Heart palpitations before bed: what should you know?

Caffeine, nicotine, alcohol, some cold remedies, a heavy meal, reflux, dehydration and emotional strain can make the heartbeat feel prominent before sleep. The transition to a quiet room can also draw attention to sensations that were less noticeable during the day. Palpitations may present with Anaemia, Hyperthyroidism, Hypoglycaemia or Atrial Fibrillation, so the timing does not prove a simple bedtime trigger.

Consider whether the feeling is a steady fast beat, an irregular flutter or isolated skipped beats. Note associated chest discomfort, breathlessness, dizziness or faintness, as these details change the urgency of assessment.

Keep a short diary of drinks, meals, medicines, stress, bedtime and each episode's duration. Avoid personal triggers near bedtime, drink fluids unless restricted, and use a calm wind-down routine. Sit upright if reflux or discomfort is present. Do not change prescribed treatment or take a heart remedy without professional advice.

Book a clinical review if the pattern is new, becoming more frequent, lasting longer, or affecting sleep. Bring your diary and a list of medicines, supplements and energy products.

Call emergency services for palpitations with chest pain, severe breathlessness, fainting, confusion, severe dizziness or a heartbeat that remains very fast or irregular. Urgent review is also appropriate if symptoms are accompanied by new swelling, breathlessness when lying down or waking gasping.

Could caffeine, reflux, a medicine or dehydration explain the timing? Do I need checks for anaemia, thyroid function, glucose or an irregular rhythm? What should I do if an episode starts after I go to bed?