HomeAnswersInternal Medicineacid refluxWhen I wake up, my heart is often racing. Why?

When I wake up, my heart is often racing. What could be the reason?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Hariharan

Medically reviewed by

iCliniq medical review team

Published At September 29, 2015
Reviewed AtJanuary 18, 2024

Patient's Query

Hello doctor,

I am a 61 year old man and in reasonably good health apart from being overweight and diagnosed diabetic 10 years ago. The following has started after I lost a lot of weight.

For the last 9 months, I have had to sleep sitting up in a chair and leaning to my left side. If I lie down to sleep horizontally, or remain sitting up but tilting even slightly backward, or if I slip down on to my back on the chair while asleep, my heart begins to get faster and faster. I feel no pain and it does not wake me up. That is the problem, I sleep through it until I wake up with the need of going to the bathroom. I suspect these episodes last for hours with my heart going dangerously fast. These are not palpitations.

When I wake up, my heart is often racing, and I have to take deep breaths for a couple of minutes to get enough oxygen inside me for the heart to return to its normal beat. It all started very suddenly, not progressive. For all these months I have been scared by the prospect of having to go to sleep and leave it as long as possible before trying, just praying that I can get through the night keeping myself upright and with a reasonably clear nose. If I can do that, I can usually make it through reasonably fine, but this is the exception rather than the rule.

Body position seems to be one key factor, clear nose another, but the first always overrides the latter in importance. I recently had to make a 6 day 1500 mile dash drive and slept every night upright in the car seat right next to an open window. I had no problems at all during those 5 nights. A cardiologist has run tests and told me there is nothing abnormal with my heart’s muscle or function.

I rented an automatic CPAP machine for 4 months, but have now returned it. It does not do much of help, but its data shows no continuous waking such as might happen with obstructive sleep apnea. It does, however, show that I go into periods of shallow breathing while asleep. The only other suggestion that I have had is that this might be some form of central sleep apnea and therefore perhaps more neurologically based. The company that rented me the CPAP machine say that a BIPAP machine might be better, as it will force me to breathe, but I would really like a more expert opinion before going down that extremely expensive road.

Do you know any other people who have had similar symptoms and experiences, and if so, what was the cause and how was it treated? Current daily medications I take are 75 mg Aspirin for blood thinning, 1 x 15 mg Pioglitazone/ 850mg Metformin tablet for controlling diabetes, 5 mg Ramipril for blood pressure, and various vitamin and fish oil supplements.

Answered by Dr. Hariharan

Hi,

Welcome to icliniq.com.

My compliments for a detailed medical history of what you have been going through in the last nine months. I have gone through it and following are the points which are important to show the way to diagnosis:

  1. Heart rate increases on lying posture.
  2. No problems while sleeping in the car with the windows open.
  3. CPAP is not working for you.
  4. Taking three main tablets and other multivitamins.
  5. Cardiologist opinion- there is nothing wrong with your heart.

What are the problems you do not probably have:

  1. We can comfortably rule out heart problems since your cardiologist said so.
  2. There seems to be no lung involvements, since there is no cough or wheezing on lying down.
  3. It is not sleep apnea, as it will affect sleep even in a sitting posture, and it will not cause increased heartbeat on lying or while waking up.

What you may have:

  1. Acidity- since you are taking Aspirin, which is one of the most important cause for acidity. Other tablets you are taking can cause acidity. Increased heartbeat on lying, acidity may cause this because if your stomach is full of acid, in sitting position the stomach remains in the abdomen, but on lying down, the stomach comes in slight contact with heart and diaphragm, the acid may irritate heart and can cause increased heart rate. Gastritis (acidity) is due to many causes like not eating food at proper intervals, too much coffee/ tea, eating hot and spicy foods, colas, junk foods, less sleep, increased work pressure/ tension/ increased thoughts, too much of worrying, smoking, and alcohol.
  2. Stress- my most probable diagnosis is acidity with reflux only, but increased stress leading to increased heart rate may be a causative factor.

My suggestions:

  1. Start taking tablet Pantoprazole and Domperidone combination twice a day before food for one month.
  2. Proper diet and lifestyle modification.
  3. Drink 1 liter of water immediately after waking up in the morning. It is difficult first but slowly you can do that.
  4. Eat at the proper time, even if you do not feel hungry, eat thrice a day at the same time every day.
  5. Avoid spicy food, colas, and junk foods.
  6. Drink or eat after the food has come to the room temperature. Do not consume hot food items.
  7. Eat one different fruit every day (not as juice).
  8. Eat a lot of vegetables.
  9. Drink milk twice a day, reduce coffee and tea. Drink 1 cup of yogurt every afternoon.
  10. Walk daily (brisk walking) for 40 minutes every day.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Hariharan

Dr. Hariharan

Diabetology

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