular functions exhibit circadian changes (circadian is from the Latin circa and diem, meaning "about one day"). Now, a heart attack depends on the imbalance between increased myocardial oxygen demand (i.e., a greater need for oxygen in your heart) and decreased myocardial oxygen supply - or both. And unfortunately, some functions in the first hours of the day require more myocardial oxygen support: waking and commencing physical activities, the peak of the adrenal hormone cortisol [which boosts blood-pressure and blood-sugar levels] and a further increase in blood pressure and heart rate due to catecholamines (adrenaline and noradrenaline), which show a peak when you wake up. All those factors lead to an increase of oxygen consumption but at the same time contribute to the constriction of vessels. So you have reduced vessel size and reduced blood flow to the coronary vessels.

[runningshoe]

I can do anything in the am. I am a mess at night. Go figure!

[Sunfish]

another "me too" to mornings being my worst...to the extent that they usually don't exist. and no matter when i wake up - even if it's 2pm - i need at least an hour (and often more) to "wake up", though that's at least partially related to waiting for my meds to kick in (esp. midodrine). i haven't always had rough mornings though post-diagnosis. when i was still able to school, work, etc. i needed to wait for my meds to kick in (30-45 minutes) but otherwise was just as much a morning person as evening. i actually rowed in college which included 5am practices! now - activity fatigue excluded - i feel better & better as the day progresses. if i push to do something the feeling better fights with my crashing from activity but my baseline, so to speak, improves as the day goes on.

but...back to now. for what it's worth i can sort of debunk the fluid/ dehydration theory, at least for me. my fluid intake is just as great throughout the night as it is during the day as i'm entirely dependent on IV hydration/ nutrition. my IVs run 22 hours a day, including overnight, but my "mornings" (often technically afternoons) are still really rough. that's not to say i don't have other times that can be equally bad, but mornings are pretty much a guarantee. or more accurately the first few hours after i wake up is not pleasant no matter what the clock says. this only seems to be true though if i've slept a full "night" as i don't have trouble after a nap. oddly enough i feel better - at least for the morning hours - if i don't sleep at all than if i sleep well all night. i obviously can't do that on a sustained basis (not more than one night) but it's strange. i do have sleep apnea but it is sufficiently being treated with a BiPAP that i use faithfully (can't sleep without it!)

so...bottom line is that i have no clue what the "why" is for me. i used to jokingly comment that i'd feel great in the mornings "if only" i could hook up to bag of saline overnight. now that i have that (be careful what you wish for!) it doesn't seem to make one bit of difference. so who knows....i still think that fluid balance is likely to play a role for at least some people.

all in all though - while i know there are some exceptions - morning struggles seem to be a common phenomenon amongst dysautonomia folks of all types/ diagnoses, severities, etc.

melissa

[jesse1919]

Me too. I'm a zombie in the morning and start to feel better at night. My pulse goes down and the difference between systolic and diastolic increases (meaning stroke volume goes up I suppose). I feel warmer and my veins on my hands stick out more. And my appetite increases too. I have a very hard time staying on a "normal" schedule because I feel most awake right before I'm supposed to go to bed. I don't sleep deeply during the last couple hours of sleep and dream a lot then.

Like Sunfish I also noticed that if I do NOT sleep a full night I feel less fatigued later that day but the next day I naturally sleep extra and then feel especially crummy. My theory about this is that one's brain naturally raises our "excitation level" (some hormone level) during the day and reduces it at night. If a normal person this works well: they are in "low" excitation at night and "medium" during the day and they only get to a "high" state for a short time if fight or flight response is triggered. In POTS (well some anyway) our bodies are always overexcited. So at night we're in "medium" and during the day we're in "high". Our amplifier gain is too high. So if a normal person sleeps more the brain "rewards" them by allowing a little higher excitation level and the person has more energy. In POTS this backfires. Our brain unwittingly pushes our excitation even higher making tachy and fatigue worse. The reward turns into punishment.

I think for me this has nothing to do with fluids or blood volume. I noticed I felt better at night before I got diagnosed. My blood volume is normal and I don't bother with salt/ fluid loading because it doesn't seem to make me feel better.

I liked the Vanderbilt presentation. It's good to see that someone has realized the significance of time of day... but on the other hand I'm sure patients have been telling their doctors this for years without any research being done and he presented it as if they discovered this.

I actually feel better standing at night than laying down during the day. So I really don't have POTS... I have DOTS: Diurnal Orthostatic Tachycardia Syndrome

[starry16]

Hi all!

When I have a flare up I notice that I am often woken up in the morning (at an hour before when I normally wake up) by a high heart rate/pounding heart (nothing crazy - usually in the high 80's or 90's, but way above my resting, which is in the low 60's), even though I've been laying down for 7-8 hours. Does anyone else get this? It makes no sense to me...unless it has to do with catecholamine peaks at that hour, as someone above mentioned. Very odd, and very uncomfortable, especially because high HR's ALWAYS come with PVC's for me...ugh.

[scarfgirl]

Katja, thanks for that link! I'm having a stupid day today, but my DH is reviewing the presentation for me right now.

[Katja]

you're welcome! I'm glad you found it interesting .

[goldicedance]

The study might have been more interesting if they measured fluid output the night before the study started. I know many of us have trouble retaining fluids at night--i.e., loads of trips to the bathroom.

What do you all think:

Thanks for sharing the link!

Lois