Derek Burnett
Derek Burnett is a Contributing Writer at Bottom Line Personal, where he writes frequently on health and wellness. He is also a contributing editor with Reader’s Digest magazine.
If you’ve been told that you have atrial fibrillation (or “A-fib”), you may have noticed that you only experience its symptoms—or experience them more strongly—at night. In fact, some people believe that their A-fib is a nighttime-only phenomenon. Here’s what to make of those nocturnal A-fib symptoms.
First, a word about what atrial fibrillation is. Your heart is a marvelously calibrated pumping machine. The familiar lub-dub of the heartbeat is not just the single contracting and releasing of one heart muscle. Instead, the upper and lower chambers of the heart contract a fraction of a second apart in a rhythm timed perfectly to empty each chamber so that blood can be pumped strongly and efficiently throughout the body. That perfect timing is controlled by electrical pulses that are generated within specialized nodes of tissue inside the heart. In atrial fibrillation, something goes awry in the electrophysiology of the heart, and instead of regular, steady signals, the electrical activity becomes erratic. The result is the rapid quivering (fibrillation) of the muscle of the heart’s upper chambers (the atria), putting them out of time with the lower chambers (the ventricles). Now the heart struggles to get blood to the brain and other tissues, often bringing on shortness of breath, dizziness, and other symptoms. Inefficient pumping also leaves too much blood behind in the heart’s chambers. This blood can stagnate and form clots that can travel to the brain and produce a stroke.
Not all people experience atrial fibrillation symptoms in the same way. In fact, some have no symptoms at all (this is sometimes called “silent” or “hidden” atrial fibrillation), while for others an episode of A-fib can be extremely disruptive. One person with symptomatic A-fib might feel one dominant symptom, while others could experience a wider array of symptoms of varying intensity. Women tend to experience A-fib symptoms more strongly than men. Older people, especially those with mild symptoms such as fatigue or dizziness, may have trouble distinguishing the manifestations of A-fib from the normal changes that come with aging.
Possible A-fib symptoms include:
When people experience A-fib during the overnight hours, they often report a slightly different set of symptoms than those they feel during the day. In fact, some may not notice their A-fib at all during the day, believing that they have A-fib only at night.
Of course atrial fibrillation symptoms can occur at any time of the day or night. A key difference between these times of day is that you are at rest during the night, not going about your daily affairs. If you’ve ever had an itchy rash, you’ve probably struggled with it the most while you were in bed. Even a cough from the common cold often feels worse at night because you’re lying there with nothing to distract you from that tickle at the back of your throat. The same thing may be true for many people with A-fib…lying there in bed, they turn their attention more closely to their breathing and heartbeat.
But that isn’t to say that the difference in symptoms between day and night is entirely in your head. In fact, sleep is thought to be a possible trigger of A-fib, so some people might actually only experience it at night. And different brain states, breathing patterns, and physical posture at night could well bring about a different set of symptoms when your heart goes into atrial fibrillation during sleep.
Sometimes people who report different A-fib symptoms at night are able to recognize them themselves, while other times it’s their sleeping partners who notice them. A-fib symptoms that you or a partner might notice could include excessively heavy breathing and prodigious sweating during sleep. A person with A-fib might also wake frequently throughout the night, sometimes with a fluttering or thumping chest. Sometimes A-fib patients wake up in the morning with a strange feeling in their chest, or they awaken feeling inexplicably anxious.
If A-fib symptoms keep you up at night or diminish your sleep quality, there may be things you can do to get better rest at night:
Hydrate. Not only is dehydration a known A-fib trigger, but research also shows that people who are dehydrated tend to get less sleep. So drink plenty of water throughout the day and especially before bedtime.
Reduce stress. Multiple studies show a connection between negative emotions and A-fib symptoms. Whether it’s through therapy, meditation, exercise, or removing stressors from your life, improving your mental well-being could help you sleep better, especially since we often ruminate about the stress in our lives at night.
Treat sleep disorders. If you think you may have sleep apnea or another sleep-related condition, get a sleep study done so you can address the problem. Sleep apnea is a known risk factor for atrial fibrillation, and the interruptions to sleep that it brings may also disturb the natural increases and decreases in heart rate that come with different sleep cycles throughout the night.
Cut out alcohol. Alcoholic beverages trigger many diagnoses of atrial fibrillation. You may find it necessary to quit drinking altogether, or at least to cut out alcohol in the later hours.
Get off your left side. A 2021 study found that, among symptomatic A-fib patients who reported a difference in symptoms depending on their sleep position, 57% said that sleeping on their left sides was what triggered their A-fib. This was especially true for those with higher body mass index. The prone position (face-down) was least likely to be reported as a trigger of A-fib.
Dial back the caffeine. Many, but not all, people notice that caffeine consumption can be a trigger for their A-fib. If you habitually drink caffeinated beverages, especially late in the day, try consuming less, consuming it earlier, or not consuming it at all and drinking decaffeinated coffee. This could be the stimulus that’s causing your nighttime A-fib symptoms.
Treat you’re A-fib
It may seem obvious, but the best way to reduce the nighttime symptoms of atrial fibrillation is to get treatment for the condition itself. Today, A-fib is a very treatable condition, with medications and minimally invasive procedures that can help keep your heart from going into A-fib or beating too rapidly. Taking your heart condition seriously and pursuing a treatment plan in close consultation with your doctor will not only help with you’re A-fib symptoms in the short term, but also can help manage your long-term risk of stroke.
