palpitations at night

Overview

Palpitations at night are feelings that your heart is pounding, racing, fluttering, or skipping a beat while you are lying down to sleep. They can feel alarming but are often harmless.

Yes, many people experience palpitations at night at some point in their lives.

Anyone can experience palpitations at night, but they are more common in people who are stressed, anxious, or have an underlying heart condition.

Symptoms

Common symptoms

• A sensation that your heart is racing or pounding in your chest
• A fluttering feeling in your chest or throat
• A feeling that your heart has skipped a beat or is beating irregularly
• Noticing your heartbeat more when lying down in a quiet room

Symptoms in children

• Children might describe a 'jumping' or 'fluttering' in the chest
• They may wake up feeling scared or anxious
• Sometimes children have no symptoms but a family member notices a fast pulse

Symptoms in older adults

• Palpitations may be felt more often or be more noticeable
• Older adults may also experience dizziness or light-headedness with palpitations
• Palpitations in older adults can sometimes be a sign of an underlying heart rhythm problem

Causes

Main causes

• Stress, anxiety, or panic attacks
• Caffeine (from coffee, tea, energy drinks), alcohol, or nicotine
• Dehydration or low electrolyte levels
• Strenuous exercise or lack of sleep
• Certain medications, including cold or allergy remedies
• Hormonal changes, such as during pregnancy or menopause
• Heart conditions like arrhythmias (irregular heartbeats)

Risk factors

• High blood pressure
• Heart disease or previous heart attack
• Overactive thyroid (hyperthyroidism)
• Sleep apnoea
• Low blood sugar (hypoglycemia)
• Age (older adults are more likely to have heart rhythm issues)

When to see a doctor

See a doctor urgently if:

• If you have palpitations along with chest pain, shortness of breath, or fainting
• If your heart is racing and does not slow down after a few minutes

Book a routine appointment if:

• If palpitations happen often and bother you
• If you have a known heart condition and notice new or worse palpitations
• If you are concerned about your symptoms

Diagnosis

Your doctor will ask about your symptoms, medical history, and any triggers. They will check your pulse and listen to your heart.

Tests that may be done

• Electrocardiogram (ECG) – a quick test that records your heart's electrical activity
• Holter monitor – a portable ECG you wear for 24 to 48 hours to capture heart rhythm over time
• Event monitor – a device you wear for weeks to record heart rhythm when you have symptoms
• Blood tests to check for thyroid problems, electrolyte imbalances, or anaemia

What to expect at your appointment

Your doctor may ask you to keep a diary of when palpitations happen and what you were doing. You may be referred to a heart specialist (cardiologist) for further testing if needed.

Treatment

Treatment for palpitations at night depends on the cause. In many cases, no treatment is needed other than avoiding triggers. If a medical condition is found, treating that condition usually relieves the palpitations.

Self-care at home

• Reduce or avoid caffeine, alcohol, and nicotine, especially in the evening
• Practice relaxation techniques such as deep breathing, meditation, or yoga
• Stay well hydrated throughout the day
• Get enough sleep and keep a regular sleep schedule
• Manage stress with exercise or talking to someone you trust

Medical treatments

If an underlying heart rhythm problem (arrhythmia) is diagnosed, doctors may prescribe medicines to control heart rate or rhythm. In some cases, a procedure called catheter ablation may be recommended to correct the electrical pathways in the heart. Always follow your doctor's advice on any treatment.

When is surgery considered?

Surgery is rarely needed for palpitations alone. It may be considered if an underlying condition such as severe heart valve disease is present.

Living with this condition

Keep a symptom diary to track when palpitations happen and what might trigger them. Learning to manage stress and avoiding known triggers can help reduce episodes.

Lifestyle tips

• Limit caffeine, nicotine, and alcohol
• Establish a calming bedtime routine
• Exercise regularly but avoid intense activity close to bedtime

Diet and exercise

Eat a balanced diet rich in fruits, vegetables, and whole grains. Staying hydrated is important. Moderate aerobic exercise, such as walking or swimming, can improve heart health but check with your doctor before starting a new routine.

Mental health and emotional wellbeing

Palpitations can cause anxiety, especially if they happen at night. Remember that most are harmless. If anxiety affects your daily life, talk to your doctor about support or counselling.

Prevention

You can reduce the chance of palpitations at night by avoiding common triggers like caffeine, alcohol, and stress. Managing underlying health conditions such as high blood pressure or thyroid issues also helps.

Complications

If left untreated

• If the palpitations are due to a heart rhythm disorder, it may lead to more serious arrhythmias
• In rare cases, untreated arrhythmias can increase the risk of stroke or heart failure

Long-term outlook

For most people, palpitations at night are harmless and go away on their own or with simple lifestyle changes. Even when caused by a heart condition, treatments are very effective and most people lead normal, active lives.

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