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Does anyone else have their heart rate suddenly drop from 110 to 60 ?? Then back up? This has been happening on my Apple Watch often and I am concerned.. 

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Erratic pulse unfortunately comes with the territory of dysautonomia. Mine can be fine, then suddenly 140bpm, then back down to 60bpm, or sometimes, too, bradycardia. 

I'm really sorry you're experiencing this. 

Do you have a good cardiologist you can consult?

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Electrical signals can interfere with the measurement so sometimes there are blips.  Or maybe you sat down for a sec?  Do you remember what you were doing?

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@Outaker I used to spend a lot of time in the ER due to dysautonomia and whenever I was hooked up to the monitor my HR would go up and down like that, with me just laying there. Of course it would soar if I had to get up to the bathroom. 

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It could also be an arrhythmia. My HR graph would look like that when I was in Afib. Do you have a model of Apple Watch that will detect arrhythmias? I use a Kardia Mobile to check if I detect a wonky HR.

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I glanced at this post after doing a search and wondered how did one of my graphs get in this forum before my first post 🙂 I have data from Apple Watch 3 & 4  Watch heart rate data output is difficult to use. Cardiogram is useful but I find the data clearer using the Viatom software as represented in the image I attached. The Viatom products are licensed as class ll medical devices. Follow-up health care after an ER visit and charts from the Sleep U monitor have gotten me 3 Dr appointments. First they look at the outlier and say it's an artifact or slipped sensor. And maybe some of them are. But I keep seeing this type of data. Depending on the view, the data with the SleepU/Viatom software shows data at 1 or 4 second intervals. The Apple watch may record continuously or when it feels like it or approximately every 4 minutes.  On occasion I can correlate the data from my watch with the SleepU monitor. And on occasion I notice a sudden onset of fatigue that correlates with a drop in HR. I don't know what to do now. I had a follow-up with a cardiologist this week. I wore a Zio Patch cardiac monitor for 2 weeks being told and thinking it would give me some clinically validated data. Not only is the visual form of the data given to me averaged over 20 minute intervals, but based on the hours mentioned for the test, they removed 3 hours of data they labeled artifacts.  I have serious quality of life issues I am trying to address.  I know the HR variations may be a symptom of something else. The Dr I saw this week even suggested that I might see another Dr. But I don't know who or where? So to conclude, your HR drop from 110 to 60 may or may not be something 🙂

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I have both an Apple Watch 4 and Samsung Galaxy 2. Sometimes I wear both (I’m a nerd who likes data). I’ve checked data against a pulse ox too. They all tend to give similar results.

The big difference is that Samsung will record every second if you want it to, and is therefore better at figuring out if a particular reading is an outlier. The Apple Watch records every 10 minutes to save battery.  The data look similar, but there is less variability on the Apple Watch, as it tries to exclude data unless you’re exercising or resting. My horizontal exercises don’t seem to fit Apples expectations, so it only records when I’m not moving at all.

I have noticed all devices (pulse ox included) occasionally not adjusting properly when my HR is really fast. It will sometimes register every other beat. So, 150 bpm becomes 75 bmp. It only ever lasts for a few minutes.

Note: the ecg on the Apple Watch 4 says “inconclusive” if my heart rate is over 100 bpm, and will say error if my hr is over 120 bpm. I don’t think it can handle fast heart rates. 

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I bought my SleepU sensor because I want to track my O2 during air travel. After purchase I wore it to see what the data looks like, how to download it, etc. Right away I started seeing these transient sudden drops in O2 and HR.  And that brought up my question wondering if drops in HR are related to sudden episodes of unexplained fatigue. 

I'm trying to understand what artifact means. I know some of my readings are from a loose sensor as I do adjust it on my body, change placement, etc. The following screen grab describes some artifacts. I have one event I caught on my SleepU monitor where I was falling asleep while actively talking with friends in the middle of the afternoon, my O2 and HR drop and the 'clinically' validated Zio Patch reading from that time is labeled artifact.  

 

Electrocardiography Pitfalls and Artifacts: The 10 Commandments

Click on image to view larger version.

Table 1

Most frequent causes of electrocardiographic artifact and other pitfalls

 
Table 1

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@AllRelative I used to be a professor, so pardon me if I’m pedantic. 

This is a common issue in all of science, engineering, and medicine. It is often hard to tell the difference between errors from faulty measurements and real data from a accurate outliers.  Most automated systems disregard both. 

One way to tell the difference is to see if the result is repeatable. Can you get the same result again? This can be challenging - especially if it is a rare event.

Another way to tell the difference is redundant measurements. If you have multiple devices measure the same outlier, then it is less likely instrumentation error.  If only one records anomalous data, it’s likely a faulty measurement.

Of course it can still be an effect of a non-related phenomenon if measured multiple times. I have no idea if this helps. 

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For pulse you can always check manually at your wrist or neck. I mean, even if you don't count with a stopwatch you should be able to tell the difference between 60 and 110. That's how I check my devices if I have doubt. 

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I know from experience that when we relax our skin may not make contact with the muscle - therefore electrical conductivity testing can be interrupted. Since you mention falling asleep it is possible that the contact between the skin sensor and your muscle was interrupted and this is one of the explanations for artifact.  It is usually because the skin does not have contact with the muscle or the muscle is too contracted ( like a spasm ). 

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@Random-Symptom Man good point about repeatability. Sadly, it repeats again and again. When I first got my Apple Watch I did not know how to make sense of HR data or even what my HR ought to be. It was using the AW where I first was able to correlate HR with sleepiness. I was sitting and talking with someone who pointed out that it looked like I was falling asleep. Sometime later I looked at the AW HR data and it showed a rapid drop. Now I know that correlation is not the same as causality but it's something to examine.

The Cardiogram app is the best I've used so far to look at this data. I've gotten the AW download and converted it to CSV, and then got stuck with no further analysis on my part.

I just got my Viatom powered HR/O2 monitor a few months ago and took some time to view the data and figure out what it meant. The dips I've seen similar to what I posted here have repeated many times. The way the Viatom software charts the HR not only covers more data points than my AW but is visual in a more meaningful way.  And I can associate many but not all of the drops with severe changes in my wakefulness. I sent one to my Dr and he said to let him know if it repeats. And it did again and again and again. And he already knew about my sleepiness/fatigue issues. After an ER visit for HR/O2 issues following an acute illness I was referred to a pulmonologist and cardiologist. 

While wearing the Zio Patch one of the events I triggered and noted my symptoms for is representative of what is occurring. One idea for the Zio Patch was to get clinically validated data Drs would trust. BUT the reports give HR data averaged over 20 min. And I need more like beat to beat. With the event I refer to here there is a 90sec trace of my cardiac activity. It noted only 1 specific HR, some tracing of HRV I cannot interpret, and then noted artifact. I've written to request more data points from this event. I also have an 8 hr period another day where my AW notes hours of unusual activity (I was not wearing my Viatom sensor that say). But the AW captures much less frequently than my Viatom sensor. The Zio Patch captured hours of HRV for that day which were later averaged in the report I saw.  

On occasion I've been able to match data from my AW and Viatom sensor. I'm not so keen on continually capturing data as figuring out a cause of my symptoms. Cardiologist said he can refer me to an arrhythmia specialist. I wanted to learn more about what is going on and if I can change any of it. The changes I see in HR and O2 may be caused by an ANS or hormonal issue. 

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@AllRelative - have you done a sleep study? Specifically a polysomnography  and MSLT? The reason I bring this up is your comment of suddenly getting tired. I just found out that some drops in my HR are due to narcolepsy. To my surprise, I just found out that I am narcoleptic. Nobody that knows me would have ever suspected it.  

I always thought of narcolepsy as something where you just fall asleep suddenly. Apparently there are two different types of narcolepsy and gradations of severity. It is diagnosed by how fast you fall asleep, and how fast you get to REM sleep. Apparently, I have both fatigue and narcolepsy. #RandomSymtopmMan!

HR, BP and O2 can drop and rise during sleep for most people. Apparently, it can drop early in me - when I get sleepy. My hr doesn’t drop as severely as what you show, but it’s significant.

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More than one sleep study and MSLT. When I would have qualified for Narcolepsy I was afraid to mention it. Now that i'm much improved with transient but bothersome episodes my Dr says the only way to confirm it for me would be to examine Orexin in CSF. Apart from being a test mostly done on animals it would not lead to anything actionable that I cannot already do. I've already tried various meds for sleep and wakefulness and I can try others as much as I can tolerate...which is a big limiter for me. Dr mentioned maybe I have microsleeps.  I recall saying to a sleep Dr once that at times I'd swear my body was awake and brain asleep and asked if he could test it. He said yes, but he would not know what to do with the data 🙂 That was years ago and a test was not done.

I've thought about getting data from prior sleep studies but I don't know it could add any useful info now. I have the summary HR and O2 from the studies but no detailed data that shows something like what I currently have evidence of.

I bought a MUSE headset some years ago but never used it. I'm not sure what the version I have can show. I'd still be interested in something that could easily measure my brainwaves when I want. I don't know what it would do to help me now. I'll be referred to an arrhythmia specialist now. and I'll mention all of this related to sleep studies too.  I consulted once with a sleep/brain researcher who studies mostly rats. That was many years ago. I could look him up after I get more confirmation of what appears to be occurring. Certainly the brain is related to sleep and breathing and wakefulness and HR, etc. 

One Dr I worked with on my ANS balance and it helped briefly but I could not hole the beneficial changes and it was all out of pocket and expensive. The work was with sound and light and based on HRV. That's certainly an area I can experiment with on my own and may do so again someday.

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@AllRelative - I have been seeing specialists at Johns Hopkins. I didn’t think I had sleep problems other than extremely mild apnea (5-7) and pots-related fatigue.  The sleep doc said he was really interested in my brain waves, both awake and asleep. I think he knew he was going to find something. At this point, I only have the quick results ( analyzed by the Sleep tech and approved by the sleep doc).

I hope I’ll have more info by the end of this week. We will see if he finds any additional insight. If he does, I’ll report back. I have no idea what Dysautonomia and Narcolepsy and REM sleep behavior disorder will look like to him.

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@Random-Symptom Man I'd be very interested in knowing more the Dr's interest. Is there something special about Hopkins for treatment or diagnosis of dydautonomia? I wondered eons ago if I had problems with my ANS. i was too tired to deal with it and now it's another 10 years later.

BTW, the accuracy range of the Viatom output I posted recently could be +/-2%. for O2. I think it's the same for HR. Even if I add 2% for both my HR and O2 I still show troublesome variations.

Good luck!

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I can go from ~120bpm to ~60bpm in a matter of a couple of beats, BUT, that's usually after exercise.  My body doesn't transition from active to idle gracefully.    Digestion can do the reverse to me, although it usually ramps up over a period of 10-20 seconds when that kicks in. 

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