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What Causes Heart Palpitations at Night?

You’re lying there, all is quiet, and suddenly you notice a feeling of heart palpitations—it might feel like your heart flutters, does flip flops, pounds, or races. Is this something you should be worried about? Should you call 9-1-1?

Usually, heart palpitations at night aren’t anything to worry about, but they can be an indication of something in your daytime or evening routine that you need to change. Rarely, they can be a sign of heart disease or a heart arrhythmia.

If you experience heart palpitations with accompanying chest pain, dizziness, or shortness of breath, seek emergency medical attention right now. Otherwise, let’s get on to the topic at hand: What causes heart palpitations at night?

Causes of Night Heart Palpitations

There are many possible causes of heart palpitations at night, many of which can also make you feel like your heart jumps when falling asleep. These 10 factors account for heart palpitations that aren’t caused by heart disease.

  1. You have heart palpitations during the day as well but it’s only quiet enough to hear them at night.
  2. You are lying on your left side and your heart is reverberating against your chest wall.
  3. You had a nightmare.
  4. You are feeling stressed.
  5. You have low blood sugar.
  6. You have low blood pressure.
  7. You are dehydrated.
  8. You had caffeine, nicotine, alcohol, or sugary or salty foods or foods containing MSG fairly close to bedtime.
  9. You take recreational drugs or medications that tend to cause palpitations, such as allergy medications or cocaine.
  10. You are experiencing hormonal changes, such as during a menstrual cycle, pregnancy, or menopause.

Sometimes, there is an underlying condition, such as an overactive thyroid, mental health illness, anemia, or Paget’s disease (a bone disorder). Other times, palpitations can be a sign of a heart disease like heart failure or cardiomyopathy.

What to Do If You Experience Heart Palpitations at Night

If you experience occasional heart palpitations, having a drink of water is often enough to calm them down. However, if you experience frequent heart palpitations (without other emergency symptoms), it’s a good idea to start keeping a journal of the date and time of the palpitations, what you’ve had to eat and drink, any medications you’ve taken, what you’re thinking about, and any other symptoms you’re experiencing.

If your symptoms continue, take your journal to a doctor or cardiac specialist and discuss the possible causes. It might be that a pattern emerges from your notes and you’re able to identify a culprit (stress or late-night snacks, for example) and solve the problem with no further testing. Alternatively, the doctor or specialist might recommend diagnostic tests, including:

  • An electrocardiogram (ECG or EKG) to record the heart’s rhythm
  • An echocardiogram to view the structure of the heart
  • Holter monitoring for 24 to 48 hours to see how your heart typically functions
  • An implanted continuous-loop event recorder
  • A stress test
  • Blood tests to check for anemia, thyroid imbalances, and electrolyte imbalances

Treatment Options for Heart Palpitations

In the best-case scenario, you’ll be able to reduce the frequency of nighttime heart palpitations by changing your dietary habits, reducing caffeine and alcohol, quitting cigarettes if you smoke, and keeping stress-inducing activities away from bedtime. Developing a calming nighttime routine that includes mindfulness or meditation might also help if you tend to lay in bed and think about things that make you feel stressed.

If you have an abnormal heart rhythm due to an acquired or structural heart disease, a cardiac specialist might recommend:

  • Having a cardiac ablation
  • Keeping a portable defibrillator in the home, such as the Philips HeartStart FRx or LIFEPAK CR2
  • Having an implantable cardioversion defibrillator installed
  • Taking medications such as beta-blockers or calcium channel blockers

Watch Your Symptoms and Know When It’s Time to Act

Heart palpitations at night are often related to lifestyle, diet, hormones, and medications, but if it’s happening frequently, start keeping a “heart journal” and see a doctor or cardiac specialist. If you are experiencing palpitations and you can’t breathe or your chest hurts, call 9-1-1.

In many cases, introducing some relaxation techniques or eating a lighter meal at night can help heart palpitations to disappear. In other cases, diagnostic testing may reveal a heart abnormality or heart disease. Either way, knowing what to look for and keeping track of your symptoms over time can help you work out what’s causing heart palpitations at night.

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