Waking in the middle of the night with a racing heart can have minor to serious causes.

Have you been awakening in the middle of the night to find that your heart is racing? Below is information for both men and women.

“One of the common causes is simply sinus tachycardia or a fast, normal rhythm,” says cardiologist Dr. Pam Marcovitz, MD, medical director of the Ministrelli Women’s Heart Center, at Beaumont Hospital, Royal Oak.

“This condition does not need to be treated and does not regularly reoccur.”

In other words, it’s just something that occurred while you happened to be asleep, and the change in pulse was enough to awaken you.

This same situation can happen during the day but go unnoticed if you’re up and about.

If you’re noticing these incidents, document when they occur and record your pulse, to see if over time, there’s a pattern or if these incidents of a “racing” heart are happening less frequently — or more frequently—than it seems.

Another possible cause of awakening with a racing heart in the middle of the night is atrial fibrillation, says Dr. Marcovitz.

A-fib is a potentially serious disorder, as it can increase the risk of blood clots and cause symptoms including faintness.

During an A-fib episode, the heart rate bounces all over the place; it’s not steady.

In sinus tachy, the sped-up rate is steady, as in, for instance, a steady rate of 110 beats per minute (which may fluctuate a few beats up or down every minute).

In A-fib, the pulse is not steady, and a heart rate monitor would show the numbers quickly jumping from (for instance) 110 to 174 to 142 to 170 to 94 to 152. Do not try to diagnose yourself with A-fib.

“Feeling frightened and/or having a dream or nightmare, especially if the dream involved running or physical activity, whether you remember it or not, is another possible cause” of being awakened in the middle of the night with a racing heart, says Dr. Marcovitz.

“This late night response, however, should only occur very occasionally.

If it occurs more frequently, including throughout the day, see your doctor for possible connection to a heart monitor, which will evaluate for treatable causes,” including A-fib.

Another possible cause is a panic attack while you’re asleep. Yes, this can happen.

Years ago I was dreaming I was with my brother; nothing too eventful was playing out.

But in the dream I became aware that my heart was pounding—and fast. This then awakened me — and my heart was racing and pounding.

What I believe happened was during the REM stage of sleep (rapid eye movement; dreaming), my body physically had a spontaneous panic attack.

And it worked its way into the dream I just happened to be having, kind of like how the need to urinate can work its way into a dream (e.g., you’re searching for a restroom but can’t find one).

So, I literally awakened with a racing heart. I was so afraid for my heart — even though I did a lot of exercise — that I called 9-1-1 and an ambulance took me to the hospital.

In the ambulance my heart rate was in the 130s. At the ER it turned out that my heart was just fine (according to an EKG, stethoscope exam and troponin test).

Other Causes of Awakening in the Middle of Night with a Racing Heart

“Sleep apnea, anxiety and high blood pressure may also cause a person to awaken with a fast or racing heart rate,” says Dr. Marcovitz.

“These are potential causes for which a person should be evaluated.”

dr. marcovitz

Dr. Marcovitz has over 37 years of experience in helping people improve their heart health.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.  

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