‘I’m a Cardiologist—Here’s Why Your Heart Races at Night (and When It’s Time To Worry)’

Below, you'll learn all about the weird feeling in your chest, including what causes heart palpitations to begin with, what’s totally normal vs. when to go to the hospital for rapid heart rate, and how to calm a racing heart at night so you can sleep like a baby.

What do heart palpitations feel like?

Heart racing at night and can't sleep? You might just be super aware of your heart beating, and maybe picking up speed. Or you could be experiencing heart palpitations, which are sensations like unusual heart beating, heart flutters, skipping a beat, or the feeling that your heart is doing a "flip" in your chest. “Collectively these sensations fall under the broad diagnosis of ‘palpitations,'” says cardiologist Elizabeth Klodas, MD, founder and chief operating officer of Step One Foods.

While the feeling of your heart skipping beats might make you nervous, these sensations are all pretty common and may not be a sign that something is wrong, says Mariell Jessup, MD, FAHA, a cardiologist and chief science and medical officer at the American Heart Association. In fact, Dr. Klodas says the heart’s rhythm isn’t always perfect even in completely healthy individuals.

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“For example, if we place a rhythm monitor on 100 patients and record their heart’s electrical activity for long enough, we will find that all 100 will have extra beats, early beats, and short runs of faster heartbeats,” she says. “Some people will feel every one of these perturbations, others will feel none.”

With that being said, Dr. Klodas notes that there are factors that can make these rhythm findings more frequent or more easily felt. So if your heart rate won't go down when you’re trying to hit the hay, you may be able to stop heart pounding at night by learning what causes heart palpitations in the first place and addressing the problem.

What causes heart palpitations at night?

Heart racing at night and can't sleep? Even if your heart is skipping beats throughout the day, you're more likely to notice heart palpitations at night when lying down. But why is that?

Oftentimes, the reason you can feel your heart beating in your chest when lying down is because when you get into bed and settle in for the night, you’re not as distracted.

However, there are a few bedtime-specific reasons your heart might be racing above your resting heart rate at night—most of which can be addressed through simple lifestyle adjustments, says Dr. Klodas.

1. Drinking caffeine or eating too close to bedtime

Common causes of nighttime heart flutters include drinking caffeine too late in the day or having elevated blood sugar, says Dr. Jessup. Too much caffeine can cause your heart to contract with more force. Eating too close to bedtime, on the other hand, can cause your blood sugar to spike because your body is not as adept at digesting at night.

2. Smoking or drinking alcohol

Both smoking and drinking alcohol can rev up your heartbeat and lead to heart palpitations, according to UnityPoint Health, so a cigarette or cocktail close to bedtime could be the culprit behind that fluttery feeling.

3. Body position

Your body position may also play a role if you're feeling heart palpitations at night when lying down. For some people, lying on their back may cause pressure changes in the body that make them more likely to feel palpitations, according to the British Heart Foundation. It's also possible that sleeping on your left side could make you more aware of that fluttery feeling because of the shorter distance between your heart and the wall of your chest.

If you notice your heart pounding harder in a certain position, try rolling over to see if the sensation goes away.

4. Stress

Mental health factors like acute emotional reactions (like anger), depression, stress, and anxiety can cause heart racing when you’re trying to sleep. If you begin to think about things troubling you when you lie down in bed, you may experience heart flutters, says Dr. Jessup. Your heart can start racing from stress thanks to the activation of your sympathetic ("fight or flight") nervous system. This may even result in things like heart palpitations with a headache or jaw pain.

To turn off this response, try breathing exercises to lower your heart rate or a micro meditation like visualization or saying a helpful mantra.

When unmanaged, chronic stress and anxiety can have serious health effects, such as heart disease, according to the Centers for Disease Control and Prevention. That's why it's important to find healthy ways to reduce your stress and anxiety in the long run. If that's something you struggle with, consider getting help from a therapist or other mental health professional.

5. Dehydration

Can dehydration cause heart palpitations at night when lying down? Certainly. There's actually a direct connection between your hydration and your heart rate.

Your heart is constantly pumping blood through your body, and staying well-hydrated helps your heart do this job more easily, says Long Cao, MD, a board-certified cardiologist with Memorial Hermann in Houston, Texas.

If you're not well-hydrated, your heart may try to compensate by beating faster, Dr. Cao says. That's part of the reason why alcohol can increase heart rate, because alcohol consumption is linked to dehydration.

Additionally, electrolytes are heavily involved in regulating your heartbeat, per the Cleveland Clinic. When you're dehydrated, the body has a harder time balancing its electrolytes, which can affect your heartbeat and might explain why your heart races at night.

How to calm a racing heart at night

It can be really hard to fall asleep when you can feel your heart beating in your chest when lying down. The good news is there are some simple ways to deal with your heart pounding at night, and these expert-approved tips are a great place to start.

1. Change your sleeping position

If you have a weird feeling in your chest and want to know exactly how to calm a racing heart at night, Dr. Jessup recommends starting by experimenting with different sleeping positions—especially if you tend to lie on your left side.

If your heart rate won’t go down, try sitting up or lying on your back, or roll over into the best sleeping position for heart palpitations: lying on your right side, which might help the rhythm to right itself.

2. Drink some water

To get rid of that weird feeling in your chest, Dr. Jessup says getting up to drink a glass of water is a good idea. Especially if you realize you have had a lot of caffeine or alcohol—and maybe not enough water—that day.

3. Do breathing exercises

Wondering how to stop heart palpitations due to anxiety? You can try some breathing exercises to calm yourself down if you're feeling stressed or think anxiety is causing heart racing when you’re trying to sleep. You'll want to focus on slow breathing, which can help you activate the parasympathetic nervous system.

“In healthy people, we see a temporary increase in heart rate with inhalation followed by a decrease with exhalation,” says Dr. Anderer. “Slow breathing can also have a direct influence on pressure receptors in the vascular and pulmonary systems and promote a state of relaxation, which tends to enhance the parasympathetic response throughout the body and allow you to ‘rest and digest.’”

4. Eat a plant-rich diet

If you can feel your heart beating in your chest when lying down, Dr. Klodas says avoiding known palpitation triggers and practicing stress management can help. But she also recommends keeping your heart healthy in general through your diet. “People who exercise regularly and eat a whole food, plant-rich diet that’s naturally high in fiber, healthy fats, and antioxidants experience fewer heart rhythm issues and less heart disease in general,” she says. “They also feel better and live longer.”

When are heart palpitations a cause for concern?

Wondering when to worry about heart palpitations? Occasional heart pounding, racing, or fluttering is pretty normal. However, if you've just started noticing palpitations, Dr. Klodas says it’s always a good idea to be evaluated by a medical provider. “Although most palpitations signal a benign cause, there are features that should trigger medical evaluation,” she says.

Below, learn how to tell what warrants a doctor visit and when a racing heart signals something more serious.

When to see a doctor for palpitations

If you’re experiencing chronic palpitations every time you go to bed, and you're hydrating, reducing stress levels, and monitoring caffeine intake—talk to a doctor. Sometimes heart palpitations can be signs of heart conditions like arrhythmia, heart valve disorders, thyroid conditions, or myocarditis. These conditions are chronic problems that require treatment, so be sure to reach out to a medical professional if you feel strange heartbeats consistently.

Heart palpitations can also be a sign of an anxiety attack. These episodes are not an immediate risk to your physical health. Rather, they are a sign you should seek mental health care.

When to go to the hospital for rapid heart rate

“Any palpitations that are newly persistent, or any palpitations that are associated with any one of shortness of breath, chest pain, and/or lightheadedness/passing out spells should be evaluated urgently,” says Dr. Klodas.

In the moment, a racing heart could signal you to tune in for signs of a heart attack. Heart attack signs include accompanying chest pain, dizziness, nausea, shortness of breath, or fainting. If you experience these symptoms in tandem with heart palpitations, seek treatment urgently.

The bottom line

It can be alarming to feel a weird sensation in your chest. Your mind might wander to the worst-case scenarios, but rest assured that slight changes in your heartbeat when you lie down are fairly common—as long as they're not chronic and no other symptoms arise. If your heart is doing gymnastics when you settle in for some sleep, roll over or get some water, then snag those zzzs.

—reviewed by Jennifer Gilbert, MD, MPH