6 Nighttime Atrial Fibrillation Symptoms: What Helps?

Atrial fibrillation, sometimes called AFib or AF, is the most common type of heart arrhythmia (abnormal heart rhythm). AFib causes the upper chambers of your heart to beat irregularly. AFib can increase your risk of severe problems like heart attack or stroke.

Symptoms of AFib can make you feel tired, dizzy, or like you will faint. However, when symptoms occur during sleep, they may not feel the same as those you have during the day. Factors that only occur at night, such as constant waking, can trigger more symptoms.

Common Atrial Fibrillation Symptoms at Night

Atrial fibrillation symptoms at night can differ from those during the day. These symptoms may feel different because you’re resting and lying down. Factors that affect your sleep can also cause them to occur more often at night.

Frequent Symptoms

Frequent nighttime AFib symptoms include the following:

• Fluttering or “thumping” in your chest
• Waking with an odd feeling in your chest
• Feelings of anxiety when waking
• Frequent nighttime waking

Reasons AFib Happens at Night

Several reasons can explain why AFib occurs at night. These generally involve changes that put more stress on your heart or disrupt your sleep pattern, such as:

• Sleep disturbances: Your heart rate normally decreases during non-rapid eye movement (NREM) sleep and increases during rapid eye movement (REM) sleep. Abrupt awakenings from factors like sleep apnea can disrupt these natural heart rate changes, increasing heart stress and AFib risk.
• Higher sensitivity to heart rate changes: Heart palpitations from heart disease, heart attack damage, AFib, or other causes may feel more intense at night. A quiet room might heighten your awareness of these palpitations, making them seem more intense or frequent.
• Caffeine and alcohol consumption: Consuming caffeine and alcohol can affect your heart rate and increase the risk of nighttime palpitations. Both can raise your heart rate during sleep, possibly heightening the risk of palpitations.
• Dehydration: Abnormal electrolytes (minerals like sodium and potassium) or not drinking enough water can cause dehydration. The condition can cause a rapid and forceful heart rate during sleep.

Co-Occurring Sleep Conditions in AFib

People with AFib often experience several sleep conditions. These can lead to poor sleep quality and may increase the prevalence and severity of AFib symptoms.

Sleep Conditions

AFib is linked to the following co-occurring sleep conditions:

• Sleep apnea (a disorder that causes the partial or complete obstruction of your upper airway several times during sleep). Obstructive sleep apnea is caused by obesity or abnormal structures in your mouth or throat. It occurs in 40% to 80% of people with heart conditions, including atrial fibrillation.
• Restless legs syndrome: Restless legs syndrome involves frequent periodic leg movement during sleep. Frequent leg movement during sleep is linked with the progression and recurrence of atrial fibrillation.
• Insomnia: Insomnia is an inability to get enough sleep for various reasons that can interfere with falling asleep, staying asleep, or waking earlier than desired. Insomnia may be associated with A-fib.

Complications of AFib

When undetected or untreated, AFib can lead to serious complications such as the following:

• Blood clots (clumps that occur in your veins or arteries when blood hardens from a liquid to a solid)
• Dementia and cognitive impairment (impaired ability to think, remember, or make decisions)
• Heart failure (a condition in which your heart can’t pump enough blood through your body)
• Stroke (a medical emergency in which blood flow is interrupted to an area of your brain)
• Cardiac arrest (sudden loss of heart function that stops breathing and blood flow to your brain)

How to Get Better Sleep With Atrial Fibrillation

You can sleep better with atrial fibrillation by making changes proven to support quality sleep. Research indicates that sleep quality is important to AFib, with sleep disruption being an important risk factor.

You can improve your sleep quality and reduce sleep disruptions by treating underlying disorders like obstructive sleep apnea that affect your ability to get restful sleep. Taking the following steps individualized for your preferences can also improve your sleep:

• Establish a set sleep schedule, going to bed and waking up at consistent times.
• Limit naps during the day.
• Set up a bedroom that is quiet and dark with a comfortable temperature.
• Use comfortable bedding that promotes pain-free sleep.
• Avoid looking at your cell phone, computer, or television screen at least 30–60 minutes before bed.
• Practice relaxation techniques like meditation, paced breathing, and mindfulness to put you in the right mindset for bed.
• Avoid consuming caffeine and alcohol later in the day.
• Remain hydrated during the day.
• Establish and maintain a healthy body weight to reduce your risk of obstructive sleep apnea.

When to Call 911 or Go to the Hospital

Atrial fibrillation increases your risk of stroke and heart attack at any time. Do not try to determine whether symptoms such as chest pain are severe. Call 911 or go to the hospital if you have any of these symptoms, which could be warning signs of the following conditions:

Heart attack warning signs:

• Chest discomfort that involves the center of your chest causing discomfort, pressure, fullness, squeezing, or pain
• Pain or discomfort in one or both arms, your back, neck, jaw, or stomach
• Shortness of breath with or without chest discomfort
• Breaking out in a cold sweat
• Nausea or light-headedness

Stroke warning signs (usually occur suddenly):

• Face drooping, usually on one side
• Weakness, numbness, tingling, or loss of movement in your face, arm, or leg on one side of your body
• Difficulty speaking or slurred speech or understanding simple statements
• Confusion
• Difficulty seeing or walking normally
• A sudden severe headache that feels worse than previous headaches
• Loss of consciousness