Heart palpitations when falling asleep

When you lie still, distractions fall away and a normal heartbeat may feel louder or more forceful. Stress at the end of the day, a racing mind, caffeine, nicotine, alcohol, dehydration or a heavy meal can add to the sensation. A change in position can also make beats more noticeable. Recurrent palpitations may occur with anaemia, thyroid overactivity or an irregular rhythm such as atrial fibrillation, so the timing alone does not establish the cause.

Pause and sit comfortably, then breathe slowly without forcing deep breaths. Check whether the beat feels regular and note any trigger, medicine or supplement taken that evening. Keep the room cool and avoid further caffeine, nicotine or alcohol. Arrange a review if the episodes keep delaying sleep, happen in the daytime too, or are becoming more frequent. A clinician may use an electrocardiogram or longer rhythm recording if the sensation is intermittent.

Get emergency help if palpitations occur with chest pain, fainting, severe breathlessness, collapse or confusion. Seek urgent advice for a heartbeat that stays very fast or irregular, or for severe dizziness or weakness. Do not wait for morning when these warning signs are present.

Ask whether your sleep routine, medicines or stimulants could explain the pattern, whether you need rhythm monitoring, and which symptoms require emergency help. Mention snoring, panic symptoms, reflux, alcohol use and any palpitations outside bedtime.