Have you ever lain in bed, just about to fall asleep, when your heart suddenly felt like it was pounding out of your chest? How about waking up during the night with a racing heart?
Fluctuations in your heart rate are completely normal and usually go unnoticed. When you’re lying quietly in bed with few distractions, however, a racing heart is hard to miss. I can’t tell you how many times I have heard from patients who experienced this and were concerned that something was seriously wrong with their heart.
I understand these episodes can be disturbing, but I want to reassure you that a fast or irregular heartbeat at night is usually nothing to worry about. Let’s look at the most common causes and what you can do about them.
Emotions Are a Leading Cause
A leading cause of a racing heart at night is emotions. When you are worried or anxious, your body’s automatic stress response kicks in, signaling the release of adrenaline and other stress hormones that ready you for action. You become more alert, your muscles tense, your blood pressure rises—and your heart rate increases.
Unfortunately, sometimes this takes on a life of its own. You start worrying that you’re having a heart attack or stroke, your anxiety increases, and your heart beats ever faster. It may even morph into a full-blown panic attack. Although these episodes are scary, they are not dangerous, and they are short. Most panic attacks subside within 10 minutes and last no longer than 20–30 minutes.
Acknowledging anxiety for what it is—and not a life-threatening heart problem—can help you get through it. Other suggestions include:
- Practice relaxation exercises: There are many techniques that focus on slowing the breath, relaxing the muscles, and calming the mind. One particularly effective one is alternate nostril breathing. Find one that works for you and make it your go-to.
- Take your pulse: A “normal” resting heart rate is 60–100 beats per minute; higher than 100 is called tachycardia. Your heart may not be beating as fast as you think. Even if it’s above 100, intermittent runs of tachycardia at night are not harmful. Simply knowing this may help you relax.
- Change your sleep position: Because of the heart’s position in your chest, a fast or irregular heartbeat may be less noticeable if you lie on your right side. Try this and see if it helps.
- Identify & deal with your stressors: Most importantly, you need to come to grips with the issues that are causing your anxiety and emotional distress. Some are obvious, while others may take some digging and soul-searching, perhaps with the help of a loved one or professional.
- Manage stress: Seek out other ways to manage stress such as regular exercise, meditation, yoga, grounding (earthing), supplements such as magnesium and ashwagandha, and taking time for yourself and the activities that restore your soul and bring you joy.
The Not-So-Sweet Stuff
Sugar is an overlooked trigger of a fast or irregular heartbeat. When you eat foods with added sugars (including natural sweeteners like honey) as well as refined carbohydrates and other high-glycemic foods, they are quickly broken down into glucose. The resulting sharp rise in blood sugar can have a stimulating effect and increase your blood pressure and heart rate.
These same foods also have a delayed effect. The pancreas must release extra insulin to move all that glucose into the cells. Excess insulin may overshoot the mark and drive blood sugar too low. This is called hypoglycemia, and among its many symptoms are anxiety and a racing heart.
I always ask my patients who report a rapid heartbeat at night if they snack in the evenings and what they snack on. The answer is often desserts and other sweets, crackers, cereal, and other high-glycemic foods that are a recipe for blood sugar highs and lows.
The solution here is obvious. Reduce your overall consumption of sugar and other fast-burning carbs. If you must have a bedtime snack, eat something that’s high in protein and fat rather than carbohydrates.
Could Alcohol Be the Problem?
You probably know excessive caffeine can cause your heart to race, but did you know alcohol can as well?
In a study conducted at the Oktoberfest in Munich, researchers used a smartphone-based EKG and a breathalyzer to measure the heart rate and rhythm and the breath alcohol concentrations of 3,012 festival attendees. They found that the more alcohol an individual drank, the faster the heart rate. Nearly 26% of those tested had tachycardia! Higher breath alcohol was also associated with a higher risk of arrhythmias—a condition referred to as “holiday heart syndrome.”
Granted, you’re not likely to binge on the large steins of beer that are the norm for Oktoberfest, but much smaller amounts of alcohol can also have adverse effects. Studies show that less than one drink a day can increase the risk of atrial fibrillation.
If you’ve been drinking in the evenings—even if it’s just a glass of wine with dinner—I suggest cutting out alcohol for a while. The same goes for coffee, tea, and other sources of caffeine late in the day. Keep notes on what you drink and eat and see if these recommended changes make a difference.
Other Considerations & Solutions
- Get adequate sleep: Tall order when a fast heartbeat is keeping you awake, but poor sleep is associated with a number of health issues, including anxiety and an elevated heart rate. Practicing good sleep hygiene can also make you more relaxed at bedtime, which is beneficial as well.
- Drink enough water: Dehydration can cause a rapid heart rate, so it's important to be well hydrated.
- Review your medications: Certain drugs, including thyroid medications, asthma inhalers, and over-the-counter cold/allergy meds with the decongestant pseudoephedrine can speed up the heart.
- Stop smoking: Smokers have significantly higher resting heart rates and poorer overall heart health. Just stop.
When You Should See a Doctor
An acute episode of tachycardia accompanied by chest pain, shortness of breath, and/or lightheadedness merits immediate medical attention.
You should also see a doctor if you have frequent bouts of tachycardia or arrhythmias to rule out atrial fibrillation, low blood pressure, anemia, diabetes, hyperthyroidism (overactive thyroid), and other medical problems that can cause a rapid heart rate.
Finally, if you are worried about a rapid heartbeat at night, discuss your concerns with your doctor and request a cardiovascular workup. I suspect that testing will reassure you that all is well.