Heart Rate Fluctuations During Sleep: What You Need to Know

There is significant fluctuation in heart rate during sleep?

Hello, doctor.
About two months ago, I started experiencing frequent palpitations and often felt my heart beating strongly while at rest.
I have a Xiaomi smartwatch that I usually wear at home, during exercise, and while sleeping.
Recently, I have felt less noticeable palpitations, but the watch frequently records strange heart rate numbers.
For example, at 7:29 AM this morning, my heart rate was 71 beats per minute, but at 7:31 AM it showed 124 beats per minute.
Until 8:05 AM, it was above 100 beats per minute, interspersed with a few readings of 60-70 beats.
After 8:07 AM, it changed to 60-80 beats per minute.
There have been times when I was sure I was asleep, and my average heart rate was 50-60 beats per minute, yet one minute showed over 100 beats per minute (the highest recorded was over 127 beats at around 4 AM one day).
During regular daily activities, I occasionally experience heart rates above 100 beats per minute.
I have wondered if there is an issue with the smartwatch, but when I wear it while running, the heart rate appears normal, around 120 beats per minute, and about 160 during sprints.
Doctor, is this condition normal? Do I need treatment? Thank you!

qǐ'é, 20~29 year old female. Ask Date: 2021/08/05

Dr. Cai Guiqin reply Cardiology

It is recommended that you visit a cardiology outpatient clinic to see if any relevant tests are needed.
Thank you, and wishing you good health!

Reply Date: 2021/08/05

More Info

Understanding heart rate fluctuations during sleep can be quite complex, and it’s important to consider various factors that may contribute to these changes. Based on your description, it seems you have been experiencing significant variations in your heart rate, both during sleep and while awake. This can understandably lead to concerns about your heart health.

Firstly, it’s essential to recognize that heart rate naturally fluctuates throughout the day and night. During sleep, particularly in the deeper stages, the heart rate typically decreases as the body enters a state of rest and recovery. A heart rate in the range of 50-60 beats per minute during sleep can be normal for many individuals, especially if you are physically fit. However, sudden spikes in heart rate, such as the 124 beats per minute you mentioned, can be alarming and may warrant further investigation.

Several factors can contribute to these fluctuations:
1. Sleep Stages: Your heart rate can vary significantly depending on the stage of sleep you are in. Rapid Eye Movement (REM) sleep, for example, is associated with increased heart rate and variability, while deeper stages of sleep typically show a lower heart rate.

2. Stress and Anxiety: Psychological factors such as stress or anxiety can lead to increased heart rates, even during sleep. If you have been experiencing heightened stress levels, this could explain some of the fluctuations you are observing.

3. Physical Activity: Your heart rate can also be influenced by your level of physical activity. If you engage in exercise, your heart rate may remain elevated for a period afterward, even during rest or sleep.

4. Health Conditions: Certain medical conditions, such as hyperthyroidism or arrhythmias, can cause irregular heart rates. Given your history of heart palpitations and the medications you are taking, it would be prudent to discuss these symptoms with your healthcare provider.

5. Device Accuracy: While wearable technology like smartwatches can provide useful insights into your heart rate, they are not always perfectly accurate. Factors such as how tightly the watch fits, its placement on your wrist, and even skin temperature can affect readings. It’s good that you’ve compared your watch readings with other activities, but if you have concerns about accuracy, consider discussing this with a healthcare professional.

Given your symptoms of palpitations and the significant fluctuations in heart rate, it would be advisable to consult with a healthcare provider. They may recommend further testing, such as a Holter monitor (a portable device that records your heart's rhythms for 24 hours or longer) or an echocardiogram, to assess your heart's function and rule out any underlying conditions.

In summary, while some fluctuations in heart rate during sleep can be normal, the patterns you are experiencing—especially the spikes—should be evaluated by a medical professional. They can provide a more comprehensive assessment and determine if any treatment is necessary. It’s always better to err on the side of caution when it comes to heart health, so don’t hesitate to seek further evaluation.

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