Heart Palpitations at Night: What They Mean, When to Worry, and What Tests Can Help

Lying in bed, lights off, everything quiet—and suddenly it feels like your heart is racing, skipping beats, or pounding out of your chest. Night-time heart palpitations can be unsettling, especially when they come out of nowhere.

Many people experience palpitations at some point. Often, they are benign sensations linked to stress, stimulants, or normal variations in heart rhythm. In other cases, they can be a sign of an underlying heart or health condition that deserves closer attention.

This guide walks through:

• What heart palpitations are
• Why they often seem worse at night
• Common causes—both harmless and more serious
• When to seek medical evaluation
• What tests are commonly used to investigate palpitations
• Practical steps to track and understand your symptoms

Throughout, the goal is clarity and reassurance—not diagnosis or treatment—so you can understand possible explanations and what to discuss with a healthcare professional.

What Are Heart Palpitations, Exactly?

Heart palpitations are subjective sensations of your heart beating. People describe them in different ways:

• “Fluttering” in the chest
• “Skipping” or “missing” beats
• A sudden “thump” or “flip-flop” sensation
• Rapid, racing heartbeat
• Strong, pounding heartbeat you can feel in your chest, throat, or neck

Palpitations are symptoms, not a diagnosis. They can be related to:

• Normal heart rhythms that you’re simply more aware of
• Minor irregular beats that are common in healthy people
• More persistent or organized rhythm disturbances, known as arrhythmias
• Non-cardiac issues such as anxiety, hormones, or medications

Palpitations during the day and palpitations at night are often caused by the same underlying process, but nighttime tends to amplify awareness and anxiety around them.

Why Do Heart Palpitations Feel Worse at Night?

Many people notice palpitations mostly when lying in bed, even if their heart rhythm is behaving the same way it does during the day. Several factors contribute to this:

1. Quiet and Stillness Make Your Heartbeat More Noticeable

During the day, your attention is scattered—work, screens, conversations, background noise. At night:

• The environment is quiet
• You are usually lying still
• There are fewer distractions

This makes any internal bodily sensation, including your heartbeat, much more noticeable.

2. Body Position and Blood Flow

Lying flat can change how blood returns to the heart and how you perceive each beat:

• Blood redistributes when you lie down
• You might feel your heartbeat more strongly in your chest, neck, or ears
• Some people notice increased awareness when lying on the left side, closer to the heart

For some, simply changing sleep position alters the intensity of palpitations.

3. Night-time Triggers: Late Caffeine, Alcohol, or Heavy Meals

Habits in the hours before bed can influence your heart rhythm:

• Caffeine (coffee, tea, energy drinks, sodas, chocolate)
• Alcohol
• Nicotine
• Large or heavy meals, especially spicy or rich foods

These can stimulate the heart, affect blood pressure, or cause reflux, which in turn may trigger or intensify palpitations.

4. Stress, Worry, and the “Midnight Mind”

Night is often when worries surface:

• Anxiety about health, finances, or relationships
• Anticipatory stress about the next day
• Fear triggered by the palpitations themselves

Emotional stress activates the “fight-or-flight” response, releasing stress hormones that can increase heart rate and make beats feel stronger or more irregular. This can create a feedback loop: you notice your heart → you worry → your heart speeds up more.

Common Causes of Heart Palpitations at Night

Palpitations can arise from many different factors. Some are usually benign, while others may signal conditions that need medical assessment.

Benign or Lifestyle-Related Causes

These are common and often not linked to structural heart disease:

1. Premature Beats (Extra Heartbeats)

The heart sometimes fires an extra beat:

• Premature atrial contractions (PACs): extra beats from the upper chambers
• Premature ventricular contractions (PVCs): extra beats from the lower chambers

These can create a feeling of:

• A skipped beat
• A brief pause followed by a strong “thump”

Many people have PACs or PVCs occasionally, even with a healthy heart. They often become more noticeable:

• When lying down
• After caffeine, alcohol, or nicotine
• During stress or lack of sleep

2. Stress, Anxiety, and Panic

Emotional states strongly influence heart rhythm. Anxiety-related palpitations often:

• Come in waves or episodes
• Are associated with racing thoughts, sweating, trembling, or a sense of dread
• May appear both day and night but feel worse when you are trying to rest

Panic episodes can cause very intense palpitations and chest discomfort that may mimic more serious problems, making it hard to distinguish without evaluation.

3. Stimulants and Substances

Several substances can trigger palpitations:

• Caffeine
• Nicotine
• Alcohol, especially in binge patterns or late at night
• Some over-the-counter cold and allergy medications
• Certain herbal supplements or energy products

These can stimulate the nervous system or directly affect the heart, sometimes leading to fluttering or racing sensations, especially when your body is at rest.

4. Dehydration or Electrolyte Imbalance

Lower fluid intake or fluid loss (through sweating, illness, or diuretics) can affect:

• Blood volume
• Levels of electrolytes such as potassium, magnesium, calcium, sodium

Shifts in these can influence heart rhythm and may contribute to palpitations, particularly at rest.

Medical Conditions That Can Cause Night-time Palpitations

Some palpitations relate to underlying health or heart conditions. Recognizing patterns can help guide appropriate evaluation.

1. Arrhythmias (Abnormal Heart Rhythms)

Arrhythmias are disturbances in how the heart’s electrical system fires. Common ones associated with palpitations include:

• Atrial fibrillation (AF): irregular, often rapid rhythm from the upper chambers
• Supraventricular tachycardia (SVT): episodes of very rapid heart rate from above the ventricles
• Atrial flutter: organized but abnormally fast rhythm in the atria
• Ventricular arrhythmias: irregular rhythms from the lower chambers (less common, often more serious)

Night-time characteristics can vary:

• AF may cause an irregular, sometimes fast heartbeat that comes and goes
• SVT can cause sudden episodes of very rapid, regular heartbeat, sometimes starting or ending abruptly
• Some arrhythmias are triggered by lying down, reflux, or sleep-related breathing issues

2. Thyroid Disorders

The thyroid gland influences metabolism and heart rate:

• Overactive thyroid (hyperthyroidism) often causes:
  • Racing heart
  • Palpitations
  • Heat intolerance
  • Weight changes
  • Tremors or nervousness

These symptoms can be present both day and night but may seem more noticeable when lying in bed.

3. Anemia

Anemia is a condition where the body has reduced red blood cells or hemoglobin, affecting oxygen delivery. The heart may beat faster or harder to compensate, which can manifest as:

• Palpitations
• Fatigue
• Shortness of breath on exertion
• Dizziness

Night-time awareness can make these sensations more prominent.

4. Heart Valve or Structural Heart Problems

Conditions affecting the heart’s structure or valves can sometimes cause palpitations, including:

• Valve narrowing or leakage
• Enlargement of heart chambers
• Weakening of the heart muscle

People with these issues may also experience:

• Shortness of breath
• Swelling in the legs
• Reduced ability to exercise

5. Sleep-Related Breathing Disorders (Including Sleep Apnea)

Sleep apnea and similar conditions involve pauses or reductions in breathing during sleep, leading to drops in oxygen and surges in stress hormones. These can:

• Trigger or worsen arrhythmias
• Cause abrupt awakenings with palpitations, gasping, or choking sensations
• Be associated with loud snoring or unrefreshing sleep

6. Hormonal Changes

Hormonal shifts, such as those during:

• Pregnancy
• Perimenopause and menopause
• Certain menstrual cycle phases

can influence heart rate, blood flow, and temperature regulation. Some people notice palpitations or hot flashes that are particularly disturbing at night.

When Are Heart Palpitations at Night More Concerning?

Palpitations can be unnerving, but they are not always dangerous. Certain warning signs suggest a higher likelihood of an underlying condition that deserves prompt medical evaluation.

⚠️ Symptoms That Typically Warrant Urgent Assessment

If palpitations are accompanied by any of the following, they may require immediate medical attention:

• Chest pain or pressure
• Fainting (syncope) or feeling like you might pass out
• Severe shortness of breath
• Sudden, intense dizziness or confusion
• Pain radiating to jaw, arm, back, or shoulder
• Palpitations following chest trauma or injury

These symptoms can be associated with serious heart events or dangerous rhythm disturbances.

🚩 Other Red Flags to Discuss Promptly With a Healthcare Professional

Even if not an emergency, it is generally considered important to seek timely evaluation when:

• Palpitations are frequent, persistent, or worsening over time
• Episodes last many minutes or longer, especially with rapid heart rate
• You have a known heart condition or prior heart attack
• There is a family history of sudden cardiac death or serious arrhythmias
• Palpitations occur in the context of significant thyroid disease, anemia, or other chronic conditions
• You notice swelling in the legs, unexplained fatigue, or reduced exercise capacity alongside palpitations

These patterns help clinicians determine which tests may be useful and how urgently to pursue them.

How Healthcare Professionals Typically Evaluate Night-time Palpitations

When someone reports heart palpitations—especially at night—a healthcare professional usually starts with a structured assessment. This process aims to clarify whether the heart appears structurally and electrically healthy, or whether more detailed investigation is needed.

1. Medical History and Symptom Description

You may be asked detailed questions such as:

• When did the palpitations start?
• How often do they occur, and how long do they last?
• Do they feel fast, irregular, or like skips?
• What were you doing before they started? (lying down, after a meal, under stress, after caffeine, etc.)
• Do they come with chest pain, dizziness, fainting, shortness of breath, or sweating?
• Any history of:
  • Heart disease or high blood pressure
  • Thyroid problems
  • Anemia
  • Lung issues
• Medications, supplements, caffeine, alcohol, nicotine use
• Family history of heart conditions or sudden death

A clear description often provides crucial clues about the likely cause.

2. Physical Examination

A physical exam may include:

• Listening to the heart and lungs
• Checking pulse rate and rhythm
• Measuring blood pressure
• Looking for signs of:
  • Fluid retention (swollen legs)
  • Thyroid enlargement
  • Anemia (paleness)
  • Other systemic conditions

Common Tests Used to Investigate Heart Palpitations

Several tests can help clarify what is happening when palpitations occur. Not everyone needs all of them; choices depend on the individual’s symptoms and risk factors.

Electrocardiogram (ECG or EKG)

What it is:
A quick, non-invasive test that records the heart’s electrical activity using electrodes on the skin.

What it may show:

• Current heart rate and rhythm
• Evidence of arrhythmias present during the test
• Clues to past heart damage or strain
• Electrical conduction abnormalities

Limitations:
If palpitations are intermittent, the ECG might be normal when it is recorded. That does not rule out issues that come and go.

Ambulatory Heart Rhythm Monitoring

If palpitations are sporadic or mainly occur at night, longer-term monitoring often provides more insight.

1. Holter Monitor

What it is:
A portable device worn continuously, usually for 24–48 hours, recording every heartbeat.

Useful when:

• Palpitations occur daily or almost daily
• There is a need to match symptoms to actual heart rhythm changes

2. Event Monitor or Patch Monitor

What it is:
A device worn for several days to weeks. Some record continuously; others are activated when you feel symptoms. Newer patch-style monitors are often stuck to the chest.

Useful when:

• Palpitations are less frequent
• Symptoms happen a few times per week or month

3. Implantable Loop Recorder

What it is:
A small device placed under the skin of the chest that can record rhythm for many months or longer.

Used in specific cases, often when:

• Symptoms are rare but concerning (e.g., unexplained fainting)
• Other monitors have not captured the rhythm disturbance

Echocardiogram (Heart Ultrasound)

What it is:
An ultrasound test that creates moving images of the heart.

What it may show:

• Size and function of the heart chambers
• How well the heart pumps blood
• Heart valve structure and function
• Presence of structural abnormalities (e.g., thickening, dilation)

This test helps determine if palpitations might relate to structural heart disease.

Blood Tests

Bloodwork can look for conditions that may trigger or worsen palpitations, such as:

• Thyroid function tests (to detect overactive or underactive thyroid)
• Electrolyte levels (potassium, magnesium, calcium, sodium)
• Complete blood count (CBC) (to check for anemia or infection)
• Markers of kidney or liver function, if relevant

Abnormalities in these areas can sometimes be corrected or managed, reducing palpitations.

Stress Test (Exercise Testing)

What it is:
Monitoring heart rhythm, blood pressure, and symptoms while walking on a treadmill or cycling on a stationary bike.

Why it is used:

• To see how the heart responds to exercise
• To evaluate for reduced blood flow to the heart muscle
• To determine whether exertion triggers arrhythmias

Stress tests are more commonly used when there are concerns about coronary artery disease, chest pain, or exercise-induced symptoms.

Tests for Sleep-Related Problems

If palpitations are associated with snoring, gasping, choking at night, or extreme daytime fatigue, a sleep evaluation may be considered.

Sleep Study (Polysomnography or Home Sleep Test)

What it is:

• Measures breathing patterns, oxygen levels, heart rhythm, and sleep stages
• Can show episodes of sleep apnea or other sleep-related breathing problems

Identifying and addressing sleep-disordered breathing can sometimes improve palpitations and overall cardiovascular health.

Practical Ways to Track Your Night-time Palpitations

Keeping accurate information about your symptoms helps make medical evaluation more effective.

📝 Symptom Diary Ideas

When you have an episode, consider noting:

• Date and time
• What you were doing before it started (lying down, just fell asleep, woke up from a dream, after a late meal, etc.)
• Duration (seconds, minutes, longer)
• How it felt:
  • Very fast?
  • Irregular?
  • Single “thump” or series of beats?
• Associated symptoms:
  • Chest discomfort
  • Dizziness or lightheadedness
  • Shortness of breath
  • Anxiety or sense of panic
• Possible triggers:
  • Caffeine, alcohol, nicotine
  • Intense emotions
  • Lack of sleep

This log can be shared with a healthcare professional and can be extremely helpful if a heart monitor is used, allowing them to match your notes with recorded heart rhythm.

Simple Lifestyle Factors Often Discussed Around Night-time Palpitations

While any treatment decisions belong to you and your healthcare team, some lifestyle-related topics commonly come up in conversations about palpitations.

These are not medical recommendations, but they offer areas you might reflect on and discuss with a professional:

• Caffeine timing:
  Some people notice fewer palpitations when they avoid caffeine in the late afternoon and evening.

• Alcohol use:
  Certain individuals experience more palpitations following alcohol, especially in the hours after drinking.

• Nicotine and vaping:
  These can stimulate the heart and may aggravate palpitations in some people.

• Hydration and balanced nutrition:
  Adequate fluid intake and a varied, balanced diet support stable blood volume and electrolytes.

• Stress management:
  Techniques like paced breathing, relaxation exercises, or mindfulness are often used to help reduce the overall level of tension and anxiety that can fuel palpitations.

• Sleep routine:
  Keeping a regular sleep schedule and calming pre-bed routine may reduce nighttime arousal and awareness of bodily sensations.

These areas are highly individual—what affects one person may not affect another—so tracking your own patterns is often more insightful than any one-size-fits-all rule.

Quick Reference: Night-time Palpitations at a Glance

Here is a simplified overview of key points to keep in mind:

How to Talk About Night-time Palpitations With a Healthcare Professional

Making the most of a medical visit can help you feel more informed and in control. You might consider:

Questions You May Want to Ask

• “Based on my symptoms, what possible causes are you considering?”
• “Do my palpitations sound more likely to be benign or related to an arrhythmia?”
• “Which tests, if any, would you recommend to investigate this further?”
• “Are there specific warning signs I should watch for that would mean I need urgent help?”
• “Could other conditions, like thyroid issues, anemia, or sleep apnea, be contributing?”
• “Is there anything in my current medications, supplements, or lifestyle that might be relevant?”

Information It Helps to Bring

• A symptom diary with dates, times, and descriptions
• A list of all medications, including over-the-counter and herbal products
• Information about family heart history, if known
• Any past test results related to the heart, thyroid, or blood counts, if available

With this context, your healthcare professional can better decide whether reassurance, monitoring, further tests, or specialist referral is appropriate.

Bringing It All Together

Night-time heart palpitations can be alarming but are not always dangerous. Many arise from:

• Normal but noticeable heartbeats in a quiet environment
• Benign extra beats
• Lifestyle triggers such as caffeine, alcohol, or stress
• Emotional states like anxiety, especially when the mind is active at night

At the same time, palpitations can occasionally signal:

• Arrhythmias that need attention
• Thyroid disease, anemia, or other systemic conditions
• Underlying structural heart or valve problems
• Sleep-related breathing disorders

Understanding the pattern, triggers, associated symptoms, and your individual risk profile is key. Commonly used tools—ECG, heart monitoring, echocardiogram, blood tests, and sometimes sleep studies—help clarify what is going on.

By observing your symptoms, keeping a record, and engaging in a clear conversation with a healthcare professional, you can move from anxiety and uncertainty toward clarity, informed decision-making, and an appropriate plan for further evaluation.