Altered sleep

Has been 3 weeks since dual wire pacemaker implant. Main concern has been frequency of waking episodes at night time. Pacemaker had been set at 60 bpm, yet my normal sleeping heart beat is much lower. Due for first tune/up in 3 weeks. Would lowering the minimum rate improve sleeping or create other unwanted issues? Had been anxious about this early on with consequent bp elevations.


why do you have it?

by Tracey_E - 2019-01-24 22:35:54

If you have av block, then your resting rate is not determined by the pacer, but by your own natual sinus rate. The pacer just makes sure your ventricles beat when the atria does. If you have sinus disfunction, then you may or may not be pacing at your lower limit. So, that's a question to ask at your check up.

60 is a standard lower limit, under that is bradycardia which is why we get paced in the first place. It's possible to feel good with it lower but many of us either wouldn't have a lower rate even if it was set lower, or wouldn't feel good with it lower than 60. Only way to know is to try it. However, I'd wait a few weeks, maybe even a few months, to make any changes. How low was your rate before? Mine was in the 40's, then dropped to the 30's, so when I had a perfectly normal rate in the 60's it suddenly seemed like it was racing. It didn't take long for it to feel normal. 

Are you waking at the same time every night? They may have it set to do a self check, and they deliberately program it for when we are asleep. They can change the time or possibly turn it off if it's waking you. 

Altered Sleep

by Tem - 2019-01-24 23:56:30

At the first pm check in hospital the technician asked me where I want the lower limit set. He was happy to set it at 50, but I preferred 60 for the reasons you gave. My resting bpm was between 40 + 55. I have been very athletic all my life + always assumed that lower heart rates were a sign of fitness. Unfortunately it works against you as you age. Ageing athletes  are very prone to heart rthymn disorders, as I discovered. I wasn’t informed as to whether the self test was operational. The forum has provided me with plenty to enquire about on my next visit. I just feel wide awake at 60bpm. It does not go below 60 when set at that level.

Lower Heart rate setting

by ar_vin - 2019-01-25 01:46:32

I was implanted with a Medtronic dual lead pacemaker for sick sinus syndrome; the initial lower HR setting was 60 when implanted. Like you I've always beeb very physically active with a resting HR in the high 40s to low 50s for many years.

After the implant I felt like the 60 bpm setting was too high for me especially at bed time. At the one week check up I had them lower it to 50 bpm. I immediately felt better and my sleep issues vanished. My lower setting has now been 50 for the past four months since the implant.

Of course YMMV - but worth having your settings tweaked at least temporarily.



Sleep quality

by Selwyn - 2019-01-25 07:54:45

Anxiety itself can disturb sleep. 

Who is not anxious 3 weeks after having a pacemaker insertion?

Why blame the poor sleep on your sleeping pulse rate?

Side effects of lowering the resting pulse: 

1.Prolonged PM  battery life.

2. Increased risk of thrombosis /embolism, therefore stroke, sudden death. ( Reason is that vascular flow rate depends on your cardiac output, and the cardiac output is diminished in proportion to your heart rate. A low flow rate predisposes you to blood clotting).

3. A lowering of your blood pressure ( same reasoning as 2.) Of course, a very low BP may cause problems such as impaired kidney function. Ever tried to get up at night  with a low BP/heart rate-?  dizziness, fainting can occur.  Generally speaking bathrooms are unyielding when you hit them!

Sleep quality

by ar_vin - 2019-01-25 13:30:56

Many of us who have been running, cycling, swimming etc for long distances for decades have naturally lower heart rates - mine has been in the high 40s-low 50s since my late teens. I know many many people who are involved in endurance sports that have lower heart rates.

To suggest that the entire population of endurance athletes is somhow at risk for the following is baloney!

"Increased risk of thrombosis /embolism, therefore stroke, sudden death. ( Reason is that vascular flow rate depends on your cardiac output, and the cardiac output is diminished in proportion to your heart rate. A low flow rate predisposes you to blood clotting)"

In any case as you do know all PM setting changes are done with the approval of an EP (if not, you have entirely different problem.....). The EP would NEVER allow HR to be lowered below a threshold that might lead to problems.

Please stop generalizing and playing doctor when you have a rather limited understanding of the range of human physiology. It's true that in some people a heart rate of 50 bpm might be dangerous. That does NOT mean that a rate 50 bpm is somehow going to cause a stroke in everybody.



Sleep Quality

by Selwyn - 2019-01-26 10:08:22

I am not suggesting that a stroke will follow with a low heart rate- what is being talked about is an increased risk, my so called, "predisposition"

(My on line  Dictionary explains this word meaning by : 1 lack of exercise may predispose one to high blood pressure: make susceptible, make liable, make prone, make vulnerable, put at risk of.)

If you care to educate yourself from an external source:

"Low heart rate. People who exercise extensively can have a lower-than-average heart rate and blood pressure. Both could be risk factors for blood pooling and clotting. A resting heart rate of less than 60 beats a minute, though not dangerous in and of itself, may increase the risk for formation of a clot.12 May 2014
The Downside of Low Heart Rate: Athletes Who Get Blood Clots ...   ( Google the Title,By Beth W. Orenstein.Medically Reviewed by Farrokh Sohrabi, MD)

Clearly the more vascular disease you have the more you are at risk. The more dehydrated you get ( does this mean atheletes?) the more at risk you are. 

Endurance atheletes have their own morbidity and mortality. Look up the statistics for marathon deaths and educate yourself further:

'Eleven runners have died while running the London Marathon since it began in 1981, and every year a handful of runners die while competing in such events (one study put the rate of sudden cardiac deaths during a marathon at 0.8 per 100,000 participants '.

'Many amateur athletes wear their reduced heart rates as a competitive badge of honor, proof that they are really fit. Unfortunately, sinus bradycardia is not always an effect worth boasting about. Lifelong athletes with low heart rates need pacemakers later in life much more often than the general population.'

And, " 'of course' an EP would NEVER allow HR to be lowered below a threshold that might lead to problems"! Where have you been for the last few years of reading this Club site?! ( Why not see  HOGG  2018-07-14 09:54:49 post on this site)

I have spent 40 years, as you put it,' playing doctor,' studying physiology when you were still at school!  . We know, there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns – the ones we don’t know we don’t know. I continue to learn medicine and do postgraduate study modules and try to keep up to date.

Try to demonstrate some objectivity.



Low Heart issues in athletes

by ar_vin - 2019-01-28 20:01:24

With due respect all you've quoted are fairy tale articles and NOT any peer reviewed science.

I don't care how many years you played doctor - it doesn't make you an "expert" on anything.

Given how dated your training might be, it's best you get yourself a real science based medical education before spreading fairy tales.



by IAN MC - 2019-01-29 13:17:00

I don't know which is the worst ....   your ignorance, your arrogance or your rudeness.

Selwyn has a lifetime's experience as a doctor. I have learned much from his contributions. I wish that more doctors contributed to this site !



Low HR

by ar_vin - 2019-01-29 21:14:58

It's good to know that Selwyn is an active contributor to this site.

I was simply responding to his poorly written post quoting a BS article that has almost zero credibility:

It's irrelevant how much experience one has - I have no way of knowing that. One can only judge any contribution by the quality of the information posted and credible sources provided as reference. The comment by Selwyn did neither - hence my response.

I'm happy to be corrected if he's willing to engage with peer reviewed published science to support his claims. Resorting to "hundred years of experience" doesn't hold much water. Please support your comments with verifiable facts from published peer reviewed literature.

I'm an experienced endurance athlete and have over the years heard and read a lot of unsupported, anecdotal mumbo jumbo.


Thrombosis Risk in Endurance Athletes.

by Selwyn - 2019-02-01 08:21:07

Deep vein thrombosis in athletes: risks of racing and resting

Beth Parker, Paul D. Thompson, Peter Kriz and Pierre d'Hemecourt

AMAA Journal. 23.1 (Winter 2010): p7+.

Fully referenced and cited by many authors.

Although not a journal article

offers a view concerning flow rate, where as every physiology student knows: Cardiac Output= Heart rate x Stroke Volume .  Flow rate then depends on cardiac output( and therefore heart rate), the diameter of the vessel, and the viscosity of the fluid within. 




takes a while

by dwelch - 2019-02-12 06:08:53

A combination of the pacer changes your hearts rythm for the better, how much better and how depends on your condition and how they are treating it.  And anxiety.  Pain alone after a new pacer (am on number five) I dont sleep well for the first few weeks, but then settle in before I realize it...First pacer took longer, my lower limit was much faster than my normal resting or sleeping rates, plus no doubt the anxiety factor.  It will pass you will settle in to this new life.

Let's not fight

by ChristopherTodd - 2019-02-26 17:58:53

I just had pacemaker put in 2 ago this past Friday. My heart swelled then had to be cut again to move lead. Now I was paced at 50 but heartrate was 43. Today they raised it to 60 and not so tired since leaving dr office. I am anxious beyond belief and really need some feedback and support, that's why I am here. I appreciate anything you have to offer. 



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I've seen many posts about people being concerned about exercise after having a device so thought I would let you know that yesterday I raced my first marathon since having my pacemaker fitted in fall 2004.