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Sleep Disorders

Madly pumping heart

08/24/2004

Question:

Can you give me a clue what is going on? About once/twice a year my body will wake me up during sleeping at night and send me into the fight/flight mode. It makes me want to run. My vision field becomes very narrowed as if I am looking through the wrong end of a telescope. My heart is beating like I did not know a heart could beat that strongly. Not like an “a fib” beat (I have had that beat once in my life about 20 years ago, so I know what that feels like) but like it is trying to play catch up after being stopped. After about a minute, it slows done to normal and I feel normal and go back to bed for a normal balance of the night. I used to have this same thing during the daytime when I am awake, but have not had that for about 40 years. As long as I wake up and the heart slows down I would not worry, but I might just lie there and die some night if I do not wake up. I am 75, do not have sleep apnea, weight 200 and am 6 feet tall, do not have high blood pressure, diabetes. I take celebrex, synthroid, norvasc, warfarin (for irregular heart beat). I get lots of exercise, sleep well. No depression, mental problems. I have a heart stent, but no by pass. But I have been having this problem since about 40 years ago, before the medicines and heart problem. A family practice Dr. once told me it might be pressure from stomach gas pressing on the vagas nerve and stopping my heart from beating. I hope I have given you enough information. I know you cannot diagnose via this website, but maybe you could rule out some things. I exercise strenously and do not get out of breath or get dizzy, so I think my heart is all right. But something is causing it to stop beating, only when I am sleeping. Thanks.

Answer:

Waking up with a rapid heart rate can be a frightful and anxiety-inducing problem. The causes are highly variable, and seeking further evaluation is appropriate.

The heart rate typically slows as one falls asleep. It remains slower than the awake heart rate with the exception of during REM sleep (or dream sleep), when the heart rate picks up and roughly matches that of the awake heart rate. In addition, during REM sleep, there may be "surges" or sudden rises in the heart rate that may reflect the increased nervous system activity that accompanies dreaming.

To determine how to proceed in your case, it is very important to establish the type of heart rhythm your heart is in when it is beating rapidly. An arrhythmia, or abnormal heart rhythm, generally requires a different evaluation than an accelerated sinus, or normal, heart rhythm. The best way to determine the type of rapid heart rhythm you are experiencing is to undergo some sort of a heart monitoring test. These are generally done at home and include the use of a small portable monitoring device that can capture your heart beat and record it for some defined period of time (ranging from days to weeks). Some monitors, such as an event monitor, allow you to alert the device when you are experiencing symptoms. Once the monitoring is complete, then a Cardiologist will review the data and determine if an abnormal heart rhythm has occurred at any time.

Arrhythmias occurring at night may result from a number of causes, such as heart disease, low oxygen level in sleep, or surges in stress hormones (sometimes seen with obstructive sleep apnea or nightmares). If an abnormal heart rhythm is the cause of your symptoms, then further cardiac and sleep evaluation would be necessary.

Sudden increases in heart rate that are normal sinus rhythm may also result from a number of underlying causes. These may include the surges in heart rate related to normal REM sleep, nightmares, anxiety / panic disorders, breathing problems in sleep (such as sleep apnea or spasms of the larynx), low oxygen level in sleep, nighttime reflux (or heartburn), alcohol / caffeine / substance use or withdraw, or certain metabolic conditions (such as low blood sugar or an untreated hyperactive thyroid).

I recommend you discuss your problems further with your primary care physician. Further history regarding additional symptoms associated with the rapid heart rate may prove useful. Portable heart rate monitoring should be considered. Referral to a Cardiologist and/or Sleep Specialist may be necessary, depending upon the results of the initial evaluation.

If you would like further information regarding sleep and sleep disorders, you can obtain it on the American Academy of Sleep Medicine website at www.aasmnet.org. This website also contains a list of Sleep Centers across the country so you can locate one near you if need be.

Good luck and here's to better sleep!

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Response by:

Dennis   Auckley, MD Dennis Auckley, MD
Associate Professor of Medicine
School of Medicine
Case Western Reserve University