Anxiety and a racing heart when trying to sleep

Quiet surroundings can make each beat more noticeable. Stress hormones, rapid breathing, caffeine, nicotine, dehydration and some medicines may also contribute.

Palpitations may feel like pounding, fluttering, skipped beats or a pulse that suddenly speeds up. Anxiety may start the sensation, and noticing it can then increase fear and keep the cycle going.

A clinician may also consider an irregular heart rhythm, an overactive thyroid, anaemia, low blood sugar or fluid loss. Note whether the rhythm feels regular, when it begins, how long it lasts and what you consumed that evening.

Sit upright, loosen tight clothing and slow your breathing, allowing a longer, relaxed exhale. Avoid repeatedly checking your pulse, which can heighten alertness. Reduce late caffeine, nicotine and stimulant-containing cold remedies, and drink fluids normally.

Arrange a routine appointment if episodes recur, wake you, occur with exercise or started after a medication change. A symptom diary and medication list can help the clinician decide whether an examination, heart tracing or blood tests are appropriate.

Seek emergency help for palpitations with chest pain or pressure, severe breathlessness, fainting, new weakness, confusion, or a fast heartbeat that does not settle while resting. Do not drive yourself if you feel faint or seriously unwell.

Prompt assessment is also sensible when you have known heart disease, are pregnant, or develop repeated dizziness. Urgency comes from these warning signs, not from whether anxiety seems likely.

Ask whether your medicines or caffeine intake could contribute, whether the rhythm should be recorded, and which symptoms should change your care plan. Mention family history of rhythm problems or sudden unexplained death.