You're lying in bed, getting ready to start your day, when suddenly you feel the strange and somewhat scary sensation of your heart pounding to beat the band. Should you call 911?
"Palpitations are the sensation of an abnormal heartbeat," says Michael J. Blaha, MD, MPH, director of clinical research at the Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, in Baltimore, Maryland. "They can last for only a second or two, usually representing a premature heartbeat. Or they can be sustained, potentially pointing to an arrhythmia."
Video of the Day
According to the American Heart Association, an arrhythmia occurs when your heart beat deviates from its normal pace. That can mean a beat that happens faster than normal, slower than normal or erratically.
In truth, a short-lived deviation may be no big deal. "Palpitations are commonly benign," Dr. Blaha says. But sometimes, he adds, they can be a sign of an important underlying condition, particularly when an arrhythmia event lasts for an extended period of time.
You Could Have Sleep Apnea
One of the underlying conditions that can cause palpitations is sleep apnea, which can be a potentially serious disorder, according to the Mayo Clinic. It occurs when breathing repeatedly starts and stops while you're asleep. Sometimes this is due to the brain's failure to properly communicate with the muscles that regulate breathing.
More commonly, though, sleep apnea can be traced back to muscle relaxation patterns in the back of the throat, which can cause airways to narrow. Such narrowing can lead to a drop in air intake and to a dip in blood oxygen levels.
Plummeting blood oxygen levels can make breathing difficult, sometimes prompting a choking, gasping or snorting reflex. This can then trigger the brain to rouse you from your sleep, if only momentarily. And that's a pattern that can repeat as many as 30 times or more an hour, all through the night. The result is decidedly bad sleep and, on occasion, heart palpitations upon waking.
"Sleep apnea is extremely common," Dr. Blaha says, especially among people with overweight. "And the sensation of heart pounding upon waking up does potentially point to sleep apnea."
"A heart-pounding sensation on awakening can be due to a number of factors," says Kenneth A. Ellenbogen, MD, professor and chair of the division of cardiology at the Virginia Commonwealth University School of Medicine in Richmond.
On the one hand, he says, such palpitations could derive from a simple change in posture while asleep. Alternately, they could stem from a sleep-to-wakening shift in an individual's so-called "autonomic tone," the nervous system's round-the-clock effort to keep bodily functions automatically chugging along, even while you're asleep.
But sleep apnea, Dr. Ellenbogen says, is probably one of the most common things behind wakening palpitations.
Heart Trouble May Be to Blame
"Sleep apnea is also an important risk factor for atrial fibrillation and heart failure," Dr. Blaha says.
Both experts recommend visiting your doctor or a cardiologist in order to figure out if heart trouble is actually the first link in a chain of health issues leading to chronic sleep apnea and, ultimately, waking palpitations.
"If a patient consistently wakes up short of breath with a sense of heart pounding, they should speak with their providers about the need for an EKG," Dr. Blaha says.
According to the National Heart, Lung and Blood Institute, in addition to arrhythmia, a host of other potentially serious cardiovascular concerns could manifest as heart palpitations, including the possibility of a heart attack, heart failure, heart valve disease or a heart muscle disease known as cardiomyopathy.
So if you're experiencing morning heart palpitations, take the advice to meet with your doctor. Testing can nail down an exact cause and get you on the road to appropriate treatment.
- Kenneth A. Ellenbogen, MD, professor, chair, division of cardiology, Virginia Commonwealth University School of Medicine, Richmond
- Michael J. Blaha, MD, MPH, director, clinical research, Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, Maryland
- National Heart, Lung, and Blood Institute: "Heart Palpitations"
- American Heart Association: "About Arrhythmia"
- Mayo Clinic: "Sleep Apnea"
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.