Causes of Heart Palpitations at Night
Medically reviewed on Feb 25, 2024 by Jillian Foglesong Stabile, MD, FAAFP. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
Table of contents
- What are Heart Palpitations?
- Heart Palpitations at Night: What You Might Experience
- Identifying Heart Challenges
- Preventing Heart Palpitations at Night
- Everlywell: Connecting You With Quality Virtual Care
- Related Content
If you believe you’re experiencing symptoms of a heart attack (abnormal chest pain, light-headedness, arm pain, and shortness of breath) or a stroke (confusion, difficulty speaking, numbness, headache, and sudden vision changes), call 9-1-1 right away. Timely treatment is critical to successful heart attack and stroke intervention.
Experiencing any abnormal cardiac symptoms—like heart palpitations at night—can be unsettling. However, in most cases, you can rest easy: nighttime heart palpitations typically aren’t a sign of a serious heart problem or cardiac incident. [1]
Even still, experiencing heart palpitations is, at best, uncomfortable. When they occur at night, an abnormal heart rhythm can disrupt your sleep, distract you from relaxing evening activities, or increase feelings of anxiety. So, what can you do about nighttime heart palpitations to improve your overall quality of life?
In this guide, we’re breaking down everything you need to know about heart palpitations at night: what they are, their causes, heart palpitation symptoms, how healthcare providers identify them, and what you can do to prevent them.
What are Heart Palpitations?
It’s important to note a key distinction between two relatively common cardiac concerns:
- Heart palpitations – Heart palpitations are the sensation of your heart pounding (beating loudly, strongly, or deeply) or racing (beating faster than normal). [1] You might feel heart palpitations in your chest, throat, head, or neck. This can cause an unpleasant awareness of your heartbeat or lead you to believe your heart is beating irregularly.
- Irregular heartbeat (arrhythmia) – While heart palpitations can make you feel like your heart is skipping beats, this sensation can sometimes result from increased awareness and anxiety. An irregular heartbeat (called an arrhythmia) is a condition that’s distinct from heart palpitations. While arrhythmias can be a sign of a more serious health concern, they are sometimes benign. [2]
Causes
Harmless heart palpitations can be caused by a number of potential factors [1]:
- Anxiety or fear – Whether you live with a diagnosed anxiety disorder or like to spend your evenings watching gripping thrillers, you may experience heart palpitations at night as a symptom of anxiety, fear, or stress.
- Stimulant intake – From socially accepted stimulants (like caffeine and nicotine) to illicit drugs (like cocaine and amphetamines) to prescription and over-the-counter medications (like amphetamine-based ADHD medications, stimulant diet pills, and decongestants like pseudoephedrine), a wide variety of stimulants can increase your heart rate and lead to heart palpitations. [1]
- Illness – If you’re running a fever while recovering from an illness (like the flu), your heart may pound or beat quickly. [1]
- Exercise – After a tough cardio session, your heart may feel like it’s beating out of your chest. [1]
Symptoms
The two main symptoms of heart palpitations are a pounding and racing heartbeat. [1] Remember that adults' normal heartbeat range is 60 to 100 beats per minute. So, one of the easiest things you can do to track your symptoms is to measure your heart rate by finding your pulse and counting beats for one minute. Then, you can figure out how to improve your resting heart rate based on your results.
If you’re experiencing heart palpitations, you may also notice other symptoms like [1]:
- Shortness of breath
- Dizziness
- General anxiety or worry
- Trouble falling asleep
Learn more about your resting heart rate by age and gender.
Heart Palpitations at Night: What You Might Experience
So, what might a night look like if you’re experiencing heart palpitations? While symptoms look different for everyone, you may encounter one or more of the following scenarios:
- You’re lying in bed and trying to wind down before falling asleep. But your heart is beating so fast that you can’t take your mind off of it, and sleep seems out of reach.
- You’re clocking in for a night shift or staying up late to study. It’s hard to concentrate on tasks because you’re distracted by your fast or pounding heartbeat.
- You’re trying to enjoy extracurricular activities after dark: heading to game night with friends, catching a soccer match at a local sports bar, or going out on a date. But your heart is pounding, and you’re having difficulty enjoying the experience.
No matter how heart palpitations manifest during your evenings, they can be distracting and difficult to tolerate—even if they are, in fact, benign.
Identifying Heart Challenges
In your quest to learn more about your heart palpitations and improve your heart health, there are a few steps you can initially take to ensure that your heart is functioning properly.
Seek Medical Advice
As always, you should seek immediate, emergency medical attention if you’re experiencing abnormal cardiac symptoms—even if you’re confident that the heart problem is not life-threatening. Approaching cardiac concerns with an abundance of caution is key.
At the same time, it’s important to know the distinct signs of a cardiac emergency, like a stroke vs. heart attack. If you’re experiencing a heart attack, you might notice symptoms like [3, 4]:
- Chest pain, pressure, heaviness, or discomfort
- Pain in one or both of your arms
- Excessive sweating without a cause
- Light-headedness or dizziness
- Nausea
- Fatigue lasting for hours or days (this symptom is most common in cisgender women)
A stroke has slightly different symptoms, and they’re relatively easy to identify [5]:
- Confusion or difficulty understanding speech
- Trouble speaking and being understood by others (e.g., slurring words)
- Severe numbness or weakness (typically on one side of the body)
- Vision changes
- Difficulty standing or walking
If you notice any of the symptoms in these lists, contact emergency medical services right away.
Undergo an EKG
If you don’t notice any of the emergent symptoms above in conjunction with your heart palpitations, they may not indicate a more serious health issue. It’s still best to consult with a licensed healthcare provider in these cases.
When you make an appointment with your provider and describe your symptoms, they may recommend a test called an electrocardiogram, or EKG. [6]
An EKG is a simple, painless test that records your heart’s electrical pulses. The output of an EKG is a series of wavy lines. Healthcare providers can interpret the results to determine:
- Your heart rate
- The regularity (or irregularity) of your heartbeat
- The timing and strength of the electrical pulses as they move through different parts of your heart
An EKG is typically a first-line test that providers can use to discover cardiac abnormalities, heart disease, and illnesses, but it can also confirm that your heart is operating as normal.
Practice Long-Term Heart Monitoring
If an EKG doesn’t produce any alarming results, but you’re still concerned about your heart palpitations, your provider may order long-term monitoring. In these cases, providers may:
- Recommend at-home monitoring – Whether you use a wearable device or simply record your pulse throughout the day or night, your provider may be interested in seeing the trends of your heart rate over the course of multiple days or weeks.
- Observe you in the office for an extended period – Extended, in-office monitoring may require specialized equipment and observation by a healthcare professional.
Preventing Heart Palpitations at Night
If your provider determines that your heart palpitations at night aren’t a sign of a more serious heart condition, they may recommend simple preventative measures to improve your quality of life—and potentially return your pulse to normal.
Stress Management
Since heart palpitations and anxiety can go hand-in-hand, your provider may recommend ways to limit your stress levels in the evenings. [1] This might look like:
- Opting for relaxing activities – Instead of watching horror flicks every night, your provider may recommend opting for less stimulating entertainment: listening to relaxing music or reading a book before bed, for instance.
- Setting better work-life boundaries – If you don’t work the night shift, your provider might recommend turning off your notifications when it’s time to wind down for the day. Unless you’re on call, your Slack messages can wait until the morning.
- Incorporating holistic strategies – Your provider may also recommend holistic activities like meditating or drinking calming teas (like chamomile and lavender) to promote relaxation and calm at night.
Management of Stimulant Medications
As mentioned above, stimulating substances and medications can cause heart palpitations. [1] Some stimulants you may use in your daily life include [1]:
- Nicotine
- Caffeine
- Pre-workout formulas with stimulants [7]
- Decongestant medications like pseudoephedrine or phenylephrine
- Stimulant medications for ADHD management
It’s important to note that some illicit substances also have stimulant properties, including [8]:
- Cocaine
- Methamphetamine
- Synthetic cathinones (“bath salts”)
While the illicit substances listed above have been clinically shown to pose a variety of health concerns, the socially accepted or medically prescribed stimulants in the first list should also be used with caution if you’re experiencing heart palpitations at night. [9, 10, 11] Your provider may recommend:
- Timing your stimulant intake to prevent negative impacts on sleep
- Reducing your overall intake or dose of stimulant medications and compounds
- Switching to non-stimulant formulas when possible
Lifestyle Changes
Your provider may also recommend making some lifestyle changes that can help you combat the effects of heart palpitations, reduce your likelihood of experiencing them, and support your overall cardiovascular health. These might include:
- Eating a nutritious, balanced diet
- Adding exercise to your daily routine
- Incorporating relaxing activities, like meditation and breathing exercises, into your routine
- Adjusting your sleep schedule to prioritize rest
These lifestyle changes can support overall wellness, and they may help reduce your heart palpitations in combination with other methods.
Everlywell: Connecting You With Quality Virtual Care
Heart palpitations at night (even when benign) can interrupt your rest, decrease your quality of life, and increase your overall worry about your health. Fortunately, licensed providers are available to help you manage your everyday wellness and prevent uncomfortable experiences, and provider access is simpler than ever before with platforms like Everlywell.
Everlywell is here to connect you with the high-quality care you deserve. We offer telehealth services, convenient at-home heart health test kits, and a variety of other resources for people looking to take control of their health. Over one million people trust Everlywell’s network of licensed providers and partner with them to make personally tailored wellness plans.
If you’re ready to discover a new approach to healthcare, make a virtual care appointment with Everlywell today.
Related Content
How to Improve Resting Heart Rate (RHR)
Stroke vs. Heart Attack: Key Differences & Symptoms
What Causes an Enlarged Heart?
References
- Heart palpitations. MedlinePlus. April 10, 2022. Medical Citation URL. Accessed January 20, 2024.
- Arrhythmias. MedlinePlus. May 8, 2022. Medical Citation URL. Accessed January 20, 2024.
- What is a heart attack? National Heart Lung and Blood Institute. March 24, 2022. Medical Citation URL. Accessed January 20, 2024.
- Symptoms. National Heart Lung and Blood Institute. March 24, 2022. Medical Citation URL. Accessed January 20, 2024.
- Symptoms. National Heart Lung and Blood Institute. May 26, 2023. Medical Citation URL. Accessed January 20, 2024.
- Electrocardiogram. MedlinePlus. February 28, 2023. Medical Citation URL. Accessed January 20, 2024.
- Stimulants: What’s the concern? Operation Supplement Safety. March 7, 2022. Medical Citation URL. Accessed January 20, 2024.
- Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C. Buffo J. Stimulant abuse: Signs, effects, and treatment options. American Addiction Centers. January 3, 2024. Medical Citation URL. Accessed January 20, 2024.
- Cocaine. MedlinePlus. November 13, 2023. Medical Citation URL. Accessed January 20, 2024.
- Know the risks of meth. SAMHSA. September 6, 2023. Medical Citation URL. Accessed January 20, 2024.
- Synthetic cathinones (“bath salts”). National Institutes of Health. August 2, 2023. Medical Citation URL. Accessed January 20, 2024.
Jillian Foglesong Stabile, MD, FAAFP is a board-certified Family Physician. Since completing her residency training in 2010, she’s been practicing full-scope family medicine in a rural setting. Dr. Foglesong Stabile’s practice includes caring for patients of all ages for preventative care as well as chronic disease management. She also provides prenatal care and delivers babies. Dr. Foglesong Stabile completed a teaching fellowship in 2020 and teaches the family medicine clerkship for one of her local medical schools. Dr. Foglesong Stabile’s favorite thing about family medicine is the variety of patients she sees in her clinical practice.