I'm on Acebutolol 200 mg 1x daily in the morning (now down to a compounded 100, let's see how that goes). This drug is not meant to be taken at night.
Metoprolol is absolutely horrid in my experience. I didn't have my 12.5 mg dose of it for one day while transitioning from the hospital to home (ah yes, they didn't think to give it to me in the hospital then) and I woke up the next morning with a heart rate of 183. The drug also gave me severe night sweats, insomnia, bad dreams that I couldn't remember, and I woke up every morning with a heart rate of 150 on it (in other words, it worsened my adrenaline dumps). The drug did not help.
Beta blockers in general aren't a good idea for dysautonomia, IMO. I had a severe POTS flare, was in the hospital for a month because of it and I couldn't move basically (in other words, I was totally bedridden). Tried all kinds of meds, but the day I realized that medication is just a bandaid for my symptoms, I was like no, I don't want to be on medication for the rest of my life.
What helped me was brain training, peripheral nerve stimulation, and a set of functional neurology assessments. Those things, walking and neuro anti-synergy exercises, lots of sleep, and a good set of nourishing vitamins (B1, B12, D + K2, copper -- from diet, not in pill form), is the only way I recovered from this.
Now about a month later of doing these things I can walk and I'm nearly back to my old self.
