Sleeping with a pacemaker


I suffer from a low heart rate when resting and have now a pacemaker . 

My question is why am I having slight difficulty sleeping ? .

Prior my heart would rest awake at 50 bpm and sleep at 39bpm . 

Now the low setting on the pacemaker is 50bpm . 

So when I go to sleep and try and nod off it feels like im sitting and watching TV,  I cant drift off . 

I use to take a valium once in a blue moon a quarter of a pill would work , now I need nearly a full pill .

What's happening ? 

What is a SR function on a pacemaker ? 



by Tracey_E - 2023-09-22 10:57:05

It can take some time to get used to the feel of a higher heart rate, and it's most noticeable at night. It will eventually feel normal again. 


by TPMP001 - 2023-09-22 11:43:43

can anyone give me tricks or tips ?

before i had the procedure i was sleeping with a pregnanmcy pillow and a elevated bed and raising my heart rate before bed . 

please dont ask how ?? haha 

is there anything that can help . 

Tracy did you feel the same , how long did it take ??

what were your syptoms ??

SR Function

by Penguin - 2023-09-22 11:45:34

Question: What is a SR function on a pacemaker ? 


'The Sleep Function suspends the programmed Lower Rate and replaces it with a Sleep Rate (slower than the Lower Rate) during a specified sleep period. The slower pacing rate during the sleep period is intended to reduce the paced rhythm during sleep.

This feature can be found in some Medtronic Pacemaker, ICD, CRT-P, and CRT-D devices. Please go to or consult with your local Medtronic representative regarding device models available in your geography.'

This is copied directly from the Medtronic website found under 'sleep function features'

Do you already have this programmed? 

I found it hard to sleep too. I didn't have a sleep function feature on my device.   I found it easier to sleep once the voltage was turned down. It is turned up initially to help the wires bed in.  I found it really difficult to cope with as it feels as if your heart beat is really forceful as well as faster. 

You can ask to have the voltage reduced. 


by TPMP001 - 2023-09-22 13:45:14

Problem is no doctor for 2 months and the clinic personnel each one as a different non optimised opinion . 

my pacemaker does have a SR function , problem is they told me is that my heart rate is set to 50 , and stabilises at 50 and that only 3 percent of the battery is being used because i only need it at night . 

they said if they did drop the heart rate bpm , it would defeat the procedure and ailment which is to stop my heart from dropping . 

if that makes sense . 

penquin do you suffer from low HR , did it work the low voltage option ??

tracey when did you start feeling better ???


before and after

by Tracey_E - 2023-09-22 14:18:44

My rate went from the 40's all my life to 22 the day I got my first pacer to 70's once I was paced. It took about 6 months to get used to it. Have you tried playing soft music or a white noise machine or one of those sounds apps (thunderstorms, ocean, etc)? 

They usually change the settings at the first follow up appointment, so that may help.. They send us home with a good guess as to what we need, and they turn it up a bit until the leads settle in and the heart gets used to being paced. After the first check, they turn it down to the lowest voltage it takes to make the heart beat. 

Lower Voltage

by Penguin - 2023-09-22 16:05:35

As Tracey mentions above the voltage is turned up higher than we need when the PM is implanted. I found this extra amount plus the higher heart rate difficult to sleep through. Turning the voltage down to the lowest voltage to make my heart beat made a huge difference for me. 

Yes, I do have a low heart rate - particularly at night. 


by Penguin - 2023-09-22 18:11:42

MBird - Thank you for your concern but I think you've misunderstood my post. I agree that there's no SR function on the Abbott Assurity PM. I got my first PM 15 years ago and I was referring to my experiences with that PM. It was not an Abbott device. 

Edited - irrelevant to OPs concerns, but explanation retained for continuity of thread.

Give it time

by PacedNRunning - 2023-09-22 21:25:57

I use to be in the low 30's sleeping prior to placement.  Mine is for AV block only and not my long standing sinus bradycardia.  Give it time.  I was initially set at 40bpm.  I had juntional issues with it so they raised it to 60. I found 60 hard to deal with because I felt like an engine in my chest all day. The PM paced me way too much for not needing it for sinus bradycardia. I want to say 88% during that time it was at 60bpm. They lowered it to 45 at my request and it did take a week to get use to, then I've been fine ever since. Just give it time and see how it goes.  You got your PM for a reason and I agree, lowering it below 50 seems as if you don't need the device. I never had symptoms with bradycardia so they allowed mine to be 45. After a couple of years, it needed to be bumped to 50 because my settings blended better at 50.  I accepted it because it was worth the trade off of my settings feeling better at other times.  

Maybe try 45? See if they would be willing to try 45.

Lack of sleep

by TPMP001 - 2023-09-22 22:53:04

It's 0300 and I'm still up . 

It feels like a double thump on my chest and like that movie crank when he injects adrelanine.  

I'll be drifting of and then boom .

Double thumb and alert .  

Problem was before the pacemaker my heart was dropping so much when I slept it felt as if I was drowning or on a plane with a pressure drop . .

Now it's safer but I can't relax because the pacemaker kicks in when I'm about to deep sleep.


I'll try asking for voltage and the SR mode too to 45 and maybe increase my heart to 55 . 

Use more battery,  but at the moment they say I'm only using 3 percent 


by TPMP001 - 2023-09-22 22:53:52

Would you think that's the right choice . 

I was not getting this in the 1st 4 weeks 


by Penguin - 2023-09-23 04:35:21

You say that you weren't getting these problems in the first four weeks. Did they start after your pacing clinic review?  If so, it's likely that changes to settings were made. I'd call the pacing clinic and ask the techs to explain any changes they made.   They may be good / necessary changes which may take time to get used to, or they may not suit you.  Discuss how you feel with the techs.

 Note: Always ask your techs to let you know about changes they make. 

Re: Battery - I wouldn't worry about battery at 3% usage. 

Re: Future changes - it's best to try one thing at a time so that you can monitor the effect. 

Re: SR function - I forgot to say that this function will be for 'set' times e.g. If you usually go to bed at 10 pm and wake up at 8 pm, you could get it programmed for sleep between those times. Note:  This is fine if your routine is very regular.  However, if you occasionally party til dawn and do any long haul travel to different time zones be aware that your h/rate may be lower at inconvenient times because the pacemaker won't adjust to time zones or alterations to your routine. 

Personally, I would:

1. Ask which settings they changed and why and discuss that over the phone on Monday. 

2. Lower the voltage to the lowest setting to produce a reliable heart beat in the first instance (if they're happy to do this).

3. Wait to see if this helps (voltage effects can be immediate or linger)

4. Try a reduction in h/rate if you're still not sleeping. (Use the SR function if you think it will suit your lifestyle).

Does that make sense?  (Bit sleep deprived myself today!) 



by piglet22 - 2023-09-23 07:43:29

Thanks for posting the links to the manuals.

Makes getting hold of all the settings even more important.

Look like some hefty documents. Wading through vintage sewing machine manuals at the moment.


by Penguin - 2023-09-23 07:58:04

 A patient friendly manual would be helpful if only to aid discussions with techs.  Medtronic seem to allow access to patients via their 'Academy' without any professional sign in.  Gemita mentioned the Academy in an earlier post. Thank her for the link Piglet! 

Changed my settings

by TPMP001 - 2023-09-27 06:06:56

So changed my settings yesterday and still had the same issues , the double thump on the left side by the pacemaker . 

they dropped the voltage and instituted a sleep mode . 

im starting to find it hard to cope , can anyone advise anything else . 

also could the reason why im feeling the thump and alertness be because the area still very tender. 

its only been 2 months 

takes time

by dwelch - 2023-10-07 07:42:22

The short answer is the same as the first answers, it takes time.  I have CCHB and by the time I got my first device not only did I go from 30s at night to 50 and had to deal with learning to fall asleep again.  But my heart and grown so large that I could feel/hear every beat it was "normal" could take my pulse by simply looking at a clock and not use my finger on my wrist or neck.  So I had the 50 bpm thing, the disturbing empty my heart has stopped feeling and this was 1980s tech so it took a good part of that first year to get the device tuned so it was triggering and not doing double beats.

You will solve this and you will be like the rest of us where you literally forget you have a pacemaker. it is like a middle toe or belly button, you know you have one but you dont ever think about it unless you bump it into something then the quick pain passes and you forget again....


double thump on the left side, do you have a biventrical?  you are only two months into having a pacer?   I get belly bumps sometimes with my biventrical, i find it amusing and funny feeling.   If it were all the time though it would make me crazy and would be camped out at the doctors door, so there is a threhsold of tolerance there.    two months you are still in the recovery period and that sucks in general, but it is only a few months every 10 years give or take, drop in the ocean.

Your choice is go through this very short transition period (months, a year)(one time) and have a longer life and peace that your condition is being managed.  Or turn off the device and be able to sleep this week and maybe you dont wake up.  Not sure what else to tell you here.  You need a lower limit and it is a step change from what you are used to, but its like new boots that you have to break in, they hurt at first but once you get them broken in, it is like heaven.

Had a buddy stop taking his blood pressure medicine because it made him sleep better and he had to use an alarm to wake up the morning.  So he chose to not take the that he could wake up without an alarm as he always had.  His choice, his life.  I think he is still alive but who knows...

While you transition, you have these extra hours every day to get more stuff done...

As an athlete or ex-athlete most folks are concerned about upper rate not lower rate.  



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