Pokey

Thanks so much, Pokey! I just asked my psychologist for a script for something to give me more energy and I don't think he really understood why I was crying to him about being so tired. He said we all wish we could stay awake 36 hours a day. The nerve!

So, at this point I will ask my EPcardio after I get my referral to see him again. Thanks again!

Getting the script was a challenge, as my cardiologist didn't have the secure RX pad necessary for this level of controlled substance. (Cardiologists don't typically prescribe this type of med, obviously.) But it worked out.

All is still well, though it is disturbing my sleep some. I am astonished that something so energizing has no effect on my pulse. However, it can cause a little anxiety, at least for me. I am still figuring out the dosing.

Take care and good luck.

Well, I had some hair left before I found a cardiologist. (I didn't tear it all out!) I actually found two and now I feel like a weenie. The first doc knew almost nothing about POTS, but is willing to learn and is local. The second doc know a great deal more about POTS, but is an hour away and out of my hospital network. I chose the second doc. I'm just tired of having to educate my doctors. I want to just go to them and have them say "this is what is going on and why it is happening..." and have them be correct. I've gone back and forth in my head, do I go back to the first one and "educate" him (aka: be his guinea pig,) or stay with the one who already knows how to treat me and just juggle all the paperwork? My husband thinks I'm overthinking this whole thing and should stay with the guy who knows.

Anyway, we still don't really know why I have the bradycardic episodes, but we do know that the chest pain is benign. Doc #2 said that since I was going HYPER-tensive when they happened, it was not causing a lack of O2 to the heart, so that wouldn't be the pain. One thing we did figure out was that it has some weird relationship to my hydration status and serum osmolality. These episodes only happen when I'm thirsty, still medicated and have a measurably high serum osm (thick blood due to dehydration.)

I would be absolutely explainable if I were a rat.....I even brought in a journal article to prove it. I think I'll go find a piece of cheese and then go find a corner in a maze to curl up and enjoy it........

At least the hair strands aren't compromising the finely honed sense of humor. Nicely done.

I see my cardiologist st Stanford about every 5 months; otherwise I see a doctor that specializes in CFS, FMS, chronic pain, dysautonomias. Not sure that he knows as much as I do about POTS at this point, but he's smart and open minded, and willing to experiment with meds as long as I bring studies that logically support the use.

My top-rated local endo and cardio were both useless.

Incidentally, POTS causes the manifestation of the same symptoms as anxiety, physically. Plenty of studies on that one. There are also some similarities with ADD, when one suffers from cerebral hypoperfusion. (This responds to a post above.)

Hope the new doc works for you, and keep up the comedy.

In the meantime I'll give a trial of no Flexeril....and cont. follow up with my primary care doc tomorrow and my pain guy. I feel anxious as regards this...........like -- should I see a Mayo cardiologist rather than a dysautomia specialist? Does anyone know what Dr. Goodman does at a new appt.? Will he diagnose dysautomia by ordering tests to prove thus? Such as tilt table etc..... Or will my blood pressure issues, and tachycardia being the norm for me -- be enough for him to make suggestions?

Sorry you are having such a rough go of it. I understand.

Note, Flexeril makes me tachy. I didn't mean to suggest that it has a favorable impact autonomically. Perhaps for some, as does Elavil, a tricyclic antidepressant.

Hang in there.

HI ....

Well honestly I have never heard of pain medication increasing blood pressures....in my experience pain medications helped blood pressures of patients experiencing pain - as the pain markedly could increase their blood pressure -- as the pain symptoms diminished their blood pressure would decrease....& of course pain meds would be held if a patients blood pressure tanked for use of them. So is there something I need to know about dysautonimic disorders and the people that have them and how their bodies respond to pain meds?

thx!

No, it's just that your pain can increase your HR and BP, as you suggest. Controlling it is important, as you also suggest. Drugs that I know have an impact on the autonomic system are Flexeril and Tramadol, as they affect serotonin and norepinephrine. I have first hand experience.

When my pain is better controlled, my BP tends to be less labile.

If I were you, I would be insisting on meds to get that BP down and would keep looking until I found a doctor that would work with me. It's sounds like you feel similarly.

Hang in there.

As I am sure you know, pain sends your BP way up. That's part of my problem -- chronic pain.

double post -- sorry.

YAY!!!! Hope the benefit lasts. Keep us posted. You've almost talked me into trying it.

Julie

FWIW, I've tried most of the mainstream things. Anything else that made my hear rate drop made me feel crappy.

Most of us have sleep issues (which I partly attribute to alpha intrustons -- HR spikes -- during sleep movement) and beta blockers and clonidine reduce melatonin production, making it more difficult to fall asleep. One of the additional benefits for the stims for me is that come late at night, I get pooped from the stim wearing out. The only downside is that when I come off my initially instant-release dose, I feel a little low; then I take another small dose. The XR could resolve that, but I am always concerned with sleep interference, and would rather take small doses over the day.

After a 3-day trial, I have no doubt this is for real.

Hang in there. I'll keep you posted.

I went through this game for a while, but mine was very blurry vision -- so blurry I couldn't see. The optometrist confirmed something was wrong, but then the big wig neuro ophthalmologist (who spent no time with me) with a team of interns, said there was nothing wrong, and the my GIANT pupils were not so large to be statistically significant. Statistically significant for what??? I still can't see clearly, no matter.

POTS wreaks havoc on my vision, and when I have migraines, it's even worse.

If only we had integrated care, where the POTS doctor spoke with the ophthalmologist.

So my hear goes out to you.

Thanks for sharing what is working for you.

I think the elevated heart rate is what concerns me most right now.

fwiw, the stimulant is dropping my HR. hang in there.

Julie, it's seemingly paradoxical, but not entirely. As MKoven pointed out, Adderall, like Midodrine, is a vasoconstrictor, that allows for better peripheral circulation and overall autonomic stability. It could be attributable to better functionality of the baroreceptor reflex.

But as you suggest Julie, I am not sure stimulants cause a reduced heart rate in ADD patients. I know it calms them, as a result of increased frontal cortex activity (which removes a lot of noise), but I think it usually elevates heart rate and BP. Indeed, many are prescribed clonidine and betas in the evening, so they can sleep.

As an additional note, apparently a decent percentage of POTS patients suffer from symptoms similar to ADD and bipolar (manic) patients in terms of brain fog, lack of concentration, short-term memory impairment. I know I do. I don' think the doctors have researched this angle enough. We need more neurologists in the field.

Thanks for your thoughts, and hope to hear more personal experiences, as well as the willingness of doctors to prescribe this meds. I am a little reluctant to ask, as I know it takes a lot more administration to RX these drugs. I already feel like a difficult patient.

Thanks much. Have a nice Sunday.

Hey Pokey,

Interesting stuff. The medical literature I've read seems contradictory. I know the stimulants cause an increase in neurotransmitters, like dopamine & norepinepherine. Norepinepherine, in particular, usually causes the HR & BP increases that you describe. But that rise in BP, can in turn can cause a DECREASE in HR (reflex bradycardia) via the baroreceptor reflex. Sort of sounds like what's happening with you.

BTW, I've never heard of ADD/ADHD patients also being prescribed clonidine & BB's to sleep. Seems like a delicate balancing act...but I get the idea. For awhile, my son was taking both (not to help with sleep though.) The clonidine was supposed to increase appetite, etc. It just made him unbearably sleepy and he stopped after a few weeks.

We've chatted here before about the overlap of ADD/ADHD symptoms and autonomic dysfunctions- definitely there! I agree that a lot more research needs to be done to understand this phenomenon.

I know what you mean about the dispensing of stimulants being a hassle for both the doc and patient. That's one of few drugs that I have to very carefully manage monthly as docs aren't allowed to write prescriptions for longer. Don't worry about being a "difficult" patient. You're lucky enough to find something that's helping. Fight for it!

Julie

Thanks for your thoughts, Julie. I altready take an ARB for paroxysmal elevated HP, but ironically, the stimulant is dropping it even more. It's somehow giving me greater autonomic stability -- and removing lability. I worked out for the first time on the stimulant today, and was well able to keep my HR under 163, which is a success for me. Usually moderate intensity takes me up to 180+, which is not comfortable.

I have an email into my doctor. We'll see if she responds.

Julie, it's seemingly paradoxical, but not entirely. As MKoven pointed out, Adderall, like Midodrine, is a vasoconstrictor, that allows for better peripheral circulation and overall autonomic stability. It could be attributable to better functionality of the baroreceptor reflex.

But as you suggest Julie, I am not sure stimulants cause a reduced heart rate in ADD patients. I know it calms them, as a result of increased frontal cortex activity (which removes a lot of noise), but I think it usually elevates heart rate and BP. Indeed, many are prescribed clonidine and betas in the evening, so they can sleep.

As an additional note, apparently a decent percentage of POTS patients suffer from symptoms similar to ADD and bipolar (manic) patients in terms of brain fog, lack of concentration, short-term memory impairment. I know I do. I don' think the doctors have researched this angle enough. We need more neurologists in the field.

Thanks for your thoughts, and hope to hear more personal experiences, as well as the willingness of doctors to prescribe this meds. I am a little reluctant to ask, as I know it takes a lot more administration to RX these drugs. I already feel like a difficult patient.

Thanks much. Have a nice Sunday.

Hi -- Needing some guidance if you can help.....

I've got that joint hypermobility thing -- or EDS=HM type and my b/p and my heart rate are giving me fits. I initially saw my primary for a baseline HTN <---- hypertension - with bouts of low b/p mostly happening after working on my feet for four hours as a cook. My b/p is high -- with the diastolic or bottom number or most important number never under 100........ Often 106 to 112....... Such as 152/110 =---> But because I also dip down low my doctor sent me to cardiology

When it dips it's after working and I am very symptomatic and it takes 2 or more hours of lying flat in bed before I feel 'recovered' for lack of a better word.... The lows are in the 90's over 60's and I feel dizzy. I was on Diovan alone at first but cardiology added Metoprolol 50mg because my holter monitor showed I am tachy with my heart rate most often over 100.......

Well I'm afraid of having a stroke with that high blood pressure most all the time. Then cardiology did a stress echo today. I was told to stop my Metoprolol for 48 hours prior to the test. Well my blood pressure shot way up to 177/122 and I had the worst headache of my life night before last. I called the oncall doc who said take the Metoprolol and go to ER. I did and everything gradually got normal - HA went way, b/p down to 144/106 - and they were happy I didn't have an aneurysm -- but no one much cared about the blood pressure.

So I go have the stress echo today and the doctor says it's a good healthy heart. No issues. I told him I'm worried about a stroke running around MOST of the time with diastolics in the 100's. He counters well you also go low and I don't want you fainting at work. I said good point but I usually only dip low once or twice a week after working on my feet -- the majority of the time I'm high and worried about it.

He said you are an unusual case and he didn't know what to do -- he says you have labile blood pressure and I'm not going to medicate you more. I asked him if he knew of other workups for labile b/p -- for say -- tumors etc.... He asked if anyone checked for Pheochromocytoma -- I said no. So he ordered catecholemines and metanephrines one by urine the other by blood. He clearly said he's not an expert on hypermobility syndrome issues.

Okay that's about it -- All of this seems to me to be related to my EDS-HM perhaps with pooling etc.... But I wish I knew who to see about it - who IS comfortable seeing patients with crazy labile blood pressures and odd diagnosis..... The neuro doc locally and at a major center miles from here both uncomfortable with it - neuro stating she treats it only with MS etc.... The major medical center thought my fatigue was psychological (prior to my holter etc.)

I wish I knew what labs to ask my primary doc to order or to suggest to order that might go with a dysautonomia diagnosis.......... Do you have suggestions for labs? Do you have suggestions for medications for me to run by her? A doctor recommendation?

Without the Metoprolol just standing my b/p was 120's -- but the doctor doesn't seem that impressed or he's hugely uncomfortable with dealing with this........And to be honest the 50 of Metoprolol isn't helping me symptom wise -- I still get tachy with standing -- I still get dizzy from standing too long -- I get orthostatic hypertension --- I have high uncontrolled blood pressure. Who do I go to with this??

Again I would fly anywhere to get someone who can help ..... I exercise daily - I've dropped 20 pounds in the last couple months , I eat healthy and my regular labs are very good. I need to keep losing weight -- But in the meantime I'm worried about these widely fluctuating blood pressures and nobody yet cares to do a tilt-table test -- they believe it to be overkill or perhaps ridiculous -- like so what? I tell them there are multiple kinds of dysautonomia caused by a million and one different reasons -- may I please get a true diagnosis so treatment is appropriate? They say no to this test......

Any suggestions appreciated -- thanks so much -- I'm losing my patience and I need help!

You sound hyperadrenergic. I'd recommend suggesting and ACE or ARB, along with mestinon. to modulate the postural tachycardia. I just posted, expressing what's worked for me, and I've tried most of the primary meds. Good luck.

Hi all. Frequent loiterer, occasional poster.

So, I believe I have been dx'd with hyperadrenergic POTS. Elevated norepinephrine, urinary and blood plasma. While I suffered from occasional presyncope prior to medication (Mestinon, 60 mg, TID), my blood pressure usually elevates when I stand, and I become mildly hypertensive, and my heart rate increases 20-26 bpm. Indeed, I am taking an ARB to reduce my BP -- and it doesn't increase my heart rate one bit. I never had much luck with medicines to reduce my heart rate, which is mildly elevated even when seated (but not lying) given my level of conditioning. I tried the betas, coreg, and clonidine; the first two caused interference with sleep, among other issues, and the third actually increased my heart rate. Elavil did the same thing.

FWIW, I tested as OI and hypovolemic during HUT, but Florinef never did me much good, unless mirgraines are good -- I take that back, I was no longer overfilling the 24-hr urine containers, LOL -- gross, I know; I take my humor where ever I can get it.

So, anyhow, here's the interesting thing, and the salient issue of this post: I recently tried a small dose of Adderall (2.5 mgs), and it knocked my pulse down to pre-POTS level -- 59-61 -- and it reduced my BP down to 92/60. And that was for 2 days in a row. Ironically, Provigil, bupropion, and coffee each elevated my pulse and blood pressure.

It's not a perfect fix, as even with the Mestinon, my pulse still jumps 20-26 upon standing, but still, my seated pulse is a good 15 to 20 beats slower than normal, as is my standing pulse -- nothing to sneeze at. It's my hope that I can further my conditioning (as I wont be going over 170 bpms when doing moderate cardio, at least that's my hope) such that POTS becomes less disabling, particularly the fatigue, pain and cognitive impairment.

I was hoping to hear if anyone else has had a similar experience. Additionally, I am wondering if POTS cardiologists are generally comfortable prescribing amphetamine, versus Ritalin, Provigil or Midodrine. (I've read Dr. Grubb's study with Ritalin, and have heard anecdotally that he rx's amphetamine.) I have some left over from when I was suffering from fatigue, before I knew I had POTS, but only a few weeks worth. I am hoping that this is generally deemed within the standard of care, any my doc will approve of a course. My doc is usually open minded.

Thank you very much for any insight.

In the last week or so, I've noticed more chronic body aches/pains. I've had similar with the flu and the occasional on and off pain, but this is more chronic.

My shoulders have shooting pains, my arms are sore, my muscles hurt, etc. I don't have the flu/cold, either. And I'm a bit more fatigued than 'normal.'

I've looked this up, and get pointed a lot to Chronic Fatigue Syndrome and Fibro. I've only been diagnosed with POTS.

I will bring this up with my EP next month, but does anyone know what I'm talking about? Any tips on managing it?

Sorry to hear of your pain. I can relate. Adrenaline surges and orthostatic hypotension both can cause body ache/fibro symptoms.

A couple things worth trying: 1) magnesium sulfate bath (if you can take baths); 2) magnesium taurate pills (highly bioavailable magnesium that will loosen muscle tightness); 3) a tussin/DM cough medicine (http://en.wikipedia.org/wiki/Dextromethorphan), which can be highly effective for painful, tight muscles, because of its mild NMDA antagonistic action.

As for scripts, I never had any luck with Cymbalta or Elavil, but Lyrica helps me, though it comes with a host of side effects, including compounded brain fog and weight gain. Flexeril, Soma, and Baclofen can also help.

Hope you feel better.

Suzi,

My copper level has always been low in my urine, but not in my blood. It was not until I started taking medication to get the copper out of my system that I started having it in my urine. There are a few different ways to test for copper. Urine, Free copper (which is free flowing in your blood, not bound to anything) and Total copper which is free copper and copper that is bound to the protein that helps get it our of your body. I do not make enough of that protein (ceruloplasm) to help the copper get out of my system. So I take medication to get rid of it. I have good and bad days. Copper also interferes with hormones. And we know that hormones make POTS worse.

Glad to hear that you learned what was wrong, Mandi. I'm curious, how did you reduce copper plasma levels?

Pokey

,

They only gave me two papers with the results on them. Most of it is in graphs and such, and the rest that is in writing is what I posted on here. Would my doctor recieve a more detailed report?

Candace

Your doctor must have more data, including a histogram showing the stages of sleep you were in, minute by minute.

Do any of the graphs state the stages of sleep, and the % in each? If so, let 'em rip.

Unfortunately, the practice of many sleep docs is to DX and treat apnea; it's a bit of a boondoggle. Unfortunately, many of these docs are not attentive to the issues attendant to fragmented sleep.

I've had 2 sleep studies now. I have virtually no stage 3 or 4 sleep, which is the restorative. Every single thing was abnormal except I don't have apnea.

The first result was reported as normal and the second as no stage 3-4, but no hypersomnia, although i fell asleep at all the 2 hour intervals, but like you did not have REM. I just gave up. morgan

This is all too common in POTS, CFS and FMS patients. Often times, there are alpha intrusions which prevent stage 3 and stage 4 sleep. Every time stage 3 starts, your autonomic system activates, and your back to level 1 or level 2.

Morgan, did you have much REM sleep? Usually, with this kind of pattern, you don't get much REM either. And this can contribute to cognitive issues, as REM is believed to be important for memory consolidation.

My sympathies that you all are going through this. FWIW, you are not alone.

If it's a cough related to congestion then plain Mucinex worked for me. And for the tickle itself, those zinc lozengors worked well ...

Sorry to hear you're sick ..

BTW, I tried Benadryl capsules for my runny nose and felt too dizzy to stand up .. I kept running into things and bruising myself too. My doc recommended Zyrtec or Claritin. I tried the Zyrtec, but that knocked me out during the day.

If you have a cough, I would recommend holding off on the antihistamines, which will dry up your secretions, which you want to cough out. Guaifenesin (generic mucinex) to cough it up, and then DXM when you want to suppress the cough. Plain old Tussin from the dollar store works fine.

Hope you feel better.

I've never had a problem with dextromethorphan. I just make sure there's nothing else in the preparation, esp no sudafed.

I am a big fan of the DXM. Really helps my body pain, as well as suppressing my cough. I think it can increase HR in some -- and it's a no-no if you are on a MAO-i. It never bothered me.

Hey everyone. I know some of you were interested in my sleep study results, so here's what I found out.

First, the reason why my doctor wanted me to have a sleep study done was because of the following symptoms:

- excessive daytime sleepiness

- very vivid dreams, even right after I layed down to go to sleep

- excessive dreaming

- waking up a lot at night

Also, I will try and put everything I found out in this post, but I'm having a hard time remembering things and am pretty exhausted from my appointment today.

So I met with my sleep doctor's nurse practitioner, who was very nice and very professional. She sat down and talked with me about my POTS/Dysautonomia and seemed to be somewhat educated on it. ( Which we all know can be a major advantage ) She then got out the results from my overnight sleep study and my daytime sleep study. She went over all the results very thoroughly and made sure I understood everything.

According to the results, my overnight sleep study, overall, was normal. Which I was not expecting because I am so tired during the day and whatnot. Here are the results for my overnight sleep study;

- Sleep latency was prolonged at 54 minutes

- REM latency was prolonged at 163.5 minutes

- The patient ( me ) obtained 600 minutes of sleep during the recording time of 735 miutes, giving an impaired sleep efficiency of 82%

- There was no detectable snoring during the study. There were only some respiratory effort related arousals and a rare hypopneic event. There was no oxygen desaturation.

- There were no cardiac rhythm abnormalities. Periodic leg movements were not seen.

-IMPRESSION: The patient had prolonged duration of sleep but with some fragmentation and there was mild impairment in sleep efficiency. There were no features of significant sleep-disordered breathing or of periodic leg movement disorder of sleep.

Next was my daytime sleep study. During the daytime sleep study I had to take a 20 minute nap every two hours. She told me that normally, it takes the normal/average person 10-15 minutes to fall asleep for a nap. The results showed though, that for the 4 naps that I took during the day, I consistently fell asleep around 7 minutes. Here are the results;

-IMPRESSION: The mean sleep latency of 7.5 minutes indicates moderate daytime sleepiness. REM sleep was not recorded, so full criteria for narcolepsy were not met, but that alone would not conclusively rule out narcolepsy. The findings suggest the need for wake-promoting medication.

So, a quick summary. Before I had my sleep study my sleep doctor suspected that I had narcolepsy. Now, because I never entered REM sleep during my 20 minute naps it is not definitive that I have narcolepsy. So after my appointment today, the nurse practitioner ordered blood work to check for narcolepsy. I'm not sure exactly how they do this but it will be sent to Mayo and I won't know the results for a few weeks. She also mentioned narcolepsy without cataplexy and hypersomnia. I did a little research and found that there are a few different types of hypersomnia ( due to different causes ). So overall we are not certain on the narcolepsy but it is still a possibility. At this point the tests, along with my symptoms, show that I do have some type of sleep disorder, whether it's narcolepsy or some type of hypersomnia. She gave me a sample of Provigil to try and see if it helps at all with the daytime sleepiness. I just have to be careful due to the fact that this drug is a stimulant and could cause a raise in blood pressure( I am being treated for high bp and tachycardia ) / heart rate/ arrythmias ( I am already at risk for arrythmias due to the fact that I am currently taking a beta blocker along with a calcium channel blocker ) and I also have MVP and some PVC's . SO I will have to see how things go. I hope this helped those who were wondering about my test results and hopeing to receive some insight to their own sleep difficulties.

( and I guess that summary wasn't very quick, was it? )

Candace

Candace, I am sorry to learn of your frustrations. If you can get your full report, including amount of time spent in the different sleep stages, I can help you interpret it. I am betting that you are getting alpha intrusions that are preventing delta sleep such that you are not getting restorative sleep. That fact that you slept 10 hours during your sleep study, and still did not feel well rested, and then fell asleep for naps in 7.5 minutes, is highly suggestive of something materially wrong with your sleep.

I've taken Provigil, and it may keep you up, but it wont resolve feelings of tiredness if you are not getting restorative sleep. It's possible that it will help consolidate sleep, such that it is less fragmented, but I dont think it's likely to make a material difference.

If you can get your full report and post it, or send it to me in a private message, I'd be glad to help out.

Best,

P

I am shocked! What kind of doctor would give you nitroglycerine if he/she suspected POTS???

I would really question their competence.

The one hallmark of POTS is your heart rate going up without medication on the TTT. AND...without knowing how your body would respond, you risk putting yourself at risk...

Doing a TTT without compression, after several minutes, my heart suddenly went into a PSVT. I was extremely sick and weak afterwards. That was in a controlled environment on a real tilt table. I think I would have been clearly near serious danger or worse had I been given any medications!!! Especially nitroglycerine.

Please get yourself to a competent ANS doctor and testing center!

tearose

Well, my POTS doctor did not order the TTT; it was my cardiologist. However, maybe he should have known better, as he did a poor man's tilt in the office, and my pulse went from 70 to 180, and then settled at around 130.

Personally, I think that the 24-Holter monitor is very valuable as part of a POTS diagnosis. My cardiologist saw the report and told me that I am anxious and need to try and relax, as my average HR was over 100 (not an exercise day). Then I saw a POTS cardiologist, and when I related this advice as she reviewed the Holter-monitor data, she laughed, commenting that apparently anxiety strikes whenever I go from a lying to standing position.

Here's what's ironic about your wish for a vet to treat you--they know quite a bit more about dysautonomia than the average physician. It's not uncommon for dogs to get dysautonomia.

Nina

Access to non-FDA approved drugs to boot . . . I say go for it!

Pokey, I take 1/2 of a 3mg tablet of Melatonin just before bedtime and it will replace what the BB destroyed. Works great for me!

Thanks for the suggestion. This happens to be the precise amount of melatonin I take. Unfortunately, this, alone, does not get me to sleep. I need to take a benzo (klonopin) or a muscle relaxant (flexeril), as well. Ironically, I am fatigued most of the day, but my body seems to run warmer at night. The daytime is my dress rehearsal. : ) Thanks for the good advice.

One more thing to consider...what does your HR do at night while you sleep---UNMEDICATED? I had a 24-hour holter monitor and it showed most of the night my HR was in the 50's to LOW 40's. My PCP looked at it after I asked him to, and yanked my evening dose of BB. If your HR is already low at night, it doesn't need to go any lower! You probably would like to actually wake up in the morning!

Okay, this scares the heck out of me. I'm on Metoprolol ER 25mg. When I had my 24-hour monitor done, I did notice a lower heart rate at night, I think around 50's. I've been on Metoprolol ER for a long while and have been okay so far as know ???, though I have no idea what my heart rate is at night. This is really freaking me out. If I did just a regular morning dose, though, how fast would it wear off? Would it last all day and be out of my system at night?

Maybe this BB is why I've had trouble with insomnia as well, though to be fair I've struggled with insomnia for years and years. I take an anti-psychotic that helps me sleep.

Amber

TF, I don't think you have anything to worry about, though it's worth raising with your doc.

Incidentally, 100 mgs of Seroquel is a pretty good dose for sleep. Doesn't that leave you with a hangover? (I neglected to look if you are BP, which would change the equation.)

In any event, I'd suggest taking it easy about the Metoprolol. I dont think you are at any significant risk of harm from too slow of a heart beat. But I can relate to being scared. Much of this stuff is scary, partly because so much of it remains to be figured out.

Take care and hang in there.

I dont have problems falling asleep on BB's, although I dont know how good the sleep that I actually get is...if this makes sense? They make me sleepy, but I have really weird and vivid dreams on them. Although, I was diagnosed really quickly with POTS (2 weeks), so I dont know if it is the BB's causing my dreaming or the POTS itself.

I only take a tiny dose (6mg) in the morning, so I dont know how much is actually left in my system by the time I go to bed.

Vivid dreams are a reported side effect, FWIW. I cant say I ever noticed that.

As for how much is in your system, you may want to research the half-life of the med. I would imagine most of it would be cleared by bedtime, unless it's an extended release.

Hang in there.