Anxiety is a very common reason for people to develop heart palpitations at night. People who are stressed out, anxious, or have an underlying anxiety disorder may notice changes in their heart rhythm in bed, and this includes people who are excited, as well as people who are nervous or afraid. There can be other causes, including certain habits or underlying medical conditions. People who notice palpitations at any time should get evaluated by a physician to see if they are dangerous.
If anxiety isn't the cause of night palpitations, a potential culprit is habits. Caffeine and stimulant medications can cause irregular heartbeat and if people consume these things too soon before bed, their hearts may beat irregularly. People may also develop palpitations after eating, and if they eat shortly before going to bed or get up at night to eat, the heart rate can change. In addition, heavy exercise can change heart rhythms and many people exercise at the end of the day, causing them to experience palpitations at night.
Pregnancy is associated with changes to heart rhythm, as are some other underlying conditions. Thyroid abnormalities, structural problems with the heart, and certain other diseases may cause palpitations. Patients tend to notice variations in the heart rhythm more at night because of the quiet, and as a result, they may think they are having palpitations only or primarily during the evening hours.
When seeking treatment for palpitations at night, it helps to provide as much information as possible. Patients should describe any associated symptoms like shortness of breath, feeling dizzy, or becoming disoriented. If possible, the duration of palpitations should be noted. Doctors can also find it helpful to know about what people did during the day, to collect information that may help them find out why the patient's heartbeat is irregular. Someone who mentions drinking black tea before bed, for instance, could simply adjust tea drinking habits and experience an improvement in palpitations at night.
Evaluation for palpitations can include ordering an electrocardiogram to check for abnormal heart rhythms, as well as conducting a study where a patient wears a monitor for a set period of time to record the patient's cardiac activity. This can be useful for things like palpitations, which often do not occur on command and thus are hard to study in a controlled environment like a cardiac lab. Doctors may recommend medications, diet and lifestyle adjustments, and other steps to treat the abnormal heart rhythm.