It’s that sudden jolt in the quiet of the night. You’re lying in bed, maybe drifting off, and then – thump-thump-flutter – your heart does a little dance you didn’t ask for. Experiencing heart palpitations at night can be really unsettling, I know. Many folks in my practice mention this. You’re often more aware of your body when everything else is still, so that little hiccup in your heart’s rhythm suddenly feels much louder. The good news? Most of the time, these nighttime flutters aren’t dangerous. But, it’s always wise to understand what might be going on.
So, What Exactly Are Heart Palpitations?
Simply put, heart palpitations are when you suddenly become very aware of your own heartbeat. It might feel like your heart is:
- Pounding or racing
- Beating too quickly
- Skipping beats
- Having an extra beat
You might feel these sensations in your chest, but sometimes people notice them more in their neck or throat. It’s a very common experience, and many people have these same palpitations during a busy day but just don’t notice them as much. When you’re resting, especially at night, they can feel more pronounced.
Now, while they can be scary, it’s important to remember they aren’t usually a sign of something serious. But, and this is an important “but,” if your heart often races when you lie down, or if these palpitations come with other symptoms, we definitely need to chat.
What Might Trigger These Nighttime Flutters?
There are quite a few reasons why you might experience heart palpitations at night. Often, they’re harmless and not linked to a major health problem. Sometimes, your heart just throws in an extra beat, or one comes a bit too early. We call these premature ventricular contractions (PVCs) or premature atrial contractions (PACs). Sounds complicated, but nearly everyone has them now and then. Not everyone feels them, though.
Here are some common culprits:
- Your sleep position: Believe it or not, sleeping hunched on your side can sometimes increase pressure inside your body and trigger palpitations.
- Stress, anxiety, or depression: Our emotions have a powerful effect on our bodies. A panic attack, for instance, often comes with a racing heart.
- Dehydration or electrolyte imbalances: Electrolytes are minerals like potassium and sodium that help keep your heart’s rhythm steady. Not enough water or an imbalance can throw things off.
- Certain substances:
- Caffeine (coffee, tea, soda)
- Alcohol
- Nicotine
- Some medications, like diet pills or decongestants with pseudoephedrine.
- Even rich foods high in carbohydrates, sodium (salt), sugar, or fat close to bedtime can sometimes be a factor.
- Fever: When your body is fighting an infection, your heart rate can increase.
- Hormonal changes: Think menopause or pregnancy. Heart palpitations during pregnancy are actually quite common and usually nothing to worry about.
- Extra weight: Carrying extra weight can put a strain on your heart and increase the risk of irregular rhythms.
When Could It Be Something More?
Less often, heart palpitations at night can be a clue that there’s an underlying health condition we need to look into. These might include:
- Anemia (a low red blood cell count)
- Heart rhythm problems (arrhythmias): This is a broad term for an abnormal heart rhythm, like atrial fibrillation (Afib), tachycardia (a consistently fast heart rate), or bradycardia (a slow heart rate).
- Thyroid issues: An overactive thyroid (hyperthyroidism) is a common cause.
- Heart conditions: Things like a previous heart attack, heart failure, cardiomyopathy (disease of the heart muscle), or problems with your heart valves.
- Low blood pressure (hypotension) or low blood sugar (hypoglycemia).
- Metabolic syndrome.
- Myocarditis (inflammation of the heart muscle, often after a virus).
How We Figure Out What’s Going On
If you come to see me about heart palpitations, the first thing I’ll do is listen. I’ll want to hear all about your symptoms: when they happen, what they feel like, how long they last, and if anything seems to make them better or worse. I’ll also listen to your heart, of course.
To get a clearer picture, we might suggest a few things:
- Blood tests: A complete blood count (CBC) can check for anemia or signs of infection. We can also check your thyroid function and electrolytes.
- Electrocardiogram (EKG or ECG): This is a quick, painless test where we attach little sensor stickers to your skin to record your heart’s electrical activity. It gives us a snapshot of your heart rhythm. You’ll just lie down for about 15 minutes.
- Ambulatory Electrocardiogram (like a Holter monitor): Sometimes, an EKG in the clinic doesn’t catch the palpitations because, well, they might not happen right then! If that’s the case, I might suggest you wear a small, portable device called a Holter monitor. You’d wear it for a day, maybe up to a week, while you go about your usual activities. It records your heart rhythm continuously, so we can see what’s happening over a longer period, especially during those nighttime episodes.
Managing Heart Palpitations at Night
Good news: most of the time, especially if they only pop up now and then, heart palpitations at night don’t need specific medical treatment. Often, a few simple changes can make a big difference.
If your heart starts racing when you’re trying to sleep, you could try:
- Deep breathing: Simple, slow, deep breaths can be very calming. Techniques like pursed-lip breathing (breathing in through your nose and out slowly through pursed lips, like you’re blowing out a candle) or meditation can help reduce stress.
- A glass of water: If dehydration is the culprit, rehydrating can help your heart work more efficiently.
- Change position: Sometimes, just rolling over, sitting up, or even getting out of bed and walking around the room for a minute while taking deep breaths can settle things down.
If we find an underlying health condition is causing the palpitations, then our focus will be on treating that condition. For example, if it’s an overactive thyroid, medication for that can resolve the heart symptoms. Sometimes, if palpitations are frequent or bothersome, we might discuss medications called beta-blockers, which can help slow your heart rate and reduce the feeling of palpitations.
We’ll always discuss all the options available for you.
What to Keep in Mind About Nighttime Heart Flutters
For most people, occasional heart palpitations at night are more annoying than dangerous. Making some lifestyle tweaks often brings relief. Think about:
- Cutting back on alcohol and caffeine, especially in the evening.
- If you smoke, let’s talk about quitting. I can help with resources.
- Avoiding big, heavy meals right before bed.
- Finding healthy ways to manage stress and anxiety – yoga, regular exercise, or talking with a therapist can be great.
- Maintaining a healthy weight.
If an underlying issue like heart disease or a thyroid problem is found, managing that condition is key to controlling the palpitations.
When to Absolutely Call Your Doctor
While many instances of heart palpitations at night are benign, please don’t hesitate to reach out if they are frequent, worsening, or just worrying you. It’s always better to get checked out.
Seek medical help right away if your heart palpitations come with any of these symptoms:
- Chest pain or discomfort
- Difficulty breathing or shortness of breath
- Dizziness, lightheadedness, or confusion
- Fainting or loss of consciousness (syncope)
- Severe swelling (edema), especially in your legs, ankles, and feet
- Unusual or sudden extreme fatigue
Also, if you use a fitness device and it alerts you to a heart rate consistently over 100 beats per minute when you’re at rest, that’s another good reason to get in touch.
Take-Home Message: Understanding Your Heartbeat
Here’s a quick recap of what’s important to remember about heart palpitations at night:
- They feel like a pounding, racing, or skipping heartbeat and are often more noticeable when you’re resting.
- Many common, often harmless, things can trigger them, like stress, caffeine, or even your sleep position.
- Less commonly, they can signal an underlying issue like anemia, thyroid problems, or a heart condition.
- If they’re frequent or come with other symptoms like chest pain or dizziness, see your doctor.
- Diagnosis often involves a discussion of symptoms, an EKG, and sometimes a Holter monitor.
- Lifestyle changes can often help, but if there’s an underlying cause, treating that is key.
You’re not alone in experiencing this. We can work together to understand what’s happening and find the best way forward for you.
