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Sleep Disorders

Rapid heart beat after awakening from sleep

03/03/2008

Question:

Hi, I am a twenty one year old male. I am five feet ten inches and 160 pounds. As far as I can remember, since I was about fifteen years old, I used to wake up in the morning, feeling as if I had no heart beat, then suddenly my heart would start beating at an abnormally rapid pace. If I tried to go back to sleep again, I would sometimes still wake up with the same scenario I just described. This used to happen to me more frequently when I was around seventeen or eighteen years old. Recently it has started occurring again. This only happens when I wake up in the morning. Can you tell me what this could be or how serious this could be. Thank you.

Sincerely

Answer:

There are a number of potential causes for the symptoms you describe and additional information will help to determine if further evaluation is needed. It's possible that the symptoms you describe could simply represent normal physiology, though they may also be signs of a more serious condition.

In normal sleep, as the night progresses, dream (or REM) sleep becomes more common and it is quite normal to awaken from a period of REM sleep in the morning. In REM sleep, there is variable nervous system activity that can lead to alterations in the heart rate. It is not uncommon that in you adults, skipped heart beats may occur during REM sleep as well as periods of more rapid heart rates. Thus, it's possible that you may simply be noticing heart variability associated with REM sleep.

It's also possible that the symptoms you describe could represent an underlying medical condition. One of the more common conditions that could lead to heart rate variability is a sleep related breathing disorder such as obstructive sleep apnea. This is a condition where people stop breathing in their sleep. Other symptoms include snoring, unrefreshing sleep, morning headaches and daytime sleepiness. The airway collapses that are part of obstructive sleep apnea can be associated with palpitations and nighttime shortness of breath.

The symptoms could also be a sign of underlying heart disease, though this would be unlikely in a young person. There are several congenital heart rhythm problems that can be associated with these symptoms.

In any case, it is something that should be evaluated by a physician. It may end up being nothing, but there may be a significant medical condition that needs to be addressed. You should speak to your Primary Care Doctor. Referral to a Sleep Specialist or Cardiologist may be needed, depending on specifics in your history and examination. Additional testing may be required to help sort out the cause of the palpitations.

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Response by:

James   Knepler, MD James Knepler, MD
Formerly, Assistant Professor
College of Medicine
University of Cincinnati