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Suggest Treatment For Chronic Insomnia While On Diltiazem
Question: I was put on Diltiazem and Eliquis after new onset AFib. 240 Mg. Diltiazem 240 Mg. 24 hr. ER twice a day (a lot) and 5 Mg. Eliquis. No history of heart issues. I believe it is stress and lack of sleep related. Had a knee surgery one week after starting meds and the swelling from the Diltiazem is impeding my physical therapy and recovery from knee surgery. Icing and elevation give short term leg swelling relief. I am a very fit and healthy 67-year-old so all new to me. Called MD today and he is changing me to a beta blocker instead of a calcium blocker (Lepressor). Any thoughts. To complicate matters, I have had chronic insomnia since starting these medications.
Brief Answer:
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that as Diltiazem has exerted an adverse effect (limbs swelling) it should be discontinued immediately. Your doctor has rightly decided in this regard.
For controlling the heart rate besides calcium channel blockers (where Diltiazem belong) other classes like beta-blockers would be beneficial.
So, Lopressor seems to be a rationale substitute to Diltiazem and lacks this unpleasant affect (leg swelling).
An average Lopressor daily dose of 100 mg (divided twice a day) would be a good therapeutic regimen.
You should continue anticoagulation (Eliquis or any other anticoagulants) as far as atrial fibrillation leads you at risk of thromboembolic events.
Regarding stress and lack of sleep, you are right; they may lead to exacerbation of cardiac arrhythmias.
In order to avoid this triggering factor, I recommend follow a careful strategy in optimizing first your sleep and after that the whole daily life-style.
Avoid stimulant drinks (caffeinated drinks, certain teas, smoking contacts), try to take dinner distantly from going to sleep.
I recommend also to check you thyroid gland function (thyroid hormones level), which could greatly influence your daily mood, sleep and heart rate.
Outside walks could be beneficial to relieve anxiety and stress; also some physical activities (yoga, aerobics, etc).
In addition some medications, like zolpidem, melatonin, etc, could be helpful at regulating your sleeping profile, if the above measures are not sufficient.
You need to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties feel free to ask me again!
Kind regards,
Dr. Iliri
I would explain as follows:
Detailed Answer:
Hello!
Welcome on HCM!
I passed carefully through your medical history and would like to explain that as Diltiazem has exerted an adverse effect (limbs swelling) it should be discontinued immediately. Your doctor has rightly decided in this regard.
For controlling the heart rate besides calcium channel blockers (where Diltiazem belong) other classes like beta-blockers would be beneficial.
So, Lopressor seems to be a rationale substitute to Diltiazem and lacks this unpleasant affect (leg swelling).
An average Lopressor daily dose of 100 mg (divided twice a day) would be a good therapeutic regimen.
You should continue anticoagulation (Eliquis or any other anticoagulants) as far as atrial fibrillation leads you at risk of thromboembolic events.
Regarding stress and lack of sleep, you are right; they may lead to exacerbation of cardiac arrhythmias.
In order to avoid this triggering factor, I recommend follow a careful strategy in optimizing first your sleep and after that the whole daily life-style.
Avoid stimulant drinks (caffeinated drinks, certain teas, smoking contacts), try to take dinner distantly from going to sleep.
I recommend also to check you thyroid gland function (thyroid hormones level), which could greatly influence your daily mood, sleep and heart rate.
Outside walks could be beneficial to relieve anxiety and stress; also some physical activities (yoga, aerobics, etc).
In addition some medications, like zolpidem, melatonin, etc, could be helpful at regulating your sleeping profile, if the above measures are not sufficient.
You need to discuss with your attending doctor on the above mentioned issues.
Hope to have been helpful to you!
In case of any further uncertainties feel free to ask me again!
Kind regards,
Dr. Iliri
Note: For further queries related to coronary artery disease and prevention, click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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