Heart Rate Sleep Monitor

[Boatman37210]

I have a hypersensitive carotid artery conditions and doctors are wanting to insert a pacemaker. I want to avoid that if possible. Pressure on the carotid artery can slow the heart down to dangerous levels.

This condition does not affect me during the day as long as I avoid any pressure on the carotid. It may affect me during sleep at night, but that is an unknown at this point. No one has put me on a heart rate monitor during sleep to see if during the night my heart rate severely drops.

Anyone know of a heart rate sleep monitor with an alarm? The alarm goes off to wake me up should the heart rate drop below a certain point.

If I cannot find one with an alarm, I am thinking about a brand called Bedit at bedit.com. Has a thin strip that is placed under the bed sheet and sends information during the night to your smart phone. Nothing is hooked to your body, so looks to be very easy to use if it works.

Thanks

[Sheryl]

I don't know of any for sale in Thailand if that is what you mean, though you can probably buy online.

However, I think it is a very bad idea because:

1. You will inevitably get many false alarms due to position changes that interrupt the monitor's sensing, or transient drops in rate not due to the carotid issue. Will interfere with your sleep.

2. In the event of a loss of heartbeat or prolonged drop below a certain level you might be unable to hear/respond to the alarm quickly enough.

3. Night time is not the only risk. While you may take pains to avoid pressure on the carotid, it is still possible that something could startle you into a posture that causes a problem, or you fall into one, or get into an accident which puts pressure on the carotid.

There are 2 ways you can safely get a reading of what your heart rate is doing during sleep:

1 - a sleep study at a sleep lab (most hospitals have them)

2 - wearing a small portable home cardiac monitoring device ("Holter monitor" or equivalent) for a few days. This would probably be better than #1 as the first option will tell you only what happened on one specific night (and a night spent in an unfamiliar environment at that) whereas the second can be done for a few days in a row and at home.

You would need to see a cardiologist for #2, would also be a chance to get a second opinion re the pacemaker. Pacemakers are recommended for hypersensitive carotid syndrome only if the condition is severe enough that there are recurring and incapacitating symptoms, e.g. repeated fainting episodes...in which case it is very effective. In people who are asymptomatic or whose symptoms can be managed through lifestyle measures, not usually recommended.

But if your issue is that you are otherwise fearful of going to sleep, and it interferes with your ability to do so, then perhaps an alarm monitor would help in that regard. If so, a pulse oximeter device that attached to your finger may be the easiest thing to find - some have alarms and they measure both pulse and blood oxygen levels. Medical equipment companies should have them, or can get them on Amazon or through lazada

http://www.lazada.co.th/shop-pulse-oximeters/

[Boatman37210]

Edited March 14, 2016 by Boatman37210

[Boatman37210]

Sheryl,

The above post was in error. Tried to edit, but after writing a lengthy response the site said I did not have the authority to edit.

Anyway, thanks for the input. I do not have any day to day symptoms, so most likely will not do the pacemaker. Will look into the finger tip monitor. Also will look into the cardiac monitor through the hospital.

[sunnyjim5]

Sheryl,

The above post was in error. Tried to edit, but after writing a lengthy response the site said I did not have the authority to edit.

Anyway, thanks for the input. I do not have any day to day symptoms, so most likely will not do the pacemaker. Will look into the finger tip monitor. Also will look into the cardiac monitor through the hospital.

Before making the decision to definitely refuse the pacemaker you should think about obtaining a second Cardiologists opinion.

The actual procedure for inserting the pacemaker is minimally invasive and often done using local anaesthetic +/- mild sedation.

[Boatman37210]

Two doctors have said pacemaker. First one said pacemaker witout too much discusion and no tests. Neither doctor talked about possible lifestyle changes rather than surgery. On a day to day basis I feel fine. No symptoms. No falling or fainting. The only reason I discovered it was one day I was feeling around for my carotid and started passing out because of preasure. For now just do not see the need, but maybe down the road will need.

[Sheryl]

See this http://emedicine.medscape.com/article/153312-treatment

Since it is only deliberate pressure in the area that causes problems and there are no spontaneously occurring symptoms, I suggest you get another opinion. Dr. Thaworn at Bangkok Christian Hospital is a very good cardiologist who takes time to listen and explain things, if you are in or can go to Bangkok.

Note though that even if pacing is not be necessary now, as you age it might become so (which might have been part of the reasoning of the doctors who recommended pacing now).

So would be wise to be under the care if a good cardiologist already. Also, make sure your wife or friends/relations (whomever might find you if you passed out) know about this history and have the name and number of your cardiologist, may save confusion, delays and unnecessary treatments etc if the condition does eventually lead you to faint.

In terms of lifestyle, the main things are to be very careful when shaving or doing anything that involves pressing on in the neck (might have to instruct barbers accordingly) and avoiding having anything too tight around the neck.

[Sheryl]

Sorry, it belatedly registered with me that you said the first doctor did no tests.

In order to diagnose this it is necessary to do a test where, under close supervision, you are hooked up to an EKG with blood pressure cuff on and the doctor presses on or massages the carotid artery area in order to replicate the symptoms and see what the BP and heart rhythm are at that time.

Has to be done by a cardiologist and, in Thailand at least (where emergency precautions and protocols in clinics/doctor offices tend to be weak) should be done in a hospital (as an outpatient - but in a hospital facility in case of adverse reaction).

If this has not yet been done then it is not even clear you have CHS.

[Boatman37210]

Sorry, it belatedly registered with me that you said the first doctor did no tests.

In order to diagnose this it is necessary to do a test where, under close supervision, you are hooked up to an EKG with blood pressure cuff on and the doctor presses on or massages the carotid artery area in order to replicate the symptoms and see what the BP and heart rhythm are at that time.

Has to be done by a cardiologist and, in Thailand at least (where emergency precautions and protocols in clinics/doctor offices tend to be weak) should be done in a hospital (as an outpatient - but in a hospital facility in case of adverse reaction).

If this has not yet been done then it is not even clear you have CHS.

Second doctor did this test and it was confirmed I have CSH. There is no doubt. Done in a hospital environment with a backup team present in case things went south. They did an MRI after to make sure there were no other possible causes. MRI came back normal.

When I first discovered I had CSH it was the right carotid. Was on a road trip at the time. Scared me, so went to a local emergency room. Doctor in the emergency said that CSH was common in people with heart disease, but only on the right side. Never on the left. He did not seem to be too concerned about it. A cardiologist a few months later said it is not normal and that I should be concerned about it.

When I did the above test could not get the right side to show symptoms. Doctor said she wanted to try the left side which I thought was odd after what the emergency room doctor said. Momentarily after the doctor applied pressure to the left side heart rate dropped down into the 30's, started passing out, and then I felt a shock. Come to find out the doctor had me hooked up to a defibrillator just in case. Once the heart rate gets too low the defibrillator kicks in. She said that both carotids can have CSH. Doctor said that physicians will see maybe one case in 5 years. If I understood her correctly, she had never seen someone with CSH.

I have sleep apnea, so have a problem sleeping. Tried to use a cpap for years, but never could adjust.

I stay tired all the time and all doctors say it is the sleep apnea. But I am wondering if CSH could also be part of the problem. If I knew that a pacemaker would improve my sleep, I would probably do it. That is why my interest in monitoring my heart rate during sleep.

[Sheryl]

If the doctor who did the test had not had much experience with CHS, all the more reason to get another opinion. There is some controversy as to the criteria for interpreting test results especially as regards cardioinhibition (slowing/cessation of heartbeat) and many clinicians consider the currently used cut-offs to be over-sensitive i.e. to yield a lot of false positives. I know you passed out, probably due to ventriuclar tachycardia or fibrillation (since they had to defibrillate), but carotid sinus massage can soemtimes do this in people without CHS as well.

If you do get another opinion, try to get all your records to bring with you.

How long ago was your sleep apnea diagnosed? Did you have a sleep study?

If the carotid was so sensitive that a simple twisting of the neck position in sleep could set it off then you would likely have episodes of faintness while awake as well.

I can appreciate the inability to use CPAP. There are alternative, oral appliances (basically a type of mouth guard that keeps the jaw a bit forward) that work about 50% of the time, have you tried these? http://www.aasmnet.org/Resources/clinicalguidelines/Oral_appliance-OSA.pdf