Q. My heart rate was around 48 to 55 BPM while sleeping. Do I need a pacemaker?

Answered by
Dr. Muhammad Zohaib Siddiq
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jul 31, 2021

Hello doctor,

I am 29 years old male. My height is 5”11, and my weight is 246 lbs. I am a smoker. I am not an atheletic. I got a watch to record my sleep. It showed last night my heart rate while sleeping was around 48 BPM to 55 BPM, and it went low to 44 BPM at one point. I am very scared. Is this very dangerous? I am going to see a cardiologist in two weeks. Also, I have skipped heartbeats for the past ten years. Kindly give your opinion.



Welcome to

Heart rate to go this down during sleep is very normal. Regarding skipped beats, if these occur daily, then have ECG (echocardiography) done when you feel such skipped beats or have Holter monitoring done. Regarding risk factors for cardiac disease, one is positive, and that is being overweight.

Please tell do you have diabetes or hypertension? Do you drink or smoke? Is there a family history of heart disease in the family? Do you exercise, or you have a sedentary lifestyle?

All these are risk factors for ischemic heart disease and should be managed. Please answer the questions so that I can guide you accordingly.

Hi doctor,

Thank you.

I read on internet, and it said if your heart rate is below 50 during the night, you will need a pacemaker. During the day, my heart rate is around 80 bpm. Just during sleep time, it goes slow. Please give your opinion.



Welcome back to

Not always, sir. A pacemaker is implanted if there is a heart block and the patient has symptoms of syncope or dizziness on slight physical activity. In the case of sinus bradycardia, no need for a pacemaker. In healthy persons, heart rate may drop to below 40 without symptoms during sleep. In athletes, it may remain below 50 even when awake. If you have skipped beats, then I recommend getting ECG or Holter monitoring done to see the heart rhythm.

I hope this was helpful.

Hi doctor,

Thank you.

I did a few ECGs, all are normal. I will see a cardiologist in two weeks. He wants to put a two-week Holter on me. Skipping beats, my doctor said it is happening because of my severe anxiety or stress. Now every time skipping happens, I feel I am going to die. I feel a panic attack, and I feel I am going to pass out. But my doctor is saying it is all in my head. How can anxiety cause more skipping beats and cause panic attacks that make me feel like I cannot breathe? Please guide me.



Welcome back to

The feeling of skipped beats is by two mechanisms:

1) Either it is only your feeling and no actual presence of skipping beats.

2) Stress causes the release of stress hormones that affect the heart and cause premature beats, which give a feeling of skipped beats because a compensatory pause follows every premature beat in a heartbeat.

Holter will differentiate between these two. I hope this was helpful.

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