Fluctuating Heart Rates During Sleep: Causes and Solutions

During sleep, the heart rate is too low and fluctuates significantly?

Hello, Doctor.
Since I started wearing a smartwatch in April, I have noticed that my heart rate averages between 45 and 120 throughout the day, and during sleep, it ranges from 45 to 60.
This morning, I discovered that my heart rate dropped to a low of 39 while sleeping, accompanied by a feeling of pressure in my chest and difficulty breathing, especially with inhalation.
The heart rate during sleep fluctuated between 39 and 90, which is a significant difference.
Since April 29, while at work, my heart rate has increased, causing discomfort in my chest, reaching as high as 140.
Over the past few days, my heart rate during work has ranged from 70 to 140.
I typically sleep from around 4 AM to noon, and my work hours are from 1 PM to 11 PM.

In the past, during my student years, I experienced severe shortness of breath that brought me to tears, prompting me to seek help.
In high school, I underwent a 24-hour ECG, which showed no issues.
I also went to the emergency room after feeling weak and experiencing a rapid heartbeat while taking a shower at night, where I was only given IV fluids.
To investigate potential heart problems, I had a cardiac examination at a cardiology clinic, including an ECG and an echocardiogram, which revealed only mild arrhythmia and palpitations.
At that time, the doctor prescribed medication for the arrhythmia, which I take whenever my heart rate becomes too fast (a small pink pill labeled STO163).

My family medical history includes heart disease, diabetes, and hyperthyroidism.
Given that the COVID-19 pandemic is still ongoing, I am hesitant to go to the hospital for an examination.
Could you please provide more information regarding my condition and possible ways to improve it? I would appreciate any advice that could help ease my mind and alleviate the discomfort in my chest.
Thank you, Doctor, for taking the time to answer my questions.
I appreciate it.

26-year-old girl, 20~29 year old female. Ask Date: 2020/05/01

Dr. He Dongjin reply Cardiology

Hello, your heart rate during sleep is between 45-60 beats per minute, with a low of 39, which is actually acceptable.
The heart also needs to rest during sleep; as long as it beats adequately, it's fine.
A heart rate fluctuation between 39-90 is still within an acceptable range.
If the electrocardiogram (ECG) and echocardiogram results are normal, there is no need to worry too much.
It seems that you may be experiencing some autonomic nervous system imbalance along with panic-induced palpitations.
If your heart rate has been consistently elevated recently, please continue taking the prescribed medication for arrhythmia.
Overall, there should be no major issues.
Don't worry, just relax.
Changhua Hospital cares about you.

Reply Date: 2020/05/01

More Info

Understanding fluctuating heart rates during sleep can be quite concerning, especially when accompanied by symptoms like chest discomfort and difficulty breathing. Based on your description, it seems you are experiencing a range of heart rates while sleeping, from as low as 39 beats per minute to as high as 90, which can be alarming. Additionally, the presence of chest pressure and difficulty in breathing, particularly during inhalation, adds to the complexity of your situation.

Firstly, it’s important to recognize that heart rates can naturally fluctuate during sleep due to various factors, including the sleep cycle stages. During deep sleep, heart rates tend to decrease, while during REM sleep, they can increase. However, a heart rate dropping to 39 beats per minute is significantly low, especially if it is accompanied by discomfort. This condition, known as bradycardia, can be benign in some individuals, particularly in athletes or those who are physically fit, but it can also indicate underlying issues, especially if symptomatic.

Given your history of respiratory difficulties and previous episodes of increased heart rates, it is crucial to consider several potential causes for your symptoms:
1. Autonomic Nervous System Dysfunction: Stress, anxiety, and changes in your daily routine can lead to dysregulation of the autonomic nervous system, which controls heart rate and respiratory function. This can result in episodes of tachycardia (increased heart rate) and bradycardia (decreased heart rate).

2. Medication Effects: You mentioned taking medication for arrhythmia. Some medications can influence heart rate and rhythm, potentially leading to fluctuations. It’s essential to discuss any side effects or concerns with your prescribing physician.

3. Sleep Apnea: This condition, characterized by repeated interruptions in breathing during sleep, can lead to significant fluctuations in heart rate. If you experience snoring or gasping for air during sleep, this could be a contributing factor.

4. Thyroid Issues: Given your family history of thyroid disease, it may be worthwhile to have your thyroid function tested. Hyperthyroidism can lead to increased heart rates, while hypothyroidism can sometimes cause bradycardia.

5. Anxiety and Stress: Psychological factors can significantly impact heart rate. If you are experiencing increased stress or anxiety, this could manifest as fluctuations in your heart rate, particularly during sleep.

To address your concerns and improve your situation, consider the following steps:
- Consult a Healthcare Professional: Although you may be hesitant to visit a hospital due to the ongoing pandemic, it is crucial to seek medical advice, especially given your symptoms. A healthcare provider can perform necessary tests, such as an echocardiogram or a 24-hour Holter monitor, to assess your heart's function more accurately.

- Monitor Your Symptoms: Keep a detailed log of your heart rates, symptoms, and any triggers you notice (such as stress, diet, or sleep patterns). This information can be invaluable for your healthcare provider.

- Lifestyle Modifications: Focus on maintaining a healthy lifestyle, including regular physical activity, a balanced diet, and adequate hydration. Reducing caffeine and alcohol intake, especially before bedtime, can also help stabilize your heart rate.

- Stress Management Techniques: Consider incorporating relaxation techniques such as deep breathing exercises, meditation, or yoga into your daily routine. These practices can help reduce anxiety and may positively impact your heart rate.

- Sleep Hygiene: Establish a regular sleep schedule and create a calming bedtime routine. Ensure your sleep environment is conducive to rest, which can help improve sleep quality and potentially stabilize heart rates.

In summary, while fluctuations in heart rate during sleep can be concerning, understanding the potential causes and implementing strategies to manage your symptoms can help. It is essential to maintain open communication with your healthcare provider to ensure that you receive appropriate care and support. Your health and well-being are paramount, and addressing these issues proactively can lead to improved quality of life.

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