Heart Racing at Night: Common Causes and What to Do

Key takeaways

• Heart racing at night is very common, and most causes aren't dangerous. Anxiety, caffeine, and alcohol are the most frequent triggers.

• Lying down can make you more aware of normal heart sensations, which may feel like racing or pounding.

• Less common causes include sleep apnea, hormonal shifts, thyroid problems, dysautonomia, and atrial fibrillation.

• Long COVID has increased rates of heart racing and POTS, especially in younger adults.

• Heart racing with chest pain, shortness of breath, or fainting needs medical attention right away.

 

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Heart palpitations at night are very common. You might feel your heart pounding, fluttering, or beating faster than usual when you lie down to sleep. Some people only notice it once in a while. Others have it almost every night.

Most of the time, heart racing at night isn't dangerous. It's often caused by things like caffeine, alcohol, or stress. But sometimes it can be a sign of an underlying medical condition that needs attention. In this article, we'll go over the common causes of heart racing at night, what you can do about it, and when it's important to see a healthcare professional.

Why does your heart race at night?

You're not imagining it. There are a few reasons heart racing feels more noticeable at night:

• The bedroom is quiet, so internal sensations are easier to feel.

• Lying down changes blood flow, which can briefly raise your heart rate.

• The shift from being busy to lying still gives your mind room to focus on your body.

• Stress and worry often surface at bedtime when distractions go away.

A normal resting heart rate for most adults is between 60 and 100 beats per minute. People who exercise often may have lower rates, sometimes in the 50s. A heart rate that occasionally rises into the 90s or low 100s at bedtime is usually not a problem. But a heart rate that stays above 100 at rest is worth checking with a doctor.

What causes heart racing at night?

There are several common causes. Most of them are everyday things that you can manage on your own.

Anxiety and stress

Anxiety is the most common cause of heart racing at bedtime. When you finally lie down at night, your mind has space to think about whatever's been bothering you. This activates your sympathetic nervous system, which is your body's "fight or flight" response. Your heart rate goes up, and your body feels more alert.

Anxiety-related heart racing usually starts after you lie down. It often gets better with slow breathing or distraction. You might also notice racing thoughts or muscle tension at the same time.

Chronic anxiety has also been linked to a higher risk of irregular heartbeats over time. So if anxiety is the main cause, treating the anxiety can help more than just managing the symptoms.

Caffeine

Caffeine is a stimulant that raises your heart rate and blocks the brain receptors that make you sleepy. It also stays in your system longer than most people think.

The half-life of caffeine averages about 5 hours. But it can range from 1.5 to 9.5 hours depending on your genetics, age, and how your liver processes it. That means a coffee at 2 PM could still leave 25 to 50 mg of caffeine in your body at bedtime.

Caffeine isn't just in coffee. Common sources include:

• Tea (black and green)

• Soda and energy drinks

• Chocolate, especially dark chocolate

• Pre-workout supplements

• Some pain relievers and migraine medications

• Decaf coffee, which has small amounts

About half the population is slow caffeine metabolizers. If that's you, even a morning cup might affect your sleep that night.

Good to know: Most sleep experts recommend cutting off caffeine 6 to 8 hours before bed. If you're a slow metabolizer, stopping after lunch or earlier may work better.

Alcohol

Alcohol can feel relaxing at first. That's why some people use it to fall asleep. But about 3 to 4 hours after drinking, your body starts metabolizing the alcohol. This often causes a rebound activation of your sympathetic nervous system, which can wake you up with a racing heart, sweating, or anxiety.

Alcohol-related heart racing usually happens in the middle of the night, not when you first go to bed. It often comes with a dry mouth, sweating, or feeling overheated. The bigger the amount of alcohol or the closer to bedtime, the worse it tends to be.

Sleep position

Some people get heart palpitations when they lie on their back or left side. Lying on the left side puts pressure on the heart, which can make you more aware of your heartbeat. Lying flat on your back changes how blood returns to the heart, which can briefly raise your heart rate.

This kind of palpitation is usually harmless. Switching to your right side or sleeping with your upper body slightly raised often helps.

Acid reflux

Acid reflux can stimulate the vagus nerve, which connects to the heart. This can cause heart palpitations, especially when you lie down after eating.

You might notice these palpitations along with heartburn, chest discomfort, or a sour taste. They tend to happen within 2 to 3 hours of eating. Elevating the head of your bed and avoiding spicy, fatty, or acidic foods at night can help.

Hormonal changes

A few hormonal conditions can cause heart racing at night:

• Perimenopause and menopause. Hot flashes are often paired with a brief rise in heart rate. Many women describe waking up with their heart pounding, feeling warm, and sweating.

• Thyroid problems. An overactive thyroid (hyperthyroidism) raises your resting heart rate and can cause palpitations day or night. Other signs include unexplained weight loss, sensitivity to heat, shaky hands, and trouble sleeping.

• Pregnancy. Increased blood volume and hormone changes can cause palpitations during pregnancy. They're usually harmless but worth mentioning to your prenatal provider.

Sleep apnea

Sleep apnea is a condition where your airway repeatedly closes during sleep. Each time it closes, your oxygen drops. Your body responds by activating the sympathetic nervous system, which raises your heart rate. People with sleep apnea often wake up with a racing heart, gasping, or feeling like they can't breathe.

Other signs of sleep apnea include:

• Loud snoring

• Pauses in breathing during sleep that someone else notices

• Waking up gasping or choking

• Feeling tired during the day, even after a full night's sleep

• Morning headaches

Sleep apnea is more common in people with obesity, but anyone can have it. If left untreated, it raises the long-term risk of high blood pressure, heart disease, and stroke.

Dysautonomia and POTS

Dysautonomia is a group of conditions that affect the autonomic nervous system, which controls things like heart rate and blood pressure. The most common form is postural orthostatic tachycardia syndrome (POTS). With POTS, your heart rate jumps significantly when you stand up.

POTS-related heart racing usually happens with position changes. It often comes with dizziness, lightheadedness, or feeling faint. It tends to be worse in the morning, after meals, or in hot weather.

Long COVID has caused a big rise in POTS cases. A 2025 study from the Karolinska Institutet found that nearly 1 in 3 adults with severe long COVID have POTS. Before the pandemic, less than 1% of the population had it. Many people with long COVID also have heart palpitations even without the full POTS diagnosis.

Atrial fibrillation and other arrhythmias

Atrial fibrillation (AFib) is an irregular heart rhythm where the upper chambers of the heart beat erratically. It can feel like fluttering, skipping beats, or a heart that speeds up and slows down at random.

AFib is different from anxiety-related palpitations in a few ways:

• The rhythm is irregular, not just fast

• It usually doesn't go away with calming techniques

• It can come with fatigue, shortness of breath, or chest discomfort

• It's more common in people over 60

Other arrhythmias include premature ventricular contractions (PVCs) and supraventricular tachycardia (SVT). Most are harmless, but those that happen often or come with symptoms should be checked by a doctor.

Also Read: Want a Healthier Heart? The AHA Says Add Sleep to Your Daily Habits

Medications that can cause heart racing at night

Some medications can raise your heart rate as a side effect. Common ones include:

• Levothyroxine for low thyroid

• ADHD medications

• Some antidepressants

• Cold and allergy medications with pseudoephedrine

• Asthma inhalers and steroids

• Some weight-loss medications

If you started a new medication and noticed your heart racing at night, talk to your pharmacist or healthcare provider. Sometimes the dose can be adjusted.

When should you see a doctor?

Most of the time, heart racing at night isn't an emergency. But certain symptoms shouldn't be ignored.

Get medical attention as soon as possible if you have:

• A heart rate that stays high and won't slow down

• Chest pain or pressure with a racing heart

• Shortness of breath that doesn't get better when you sit up

• Fainting or feeling as if you might faint

• An irregular rhythm (skipped beats, fluttering) that lasts more than a few minutes

• Heart racing with sweating, nausea, or pain in your arm, jaw, or back

• New nighttime heart racing if you're over 50 or have a history of heart disease

Call 911 or go to the nearest emergency room if heart racing comes with chest pain, severe shortness of breath, fainting, or other symptoms that suggest a heart attack.

For symptoms that aren't emergencies but happen often or interfere with sleep, see your primary care doctor or a cardiologist. They might order tests like an electrocardiogram (ECG), a Holter monitor, blood work, or a sleep study to find out what's going on.

What can you do about it?

The right approach depends on what's causing the racing heart. But several things help with most types.

Cut back on common triggers

• Stop caffeine by early afternoon, or earlier if it tends to keep you up

• Limit alcohol, especially within 3 hours of bedtime

• Avoid large or spicy meals close to bedtime

• Drink enough water during the day

• Skip intense exercise late in the evening

Try calming techniques in the moment

When your heart races at bedtime, slow breathing helps activate your parasympathetic nervous system. This is the opposite of "fight or flight" and tells your body to calm down.

A few techniques to try:

• Box breathing. Breathe in for 4 seconds, hold for 4, breathe out for 4, hold for 4. Repeat for 2 to 3 minutes.

• 4-7-8 breathing. Breathe in for 4 seconds, hold for 7, breathe out slowly for 8. Repeat 4 times.

• Sit up briefly. If lying flat triggers the palpitations, sit up for a few minutes until the feeling passes.

• Cold water. Splashing cold water on your face or holding a cold pack to your chest can activate the vagus nerve and slow your heart rate.

Address anxiety

If anxiety is the main driver, treating it directly tends to work better than just managing the symptoms.

• Cognitive behavioral therapy (CBT) is effective for anxiety and insomnia

• Mindfulness and meditation reduce sympathetic activity over time

• Talking to a healthcare provider about anxiety treatment options may help

• Some non-hormonal and melatonin-free supplements like Sip2Sleep®, which combines tart cherry extract and Rafuma leaf, have been studied for sleep quality and anxiety in adults with insomnia. Check with a healthcare provider before starting any new supplement.

Improve your sleep habits

Good sleep habits help reduce nighttime heart racing for many people:

• Keep a consistent bedtime and wake time

• Wind down for 30 to 60 minutes before bed without screens

• Keep your bedroom cool, dark, and quiet

• Use the bed for sleep, not work or scrolling

• Get morning sunlight to help your circadian rhythm

Treat the underlying cause

If a specific condition is causing the heart racing, treating it usually fixes the symptom. For example:

• Sleep apnea can be treated with CPAP or other therapies

• Hyperthyroidism is treated with medication

• POTS management includes hydration, salt intake, compression garments, and gradual exercise

• Hormone changes during perimenopause may improve with hormone therapy

• Acid reflux is managed with diet changes and sometimes medication

Frequently asked questions

Why does my heart beat so fast when I try to fall asleep?

The most common reason is anxiety or stress activating your sympathetic nervous system at bedtime. Caffeine, alcohol, and lying-down position changes are also common causes. If it happens often or comes with other symptoms, talk to a doctor.

How can I stop heart palpitations at night?

Cutting back on caffeine, alcohol, and stress are the most common ways to prevent nighttime palpitations. Treating underlying causes like anxiety, sleep apnea, or thyroid issues addresses the root problem. For occasional palpitations not tied to a medical condition, better sleep habits often help.

Is a heart racing at night dangerous?

Most of the time it's not. Anxiety, caffeine, and alcohol cause most cases. But heart racing with chest pain, shortness of breath, fainting, or a persistently irregular rhythm needs medical attention right away. New or frequent symptoms in people over 50 or with heart disease risk factors should be checked by a doctor.

Can anxiety cause heart racing at night?

Yes. Anxiety is the most common cause of nighttime heart racing. Your sympathetic nervous system activates when your mind quiets down at bedtime and stress surfaces. Treating anxiety with therapy, mindfulness, or other approaches often reduces palpitations.

Why does my heart race when I wake up from sleep?

Waking up suddenly, especially from deep sleep, can cause a brief surge in heart rate. This is usually harmless. POTS and sleep apnea can also cause heart racing on waking, so it's worth checking with a doctor if it happens often.

The bottom line

Heart racing at night is very common, and most causes are manageable. Anxiety, caffeine, alcohol, and sleep position make up most cases. Less common causes include sleep apnea, hormonal changes, dysautonomia, and arrhythmias.

Cutting back on triggers, improving your sleep habits, and addressing anxiety help most people. But don't ignore symptoms that feel severe or come with chest pain, shortness of breath, or fainting. A healthcare professional can help figure out what's going on.

References

1. Cleveland Clinic. Heart Palpitations at Night: Symptoms, Causes and Treatment.
   
   

2. Sleep Foundation. Heart Palpitations at Night: Diagnosis and Treatment.
   
   

3. Healthline. Waking Up with Heart Racing: Causes and Treatment. Updated October 1, 2025.
   
   

4. Karolinska Institutet. POTS in severe long COVID. Circulation: Arrhythmia and Electrophysiology. 2025.
   
   

5. JACC Advances. Characterization of Postural Orthostatic Tachycardia Syndrome in Long COVID: Self-reported Data From the LISTEN Study. 2025.
   
   

6. American Academy of Sleep Medicine. Sleep and Caffeine.
   
   

7. Erfe MCB, Oliver PL, Kazaryan A, et al. Combined Effects of Prunus Cerasus (Montmorency Tart Cherry) and Apocynum Venetum (Venetron) On Sleep and Anxiety in Adults with Insomnia. medRxiv. 2024.
   
   

8. Drake C, Roehrs T, Shambroom J, Roth T. Caffeine Effects on Sleep Taken 0, 3, or 6 Hours before Going to Bed. Journal of Clinical Sleep Medicine. 2013.