Emergency signs: act first
Call your local emergency number straight away if you have chest pain or pressure, fainting or near fainting, severe shortness of breath, a racing heart with dizziness, pain spreading to the arm or jaw, or blue lips. Do not wait to see whether it passes and do not drive yourself.
The rest of this page is for milder, repeated episodes that you should still discuss with a doctor.
Why the heart can pound at night
At night the room is quiet, so you notice your pulse. Waking from sleep also triggers a burst of adrenaline, which can make the heart race for a minute or two. The NHLBI explains that an arrhythmia is a problem with the rate or rhythm of the heartbeat, and that many are harmless while some need treatment. A pounding or fluttering heart that returns often deserves a check.
Common non heart triggers include late caffeine, alcohol, nicotine, stress, a bad dream or panic attack, dehydration and fever.
Breathing pauses and sleep apnoea
In obstructive sleep apnoea the airway repeatedly narrows or closes during sleep. People may wake gasping or choking, with a pounding heart. The NHLBI notes that apnoea raises the risk of high blood pressure and heart rhythm problems. The clinical practice guideline from Kapur and colleagues recommends a sleep study when symptoms suggest apnoea, such as loud snoring, witnessed pauses and daytime sleepiness.
Try the nasal vs mouth breathing screener and read sleep apnoea symptoms, testing and measurement.
Reflux, choking and cough at night
Stomach acid that reaches the throat can cause sudden coughing, choking and a burning chest, sometimes mistaken for a heart problem. Raising the head of the bed, sleeping on the left side and leaving 2 to 3 hours after meals can help. See the late meal curfew calculator and fix sleep with acid reflux. Chest pain should never be assumed to be reflux without a medical check.
Anxiety and panic at night
Panic attacks can wake you with a racing heart, sweating and fear of dying. They are frightening but not dangerous in themselves. Slow breathing helps: use the panic button insomnia reset and read fix sleep after a panic attack. If episodes repeat, talk to a doctor, and also rule out heart causes.
What to do the next day
- Write down the time, what you felt, how long it lasted and what you had that evening.
- Cut caffeine, alcohol and nicotine for a week. Use the caffeine half life calculator.
- Book a visit with your doctor if it happens more than once.
- Ask about an ECG, a heart rhythm monitor, blood tests and a sleep study.
- Keep a regular sleep schedule with the bedtime calculator.
Higher risk groups
- People with known heart disease, high blood pressure or diabetes
- People who snore loudly or are overweight
- Older adults
- People taking stimulants or some cold medicines
- Pregnant people, who should always report new palpitations to their care team
Helping yourself in the moment
Sit up, breathe slowly in through the nose for four counts and out for six, and sip cool water. Avoid caffeine. If the feeling passes within a couple of minutes and you feel normal, you can try to rest, but still tell your doctor. If it does not pass, or you feel unwell, seek urgent care.
What tests a doctor may suggest
A doctor will ask about the timing, duration and triggers of the episodes and examine you. Common tests include a resting ECG, a portable heart rhythm monitor worn for days or weeks, blood tests for the thyroid, anaemia and electrolytes, and sometimes an echocardiogram.
If your history suggests apnoea, a home sleep test or a lab sleep study can be arranged. Treatments depend on the cause and can include lifestyle change, a CPAP machine, treatment of reflux or anxiety care. Bring your diary to the visit.
Frequently Asked Questions
Why does my heart race when I wake up at night? ›
Waking releases adrenaline. Anxiety, caffeine, alcohol, reflux, apnoea and heart rhythm problems can also be the cause.
Is heart racing at night dangerous? ›
Often it is not, but chest pain, fainting or severe breathlessness are emergencies. Repeated episodes need a medical check.
Can sleep apnoea cause a pounding heart? ›
Yes. Breathing pauses can cause gasping awakenings and are linked with heart rhythm problems.
Should I go to the emergency room? ›
Yes for chest pain, fainting, severe breathlessness or blue lips.
What tests might a doctor do? ›
An ECG, a heart rhythm monitor, blood tests and possibly a sleep study.
Can anxiety cause night time palpitations? ›
Yes, but a doctor should rule out heart causes first.
Written by F.A and last updated on 5 November 2026. Claims are checked against the peer reviewed papers and public health sources listed below, and findings from small or early studies are labelled as such. We follow our editorial policy and explain how times and results are calculated in our methodology. Calculators run in your browser and store nothing. Found an error? Tell us and we will correct it.
Sources
- NHLBI. Arrhythmias
- NHLBI. Sleep apnea
- Kapur VK et al. Clinical practice guideline for diagnostic testing for adult obstructive sleep apnea. J Clin Sleep Med 2017
- Hirshkowitz M et al. National Sleep Foundation's sleep time duration recommendations. Sleep Health 2015
This page gives general information for adults and is not medical advice. If you have ongoing sleep problems, loud snoring, breathing pauses or heavy daytime sleepiness, speak to a doctor. Times and results are estimates.
