Heart Palpitations at Night: Diagnosis and Treatment

Heart palpitations can make someone feel like their heart is fluttering, racing, pounding, or skipping beats. Waking up with these sensations, or feeling them while trying to fall asleep, can be alarming. But heart palpitations are common at night, and in most cases they are not signs of a medical emergency. 

While nighttime heart palpitations sometimes indicate a problem with the heart, they may also be caused by anxiety, caffeine, certain medications, or other factors.

How to Recognize Heart Palpitation Symptoms

With heart palpitations, a person has an uncomfortable awareness of their own heartbeat. They may feel as if their heart is beating more strongly than usual, or they may perceive actual changes in heart rate and rhythm.

A person with heart palpitations might notice one or more of these sensations when lying down at night:

• Rapid heart rate
• Irregular heart rhythm
• Fluttering in the chest
• Pounding in the chest or neck

What Causes Heart Racing at Night?

There are a number of known causes of nighttime heart palpitations, ranging from heart problems to the positions people sleep in. However, in some cases heart palpitations may occur for no known reason Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source .

Medical and Mental Health Conditions 

Researchers have linked various medical and mental health conditions with heart palpitations that happen at night.

• Heart conditions: Several heart problems can cause sleep-disrupting heart palpitations, including heart disease, damage from a heart attack, and heart rhythm disorders called arrhythmias. And palpitations caused by a heart condition may be more noticeable when a person is lying down. 
• Sleep apnea: Sleep apnea causes repeated pauses or reductions in breathing during sleep. These breathing disruptions can cause oxygen levels to dip, which can stress the heart and lead to heart palpitations at night.
• Stress and anxiety: Already known to interfere with sleep, stress and anxiety can also bring on heart palpitations. Additionally, research suggests that people with chronic anxiety are more likely to develop arrhythmias Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source that cause irregular heartbeats. 

Alcohol and Caffeine 

Consuming certain beverages, especially close to bedtime, can also trigger heart palpitations at night.

• Alcohol consumption: Heavy alcohol users have a greater risk of cardiomyopathy, a condition that enlarges the heart and increases the risk of arrhythmias.
  Since people usually drink alcohol after 6 p.m., and because alcohol can interfere with sleep, people may be more likely to notice alcohol-induced palpitations at night.
• Caffeine use: Caffeine can elevate the heart rate and may add extra beats. The effects of caffeine can last up to eight hours, so people who consume caffeine in the afternoon and evening have a greater chance of nighttime heart palpitations.

Temporary Physical States

Nighttime heart palpitations are also more likely to happen when a person does not get the water or nutrition their body needs. Additionally, certain sleep positions can make heart palpitations more likely. 

• Dehydration: Not drinking enough water can make the heart beat fast and forcefully. Therefore, people who go to bed dehydrated may have a greater chance of heart palpitations. In addition, research shows that dehydration can shorten the time spent asleep Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , so it could increase the chances of noticing heart palpitations at night.
• Electrolyte imbalances: Arrhythmias, or irregular heartbeats, can result from low levels of electrolytes such as potassium and magnesium. An electrolyte imbalance may occur at night if a person does not consume enough nutritious food and drink during the day.
• Sleep position: People who sleep on their backs or on their left sides are more likely to have heart palpitations. Sleeping on the left side, in particular, may increase awareness of heart sensations, as it shortens the distance between the heart and the chest wall.

Other Causes

A variety of triggers may also be responsible for heart palpitations that can occur at any time, including at night.

• Thyroid problems: An overactive thyroid gland can result in a rapid heart rate or irregular heart rhythm.
• Pregnancy: Pregnant people often notice heart palpitations, possibly because of the increased heart rate Trusted Source UpToDate More than 2 million healthcare providers around the world choose UpToDate to help make appropriate care decisions and drive better health outcomes. UpToDate delivers evidence-based clinical decision support that is clear, actionable, and rich with real-world insights. View Source and blood volume during pregnancy.

• Anemia: If a person’s body does not have enough red blood cells to keep the body supplied with oxygen, their heart may beat faster than usual.
• Hypoglycemia: Low blood sugar levels can cause anxiety symptoms Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , including heart palpitations.
• Fever: Fevers often cause a person’s heart rate to become more rapid.
• Medications and recreational drugs: Certain prescription and over-the-counter medications, such as blood pressure medications and decongestants, can cause heart palpitations, as can the use of recreational stimulants such as cocaine.

How Heart Palpitations Are Diagnosed

A doctor may be able to diagnose the cause of a person’s heart palpitations by conducting a thorough physical examination, reviewing their medical history, and ordering diagnostic tests.

Physical Examination

During a physical examination, the doctor will check a person’s pulse, blood pressure, blood oxygen levels, and temperature, as well as listen to the person’s heart for any abnormal sounds. The doctor may ask about the frequency and duration of the palpitations and if any triggers, such as caffeine or stress, make them worse. Additionally, the doctor may ask about the medications a person takes and whether heart palpitations run in their family.

Electrocardiogram

One standard medical test for people with palpitations is the electrocardiogram (ECG or EKG). An ECG is a painless, non-invasive procedure that records the electrical signals produced by heartbeats. Doctors can use this information to identify abnormal heart rhythms.

Since heart palpitations might not happen at the time of the ECG, the test may not detect any unusual heart activity. In this case, the doctor may recommend wearing a monitor to track the heart’s activity for a few days. 

Other Diagnostic Tests

Based on the results of the ECG, the doctor may also order blood tests or other diagnostic tests. These tests can help doctors learn whether the heart palpitations might be related to anemia, electrolyte imbalance, an overactive thyroid, or other underlying health concerns.

How Are Heart Palpitations Treated?

The treatment for heart palpitations varies depending on the cause. If a doctor determines a person has an arrhythmia, they might recommend specific drugs that help the heart beat at a regular rhythm.

If a doctor believes an underlying condition is to blame, then treating that condition may also resolve the palpitations. For example, if heart palpitations occur alongside anxiety, doctors may recommend anti-anxiety medication or a form of talk therapy. If treating the anxiety successfully reduces the palpitations, the person may not need any further treatment.

Similarly, if a person’s heart palpitations start alongside a new medication, the doctor might recommend changing the medication.

If the doctor cannot find a cause, and if the person shows no signs of a heart condition or other medical problem, the doctor might reassure them that their palpitations are harmless and recommend no treatment at all. However, if any additional symptoms develop or the palpitations change in intensity or frequency, the person should report those observations to their doctor.

How to Prevent Heart Palpitations at Night

In addition to medical treatments, certain lifestyle changes might help prevent palpitations from happening at night. These include:

• Limiting caffeine, nicotine, and alcohol intake, especially at night
• Making sure to stay hydrated throughout the day
• Trying a different sleep position
• Finding ways to reduce stress, such as exercising, getting seven or more hours of sleep every night, and doing things you enjoy
• Trying relaxing activities such as yoga, meditation, or breathing exercises

Poor sleep has been associated with an irregular heartbeat, and sleep loss can lead to anxiety, which can cause heart palpitations. For these reasons, maintaining healthy sleep practices hygiene might also benefit your heart. You can help establish good sleep habits by:

• Setting a consistent bedtime and wake-up time
• Keeping your bedroom quiet, dark, and cool
• Limiting exposure to screens, such as TVs and computers, close to bedtime
• Avoiding heavy meals at least two hours before bedtime

When to See a Doctor

While heart palpitations are usually not serious Trusted Source Merck Manual First published in 1899 as a small reference book for physicians and pharmacists, the Manual grew in size and scope to become one of the most widely used comprehensive medical resources for professionals and consumers. View Source , you may wish to consult your doctor to make sure. Your doctor can perform tests that could identify a cause of your palpitations and recommend the treatments that will work best for you.

In some situations, heart palpitations can be related to a serious health condition. Seek immediate medical attention or call 911 if you experience any of these symptoms alongside heart palpitations:

• Light-headedness or dizziness
• Chest pain
• Trouble breathing
• A resting heart rate of more than 120 or less than 45 beats per minute
• Fainting or loss of consciousness