How to avoid afib attacks?


Can’t sleep? You may be at risk for atrial fibrillation

In the journals

Published: October, 2018

If you have problems sleeping through the night, you may be at risk for atrial fibrillation (afib), an irregular heart rate that may cause heart palpitations and is a leading cause of stroke.

A study published online June 25, 2018, by HeartRhythm reviewed four studies and found a link between afib and poor sleep. In one study, people with afib had more frequent nighttime awakenings compared with those who did not have the condition. In the other studies, poor sleep quality, including frequent nighttime awakenings and less REM (rapid eye movement) sleep, predicted which individuals would develop afib.

It’s not clear how poor sleep may be a possible risk factor for afib, but the researchers noted that other studies have shown that sleep apnea — a disorder in which your breathing repeatedly stops and restarts — is also associated with a higher risk of afib, although the exact reason is unknown.

They suggested people speak with their doctor about any sleep problems and try to practice better sleep hygiene — for instance by going to bed at the same time each night; creating a dark, cool sleeping environment; and avoiding caffeine and screen time before bedtime.

As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

Keeping Up Your Energy with AFib

Do you know how to handle fatigue with AFib?

Between the sleepiness, fatigue, low energy and general malaise atrial fibrillation can be a draining disorder. While some people won’t detect too much of a difference in their energy levels, many of those who live with AFib complain of frequent fatigue that can interrupt their daily routine.

What’s to blame for your low energy? The frequency and severity of your AFib episodes, your daily activity and habits, and your treatments can all factor into how tired you feel. Understanding what’s at the heart of your AFib fatigue is the first step. Once you know, you can apply some smart strategies to boost your energy.

Where does your fatigue come from?

When your heart beats faster than normal for a long stretch of time, the muscle gets tired. That’s the short answer. However, understanding what exactly is happening with AFib can help you pinpoint the problem (and hopefully help you to treat it).

A rapid heart rate is a primary issue: healthy atria contract between 60 and 80 times a minute, but when your atria are in fibrillation, the contractions are incomplete. Instead, these upper chambers quiver – up to 400 times each minute.

Although your AV node tries to calm this overactivity, it can’t halt every extra electrical impulse. These erratic electrical signals funnel into the ventricles, causing the heart to beat much faster than normal, and that can feel like an exhausting workout.

A rapid heartbeat is only one part of the equation; inefficient blood flow can be another source of fatigue. When the atrial chambers flutter instead of contract, they can’t pump blood as well, which means the oxygen-rich blood your tissues rely on won’t always reach them. When your tissues and organs run out of fuel, you can feel weak and tired.

Is another condition at play?

It’s not unusual for AFib to come with (or from) other chronic conditions, especially if that other issue has been mismanaged or gone untreated. Cardiovascular disease is a significant risk factor for AFib, and it can bring side effects like shortness of breath, and, in turn, decreased energy. Congenital heart defects can also be to blame – for some people, one of the first warning signs of a defect is shortness of breath and fatigue.

Although older age, high blood pressure, and heart disease top the list of fatigue risk factors, other health issues can also drain your energy and encourage AFib symptoms. Sleep apnea, asthma, and COPD can all interfere with how oxygen moves to your tissues, which means they can cause even more fatigue than you’d have with AFib alone.

Change your habits, change your energy levels

Managing your AFib symptoms is a key to improving processes in your body and boosting your energy levels. You can modify your routine to respect your limitations, helping you to conserve more energy to use throughout the day. And by working to keep your symptoms to a minimum, you can avoid the consequences of a prolonged elevated heart rate.

Move in intervals. When you parcel your activity into shorter stretches, your energy stores can last longer. Try to space out your errands through the course of your day. When you exercise, alternate a few minutes of effort with a few minutes of rest, to better balance your cardio benefits with AFib symptom management.

You might find your energy levels are higher at a certain time of day. Pay attention to those patterns – it can help you plan your activities strategically.

Mind your minerals. Many people – and AFib patients in particular – tend to have low levels of magnesium, which can manifest in a number of ways, like muscle twitches, cramps, and fatigue. Since magnesium is crucial for healthy cells, you’ll want to make sure your magnesium level is topped up.

Look out for the warning signs of a magnesium deficiency: when your AFib symptoms come alongside discomforts like muscle spasms, insomnia, and irritability, you might need more magnesium. While a balanced diet can help bring up the level of this electrolyte, it probably won’t be enough. Supplements, in the form of pills or topical spray, can be an easier and more effective way to get magnesium to your tissues and relieve some of the extreme fatigue.

Check in with your sleep

A healthy lifestyle is vital, but focused AFib management plays an important role in your quality of life, too. Sleep is incredibly important for your body to reset and recover. Your sleep needs can change as your age or as your AFib progresses, so it’s a good idea to look closely at your routine to make sure you’ve done what you can to keep symptoms under control.

Morning stress could set you on an uncomfortable path for the rest of the day, but a good night’s sleep can help you wake with a clear head and a proactive mood. Are you getting enough sleep? Is it quality sleep? Instead of relying on coffee to kickstart your day (caffeine is a notorious AFib trigger), pay more attention to getting a solid eight hours of rejuvenating sleep – which probably means cutting out alcohol in the evening.

Modify your treatment plan

Medication can help you manage your AFib, but your dosage needs can change over time. Drugs like beta blockers can cause significant fatigue. Remember that there are different medications to treat AFib and heart disease, and surgical options to consider when medication aren’t cutting it. Speak to your doctor about catheter ablation or the surgical maze procedure – these might be logical next steps to get your heart rhythm under control for the long term, which will reduce your symptoms or even eliminate them altogether.

What can I do to prevent (reduce my risk for) atrial fibrillation (AFib)?

To reduce your risk for the onset of AFib, maintaining a heart-healthy lifestyle is always your best option. If you have been diagnosed with AFib, take medications if they are prescribed for you, and get proper treatment and management of your condition so you can reduce the risk of AFib’s harmful consequences.

View an animation of atrial fibrillation.

What can I do to reduce my risk of complications associated with atrial fibrillation?

  • Get regular physical activity
  • Eat a heart-healthy diet, low in salt, saturated fats, trans fats, and cholesterol
  • Manage high blood pressure
  • Avoid excessive amounts of alcohol and caffeine
  • Don’t smoke
  • Control cholesterol
  • Maintain a healthy weight

All of these goals aide in the prevention of (reducing the risk for) heart disease, and will help keep your circulatory system in the best condition.

Other underlying conditions may need treatment because they can contribute to the onset of AFib:

  • High blood pressure (hypertension)
  • Sleep apnea
  • Thyroid disease (hyperthyroidism)
  • Diabetes
  • Chronic lung disease
  • Other heart conditions (heart attack, heart valve disease, or heart failure)
  • Family history
  • Obesity

What can I do to prevent (reduce my risk for) stroke?

The risk of stroke in the AFib patient is as much as 5 times greater than that of the person without the heart disease.

Get treated

The treatment of AFib is imperative for the prevention of (reducing the risk for) stroke.

Know your additional risk factors

Some other examples of stroke risk factors are:

  • History of high blood pressure
  • Increased age
  • Previous stroke or (TIA)
  • Diabetes
  • Heart disease
  • Family history
  • Obesity
  • Smoking

Commit to a heart-healthy lifestyle

The good news is that up to 80 percent of strokes can be prevented. You can control your risk factors by changing your lifestyle and by treating your medical conditions as instructed.

Download our patient information sheets on how to live a heart-healthy lifestyle.

5 Surprising Triggers for Afib

2. Air Pollution and Environmental Factors

Although the research is still emerging, some studies have demonstrated an association between air pollution and a higher risk of afib. A study published June 2017 in the International Journal of Environmental Research and Public Health showed that increased exposure to air pollutants within the previous 24 hours was associated with a greater number of afib-related emergency room visits.

In a study published in March 2017 in Environmental Health Perspectives, researchers in Denmark found that long-term exposure to traffic-related air pollution correlated with a higher risk of afib.

3. Certain Foods and Beverages

The triggers for afib can be very specific to the patient, notes Mark (Nathan A.)_Estes, MD, a cardiologist at the University of Pittsburgh Medical Center. “In some cases, patients experience increased afib episodes after eating cold foods like ice cream or cold drinks.” Other patients report more afib episodes after eating certain types of cuisines, such as Chinese food. The main thing is to be aware of your specific food-related triggers. It may help to keep a food journal in order to know which foods may be associated with your episodes.

For people who enjoy a cup of coffee, you may be in luck. Healthcare providers have historically warned people with afib about the potential harms of drinking caffeinated beverages. But a comprehensive study published in April 2016 in the Journal of the American College of Cardiology: Clinical Electrophysiology, found that tea and coffee are safe for people with afib when consumed at moderate levels. In some cases, tea and coffee may actually be protective against afib.

4. Too Much Physical Activity or the Wrong Types of Exercise

“Afib is often considered a lifestyle disease,” says Dr. Estes. “To reduce your risk of afib, it’s important to follow a healthy diet, manage your weight, and to exercise on five or more days of the week.”

More exercise, however, is not always better. In fact, vigorous exercise can actually cause afib. Examples of vigorous exercises include strenuous hiking, long-distance running, or very high impact aerobic exercises. The sweet spot appears to be somewhere in the middle — regular but moderate exercise.

If you’re considering a new exercise program, talk to your healthcare providers about the best plan for you. Many people find that walking is a good start. You may also want to consider a heart rate monitor to ensure that you stay in a safe heartbeat range. Another useful guide is whether you can carry on a normal conversation during exercise; if you can’t, the intensity is probably greater than moderate.

5. Sex Hormones

Some research shows testosterone in men is associated with a higher risk of afib, whereas a study published in July 2018 in the European Journal of Cardiology shows the opposite. And a study published in October 2017 in Endocrine observed that higher levels of bioavailable testosterone in men was associated with a higher risk of afib. For women in the study, however, higher levels of bioavailable testosterone were associated with a lower risk of afib.

Importance of Lifestyle Changes and Tracking Your Pulse

“Long-term, what works the best to prevent or manage afib is lifestyle optimization,” says Day. This includes maintaining a normal body weight, eating a healthy diet, getting good sleep, and regular physical activity.

“Lifestyle changes can take care of about 50 percent of afib cases,” says Day. “For those who don’t respond to lifestyle changes alone, the next best long-term option is to get afib ablation in conjunction with lifestyle optimization.”

Day notes that tracking your pulse is easy and can be done in as little as 10 seconds a day. You can use devices like the Apple Watch 4, which has an FDA-approved electrocardiogram (ECG) monitor built in to help detect afib. If you don’t want to buy a watch or other wearable device, you can also take your own pulse without any special equipment. The main point is to be sure that your pulse is not too fast or too slow. And that it’s not too irregular.

“A normal heart rate for most people will be about 50 to 90 beats a minute, and it should be regular,” says Day. “If you have a chaotic pulse, there’s a good chance that you may be in afib.”

Atrial fibrillation

Atrial fibrillation is a type of abnormal heart rhythm (arrhythmia) of your heart.

Atrial fibrillation starts in the upper chambers of your heart (the atria) and causes them to quiver (fibrillate), instead of beating normally.

This can mean your heart doesn’t pump blood around your body as efficiently as it should.

Some people have a single episode of atrial fibrillation. For others it can come and go (sporadic or paroxysmal), or be permanent (persistent).

It’s important to diagnose and treat atrial fibrillation because it can cause blood clots that can block blood supply to your vital organs and lead to a stroke. It may also be a sign that you have heart disease.


The most common causes of atrial fibrillation are:

  • long-term high blood pressure
  • coronary heart disease (blocked arteries)
  • valvular heart disease (problems with your heart valves).

It is sometimes caused by hyperthyroidism (when your thyroid is too active). This cause can be treated.

Atrial fibrillation can also be associated with chest trauma or surgery, or too much caffeine or alcohol. Some medicines or diseases (like pneumonia) can trigger atrial fibrillation. Sometimes there is no known cause.


Atrial fibrillation can cause symptoms like:

  • a ‘fluttering’ heartbeat
  • an irregular pulse
  • weakness
  • tiredness
  • dizziness.


If your doctor suspects you have atrial fibrillation, they may do tests like an electrocardiogram (ECG) or echocardiogram. Read more about medical tests


Your doctor will decide on the best treatment, depending on:

  • how bad your symptoms are
  • the cause (if known)
  • how long you have had the problem
  • your risk of stroke and other problems
  • the risks of each treatment.


Most people with atrial fibrillation will need to take medicines. Your doctor will decide the best ones. Ask your doctor for information on these medicines.

They may prescribe medicines to restore or maintain a normal heart beat in the short or long term.

Most medicines usually have to be taken for the long term. It’s important to take medicines as prescribed.

Read more about medicines.


Your doctor may also recommend procedures like:

  • electrical cardioversion
  • catheter ablation
  • surgery (very rare) to try to make your heart beat normally.

Read more about heart procedures

Lifestyle changes

As with other heart conditions the best way to manage your heart health is to make sure you see your doctor regularly and reduce the risks. It’s important to manage the risk factors for heart disease to avoid more heart problems. Find out about the risk factors and what you can do about them

You may also need to reduce your caffeine intake. Talk with your doctor about what’s best for you.

Ways to stop an A-fib episode

There are several methods that may help stop an episode of paroxysmal or persistent A-fib once it starts.

These include:

1. Take slow, deep breaths

Share on PinterestIt is believed that yoga can be beneficial to those with A-fib to relax.

To practice deep breathing, sit down and place one hand on the stomach.

Inhale deeply through the nose, all the way into the stomach, for a count of 4 seconds.

Do this to slowly fill up the lungs with air gradually, until they are completely filled.

Hold this breath for a moment, before exhaling through the mouth for the same amount of time.

2. Drink cold water

Slowly drinking a glass of cold water can help steady the heart rate. This tip is especially useful for those whose A-fib episode has been brought on by dehydration.

3. Aerobic activity

Some people report feeling better after exercising. A 2002 case study, published in the New England Journal of Medicine, found that a 45-year-old athlete with paroxysmal A-fib stopped symptoms by engaging in a low impact aerobic activity. In this case study, the athlete used an elliptical machine or a cross-country skiing machine.

People wishing to try this method of dealing with an A-fib attack should speak to their doctor first.

4. Yoga

Yoga is known to relax those who practice it by focusing on the breathing. This could be beneficial for those with A-fib — both to stop a current episode and as a preventative technique.

In 2015, a study published in the Journal of Arrhythmia reported that people with A-fib who undertook twice-weekly yoga sessions over a 3-month period enjoyed significant reductions in high blood pressure and heart rate. Participants also reported a better quality of life.

5. Biofeedback training

Biofeedback techniques can have a calming effect on people during an A-fib episode. Biofeedback involves training the mind to control the body’s responses to external and internal triggers. It can improve a person’s control of their autonomic nervous system functions, which can stabilize the heart’s rhythm.

While preliminary research on biofeedback suggests that it can be used to decrease episodes of fibrillation, more controlled research is necessary.

6. Vagal maneuvers

These techniques may stop a paroxysmal A-fib episode. Vagal maneuvers involve doing things to trigger the vagus nerve, a nerve that impacts heart function.

Examples of such maneuvers include coughing, or engaging the muscles as if having a bowel movement.

7. Exercise

Exercise helps with weight management, regulates the heart rate, stops stress, and lowers blood pressure.

Aim for at least 20 minutes of aerobic activity most days, such as:

  • walking
  • jogging
  • hiking
  • cycling
  • using an elliptical machine

Lifting weights can also be beneficial. Always warm up before exercise and stay hydrated throughout.

8. Eat a healthful diet

Follow a heart-healthy diet to reduce the risk of A-fib episodes, strokes, and heart conditions.

It is also important to stay hydrated throughout the day to prevent A-fib episodes and other health concerns.

  • Alcohol: Research suggests that even moderate drinking can cause A-fib episodes in those with heart disease or diabetes. People with A-fib should drink no more than two alcoholic beverages on any day.
  • Caffeine: Research on the benefits or risks of caffeine for people with A-fib is mixed. While moderate amounts of coffee or tea may be fine, it may be best to avoid excessive quantities of caffeine.

9. Manage high blood pressure and cholesterol

Having high cholesterol is a risk factor for a heart attack, which can also impact the heart rate. High blood pressure can interfere with the electrical system that regulates a steady heartbeat.

It is important to work with a doctor if lifestyle changes cannot keep these health markers in the healthy range. For some people, medication may be necessary.

Blood pressure monitors are available from pharmacies or you can purchase them online.

10. Get enough sleep

Lack of sleep could trigger an A-fib episode. Furthermore, some sleep conditions — including sleep apnea and insomnia — can increase the risk of heart problems.

For optimal health, people should aim to get between 7 and 9 hours of quality sleep a night. Anyone who suspects they have sleep apnea should consult a doctor.

11. Maintain a healthy weight

Being overweight or obese can increase the risk of diabetes, sleep apnea, and high blood pressure, which are all risk factors for A-fib.

12. Do not smoke

Smoking has been linked to an increased incidence of A-fib. Research suggests that current smokers have a more than twofold-increased risk of A-fib than non-smokers and former smokers.

Tobacco use also increases the risk of stroke and other heart conditions.

13. Stop stressing

Intense emotions, such as stress and anger, can cause problems with the heart’s rhythm. Practice good stress management techniques, such as:

  • exercise
  • deep breathing
  • meditation
  • progressive muscle relaxation
  • yoga

Many of these can also be used to stop A-fib attacks in their tracks.

Avoiding atrial fibrillation

How maintaining a healthy weight and other lifestyle habits can help prevent this common heart rhythm disorder.

Published: February, 2017

During a bout of atrial fibrillation, your heart may beat so rapidly, it may feel as though it’s going to explode out of your chest. Commonly known as afib, this heart rhythm problem can leave you breathless and lightheaded—or cause no symptoms at all. About 9% of people ages 65 and older have afib, which raises the risk of stroke and other heart-related problems. But there are ways to lower your odds of developing afib—or to reduce its impact if you already have the condition.

Lessen your load

By far, the most important step you can take is to attain and stay at a healthy weight. “We have good evidence from multiple studies showing that people who are overweight have a higher risk of afib than people who are at a healthy weight,” says Harvard professor of medicine Dr. Christine Albert, who directs the Center for Arrhythmia Prevention at Brigham and Women’s Hospital. And the more you weigh, the higher your risk: people who are overweight have a 20% to 25% higher risk, whereas those who are obese (a body mass index, or BMI, of 30 or higher) have a 60% higher risk. (To calculate your BMI, see

To continue reading this article, you must login.

Subscribe to Harvard Health Online for immediate access to health news and information from Harvard Medical School.

  • Research health conditions
  • Check your symptoms
  • Prepare for a doctor’s visit or test
  • Find the best treatments and procedures for you
  • Explore options for better nutrition and exercise

Learn more about the many benefits and features of joining Harvard Health Online “

About the author

Leave a Reply

Your email address will not be published. Required fields are marked *