Struggling with Insomnia and Heart Palpitations: Seeking Answers

I can't sleep at night and I keep feeling the sound of my heartbeat?

Doctor, I apologize for bothering you with my questions.
I have been experiencing insomnia for about two weeks because I constantly feel a vibration in my heartbeat, which makes me very uncomfortable and unable to sleep.
Every time I lie down, I feel soreness in my neck and upper back, and it feels very tight.
I have had issues with palpitations before, and I visited the cardiology department at Chi Mei Medical Center in Tainan, where I was diagnosed with non-rheumatic mitral valve insufficiency.
An orthopedic clinic also took X-rays and indicated that I have spinal compression.
However, several electrocardiograms (one of which involved wearing a monitor for a whole day) have all come back normal.
My quality of life is very poor, and I am suffering; I can't sleep and constantly feel my heart racing.
I have even manually measured my heart rate at fifty beats per minute while lying down before sleep.
When I often experience palpitations, I feel like I'm about to faint or die, and I have gone to the emergency room in the early morning when my heart rate was very fast, but the doctor just gave me an IV, and I felt better afterward.

As a soldier, I have been on a 24-hour rotating shift for three years, with irregular work hours, sometimes catching up on sleep in the early morning or during the day.
It is also difficult to seek medical attention while stationed on an offshore island.
I am at a loss about what kind of doctor to see.
I wonder if my recent symptoms are related to quitting smoking; I have been smoke-free for five weeks, but I am unsure if this is the cause.
My symptoms include frequent discomfort and soreness in my back and neck, and I find myself subconsciously twisting my head.
When palpitations occur, I become very anxious, thinking I am about to die, and I cannot relax.
This has been going on for a long time, and I don't know what to do.
I am unsure if this is panic, cervical nerve compression, or a heart condition.

Doctor, could you please help me with advice and answers? I sincerely appreciate it.
Thank you very much!

Mr. Lou, 20~29 year old female. Ask Date: 2020/04/21

Dr. He Dongjin reply Cardiology

Hello, it seems that the shift work is causing autonomic nervous system dysregulation and panic disorder.
It is recommended to consult a psychiatrist for medication or consider not working shifts anymore.
Changhua Hospital cares about your well-being.

Reply Date: 2020/04/21

More Info

It sounds like you are experiencing a challenging combination of symptoms, including insomnia, heart palpitations, and discomfort in your neck and back. These issues can be quite distressing and can significantly impact your quality of life. Let’s break down your concerns and explore some potential explanations and recommendations based on your symptoms and medical history.

Understanding Your Symptoms
1. Heart Palpitations: Heart palpitations can feel like your heart is racing, fluttering, or pounding. They can be caused by a variety of factors, including anxiety, stress, caffeine, nicotine, or underlying heart conditions. Given your history of non-rheumatic mitral valve regurgitation and the normal results from multiple ECGs and echocardiograms, it seems that your heart is structurally sound, which is reassuring. However, palpitations can still occur due to anxiety or panic attacks, especially if you have a history of these conditions.

2. Insomnia: The inability to sleep can be exacerbated by anxiety and physical discomfort. When you are anxious, your body releases stress hormones like adrenaline, which can increase your heart rate and make it difficult to relax enough to fall asleep. Additionally, the physical discomfort in your neck and back may also contribute to your inability to find a comfortable sleeping position.

3. Neck and Back Discomfort: The tightness and discomfort in your neck and upper back could be related to muscle tension, which is often a physical manifestation of stress and anxiety. If you have been under significant stress, such as from your military duties and irregular work hours, this could lead to muscle tension and discomfort.

4. Lifestyle Factors: You mentioned that you recently quit smoking, which can also affect your body in various ways. Withdrawal from nicotine can lead to increased anxiety and changes in sleep patterns. Additionally, irregular sleep schedules due to your military duties can disrupt your circadian rhythm, further complicating your sleep issues.

Recommendations
1. Consult a Healthcare Professional: It’s crucial to continue seeking medical advice. Since you have a complex history, consider consulting both a cardiologist and a mental health professional. A cardiologist can help rule out any potential heart-related issues, while a mental health professional can assist with anxiety management and insomnia.

2. Cognitive Behavioral Therapy (CBT): This form of therapy is effective for treating anxiety and insomnia. It can help you identify and change negative thought patterns that contribute to your anxiety and sleep disturbances.

3. Relaxation Techniques: Incorporate relaxation techniques into your daily routine. Practices such as deep breathing exercises, progressive muscle relaxation, or mindfulness meditation can help reduce anxiety and promote better sleep.

4. Regular Exercise: Engaging in regular physical activity can help alleviate anxiety and improve sleep quality. However, try to avoid vigorous exercise close to bedtime, as it may have the opposite effect.

5. Sleep Hygiene: Establish a consistent sleep routine. Go to bed and wake up at the same time every day, create a comfortable sleep environment, and limit exposure to screens before bedtime.

6. Monitor Caffeine and Alcohol Intake: Both substances can affect your sleep and anxiety levels. Reducing or eliminating them may help improve your symptoms.

7. Consider Medication: If anxiety continues to be a significant issue, discuss with your healthcare provider the possibility of medication to help manage your symptoms. This could include anti-anxiety medications or sleep aids, depending on your specific needs.

Conclusion
Your symptoms are likely multifactorial, involving both physical and psychological components. It’s essential to address both aspects to improve your overall well-being. Continue to seek medical advice, and don’t hesitate to reach out for support from mental health professionals. Remember, you are not alone in this, and with the right approach, you can find relief from your symptoms.

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