Any unusual symptoms or experiences related to your heart can be scary. But if you are lying in bed and your heart starts to feel like it’s beating too fast or skipping beats, it doesn’t always mean there’s something serious going on. In fact, there are a handful of common causes of a racing heart at night, many of which are not a reason for concern.
Meet the experts: Lu Chen, M.D., a cardiac electrophysiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA; Kevin Kheder, M.D., an interventional cardiologist at Hoag’s Jeffrey M. Carlton Heart & Vascular Institute in Newport Beach, CA.
“A racing heart—also known as palpitations—can feel like fluttering, pounding, skipping beats, or a rapid, irregular rhythm,” explains Lu Chen, M.D., a cardiac electrophysiologist at MemorialCare Heart & Vascular Institute at Orange Coast Medical Center in Fountain Valley, CA. While your heart can race at any time of day (and many of the below causes can contribute to palpitations at other times besides nighttime), the irregularities tend to feel more obvious at night. “These sensations often feel more noticeable at night, especially when you’re lying down in a quiet environment and more aware of your body,” says Dr. Chen. “Certain positions—like lying on your left side or stomach—can also make your heartbeat feel more pronounced.”
Read on to discover the most common reasons you may experience a racing heart at night, plus what to do and when you may need to give your doctor a call.
Common causes of a racing heart at night
In addition to the sensations mentioned above, there are a few others that you may experience if your heart starts to race. “You may notice chest discomfort, shortness of breath, dizziness, or anxiety along with the sensation of your heart ‘beating out of your chest,’” says Kevin Kheder, M.D., an interventional cardiologist at Hoag’s Jeffrey M. Carlton Heart & Vascular Institute in Newport Beach, CA. So, what exactly causes your heart to begin to race? These are the main causes to know.
Everyday factors
For starters, your racing heart could be caused by something that technically has nothing to do with your cardiovascular system. “Common causes include stress or anxiety, alcohol, caffeine consumed later in the day, and dehydration,” Dr. Kheder says. Dr. Chen adds acid reflux to this list as well.
Medications
Some medications can cause heart palpitations, notes Dr. Kheder. According to the American Heart Association, these include (but are not limited to) drugs used to treat arrhythmias (a.k.a. abnormal heart rhythms) and high blood pressure, as well as certain antidepressants.
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Sleep apnea
If you’ve been diagnosed with a sleep disorder such as sleep apnea, that may trigger a racing heart, says Dr. Chen. “Sleep apnea can lower oxygen levels and strain the heart,” he explains, which may lead to irregular rhythms and increase your risk for developing atrial fibrillation, a common heart rhythm disorder, per UC Health. Speaking of atrial fibrillation, heart rhythm disorders like AFib may also contribute to sensations of your heart racing at night, Dr. Kheder adds.
Hormonal changes
“Hormonal changes, including menopause, can also contribute to a racing heart,” says Dr. Kheder. According to the Endocrine Society, heart rate can increase by as much as eight to 16 beats per minute during a hot flash, which may leave you feeling winded without ever leaving your bed.
While all of these factors may contribute to feelings of a racing heart at night, they aren’t restricted to the moonlit hours. “Most of these factors aren’t limited to nighttime,” says Dr. Kheder. “Caffeine, dehydration, anxiety, certain medications, and abnormal heart rhythms can cause palpitations at any time. The difference is that nighttime tends to be when people notice them most because they’re at rest.”
What to do if your heart starts racing
If you occasionally experience a racing heart at night, there’s no reason to panic. “Most episodes of a racing heart are benign, but certain symptoms should not be ignored,” says Dr. Chen. If these episodes happen infrequently and go away on their own, Dr. Kheder suggests thinking back to what you were doing and how you were feeling that evening. “Consider whether you were dehydrated, consumed caffeine or alcohol, or were under unusual stress,” he says. “If it happens repeatedly, it’s worth discussing with your healthcare provider who may recommend testing such as an electrocardiogram or a heart monitor.”
That said, if your palpitations become frequent, last more than a few minutes, wake you up from sleep, or are accompanied by symptoms like dizziness, shortness of breath, chest pain, or fainting, it’s important to give your doctor a call right away. “These could signal reduced blood flow to the brain or a more serious heart condition,” Dr. Chen says. “Early evaluation can help determine whether the cause is harmless—or something that needs treatment.”
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