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Palpitations and Insomnia





























Palpitations and Insomnia

Palpitation manifests as heart fluttering, leading to difficulty falling asleep and waking up easily and early.

Various organic or functional diseases may cause palpitations.

Medication and psychotherapy could work as the primary treatment.

A positive mental attitude and good sleep habits in daily life can help alleviate palpitation issues.


Definition

Palpitations and insomnia refer to the simultaneous occurrence of abnormal heartbeat feelings and poor sleep quality. This condition primarily develops heart fluttering and palpitations, accompanied by difficulty falling asleep, waking up easily and early, difficulty in falling back to sleep after waking up, etc. The insomniac may feel lethargic and drowsy after sleep. These symptoms may occur due to some diseases, medication, and psychological factors, affecting the insomniac's daily life and work, and even leading to other severe complications.



Epidemiology

The central nervous system and the autonomic nervous system regulate sleep. A close neural coupling between the central nervous system and cardiopulmonary function exists, with dynamic heart rate, blood pressure, coronary blood flow, and respiration changes.



Non-REM (Rapid-Eye Movement) sleep operates with the coordination of a relatively stable autonomic nervous system, breathing, pumping function of the heart, and blood pressure. During REM sleep, cardiac sympathetic and parasympathetic nerve variations may cause cardiac rhythm changes.



A healthy person can tolerate slight variations in the autonomic nervous system activities. However, people with organic or functional changes in the heart cannot handle the autonomic nervous system changes, resulting in symptoms such as heart fluttering and palpitations, difficulty falling asleep, and waking up readily.



The neuroendocrine system regulates the sleep process, which has two phases: resting and active. The two phases alternate and help the body retain and store energy for the next day's activity. In the rest phase, the human body is relaxed, and the overall metabolism is slow. Primarily, this phase restores physical strength. In the active phase, the overall metabolism is high, and the body replenishes energy and substances required by brain tissue. Moreover, this phase restores brain functions.



However, heart palpitations caused by physical activities, diseases, psychological factors, and medication may disrupt the normal sleeping process of the human body, causing over-excitement and challenges in falling asleep or shortened sleep. Similarly, they interrupt the balance between all sleep-related factors, leading to poor sleep quality.



Causes

A variety of factors—alone or combined—including disease, psychosomatic aspects, drug or substance intake, unhealthy lifestyles, etc. can cause palpitations and insomnia. Common factors that can cause palpitations and insomnia include physical and mental diseases.


i. Physical Diseases

1. Cardiovascular diseases are the leading cause of palpitations and insomnia. Arrhythmia, with typical symptoms of palpitations, sweating, weakness, breath-holding, etc., may lead to difficulty falling asleep or waking up quickly. Coronary heart disease with specific symptoms—e.g., chest pain (angina), chest pressure, shortness of breath, and palpitations, among others—may lead to difficulty falling asleep, light sleeping, and waking up readily. Similarly, heart failure, with typical symptoms of palpitations, weakness, fatigue, dyspnea, and orthopnea, may lead to difficulty falling asleep, waking up easily and early awakening.



2. Individuals with hyperthyroidism feel overexcited due to high metabolism, which may lead to palpitations, shortness of breath, tachycardia and insomnia.



3. Individuals with diabetes may experience hypoglycemia at night due to poor blood glucose control, leading to palpitations, sweating, and trembling, thus causing insomnia.



4. People with sleep apnea syndrome often experience apnea during sleep. In severe cases, they may wake up from sleep with a feeling of suffocation and dying and have challenges falling back to sleep due to palpitations. Furthermore, individuals with narcolepsy often experience heart fluttering and palpitations when waking up from sleep paralysis.

5. Due to variations in hormone levels, individuals with the menopausal syndrome often experience menstrual changes, hot flashes, palpitations, and insomnia.



6. The adverse reactions of many drugs can cause palpitations and insomnia, such as anti-depressants, central stimulants, narcotic analgesics, anti-asthmatic drugs, anti-hypertensive drugs, and some others medications like levothyroxine, moxifloxacin, and cilostazol, etc.


Psychological Factors

1. Sleep problems associated with anxiety disorders are typical complaints of individual with palpitations and insomnia. Compared to the non-anxious population, individuals with anxiety disorders show a significantly higher prevalence of insomnia. They often complain about difficulty falling asleep or waking up suddenly during sleep, accompanied by palpitations, shortness of breath, and other symptoms. Individuals may suffer from palpitations and insomnia due to excessive anxiety, leading to aggravating anxiety disorders, a vicious cycle.



2. Psychological problems or neurological dysfunction can cause cardiovascular disease-related symptoms such as palpitations, sweating, and weakness, often accompanied by insomnia symptoms. Most individuals with cardiac neurosis do not have organic changes in the heart but functional disorders requiring emotion regulation and psychological counseling.


Environment

1. The bed is too soft or hard, the coverings are too thin or thick, and the pillow is uncomfortable. If there is noise or light in the bedroom and the temperature is too high or low. Moreover, caring for older people or children may affect sleep and lead to palpitations and insomnia.



2. Changing the living environment due to moving or traveling to an unfamiliar place may make people feel insecure, thus causing anxiety, palpitations, and insomnia.


Lifestyle

1. Irregular work and rest schedule. Staying up late often leads to over-excitement at night, leading to palpitations and insomnia. Similarly, spending too much time in bed during the daytime and long naps in the late afternoon or evening can create insomnia, sometimes accompanied by symptoms like palpitations.



2. Poor sleep habits. Drinking tea or coffee, smoking, consuming alcohol, playing games, and watching horror movies on electronic devices like smartphones and PCs before bedtime may create over excitement at bedtime, causing palpitations and insomnia. Likewise, undereating (or overeating) at dinner and going to bed on an empty (or full) stomach may impact sleep, sometimes, producing palpitations. Severe exercise two hours before bedtime can also increase nerve excitability and cause palpitations and insomnia.



Symptoms

If individuals have recently experienced palpitations, difficulty falling asleep, shortened sleep time, and waking up multiple times at night, their doctors should rule out organic diseases first. If functional disorders cause the condition, individuals can first try self-regulation and see if there's any improvement. In case of organic disease, individuals should seek medical attention promptly.



Diagnosis

The physician will make a preliminary diagnosis based on the complaints of an individual, current medical history, clinical symptoms, and sleep quality assessment, then determine the causes for palpitations and insomnia in combination with laboratory tests, imaging tests, special tests, and sleep assessments.


Emergency Indications

In some cases, symptoms of palpitations and insomnia occur in individuals with a history of organic diseases like coronary heart disease, arrhythmia, heart failure, heart valve disease, and cardiomyopathy. Consequently, individuals should seek medical attention promptly and call the local emergency number if necessary.


Related Examinations

Physical Examination Inspection

An initial assessment of the severity of insomnia through observation of the overall mental state of individuals, dark circles under the eyes, etc., can help cure insomnia. The doctors can conduct an initial determination of whether an individual has arrhythmia and other diseases.


Laboratory Tests

Check on routine blood tests, detection of anemia, and changes in white blood cells and platelets, among others, to help comprehend the general condition of the person.

Check on the thyroid function, rule out cardiac discomfort symptoms caused by abnormal thyroid function.

Check on cardiac enzymes, detection of damage to heart cells caused by organic heart disease.

Check on sex hormone level test, determine the functional status of the ovaries to help specify whether individuals has conditions like menopausal syndrome.

Imaging Examinations Echo-Cardiogram

Evaluation of the structure and function of the heart to check for organic heart disease, and vascular condition of the heart to check for cardiac ischemia and coronary heart disease.


Electrocardiogram (ECG)

ECG can determine the detection of arrhythmias such as sinus tachycardia, premature atrial or ventricular contractions, or ST-T changes. 24-hour ambulatory ECG can detect transient cardiac rhythm abnormalities.


Electroencephalogram (EEG)

EEG is another valuable test for detecting abnormal brain waves caused by schizophrenia, brain damage, and other diseases.


Sleep Assessment

Sleep Diary

Individuals can complete a sleep diary at home for one or two weeks on their own or with the assistance of their family members. This would be helpful for the doctor to understand individuals' sleep quality.They should record the sleep time in multiple scenarios, including but not limited to:



The time to go to bed

The time of falling asleep

The number of times an individual wakes up during the night

The time it takes to fall back to sleep

The time of waking up after falling asleep

The time of getting up each morning

Duration of daytime naps

Problems encountered during the sleep quality

Medications on substances affecting sleep are being taken


Doctors can understand the sleep pattern of an individual better after studying this information.


Polysomnography

Doctors recommend that sleep stage respiratory event of an individual (such as obstructive sleep apnea, central sleep apnea), snoring (whether snoring or not and the severity), sleep position, end-expiratory or transcutaneous carbon dioxide, blood oxygen saturation, heart rate, and other abnormal behaviors during the night with audio and video monitoring. Analysis of the relevant data can yield a large amount of information, such as the sleep architecture, the frequency of abnormal events during sleep and various diagnostic indicators, which can help with final diagnosis.



Treatment

Individuals should undergo comprehensive treatment to reduce palpitations, improve sleep quality, increase adequate sleep time, and restore a regular daytime schedule. Generally, the symptoms of palpitations and insomnia will disappear after active treatment of the primary disease and elimination of the triggering factors.



Due to individual differences, there is no absolute best, fastest, and most effective medication yet. Besides commonly used over-the-counter medications, doctors should prescribe other drugs under medical supervision.


Symptomatic Treatment

Choose different hypnotics, including benzodiazepines and non-benzodiazepines, according to the condition and the severity of insomnia. Individuals can use short-acting hypnotics before falling asleep. Similarly, intermediate-acting hypnotics are vital for individuals who wake up quickly. Long-acting hypnotics such as zopiclone and diazepam are essential for individuals who wake up early.


Etiological Treatment

Individuals should take appropriate medications based on the primary disease. For example, anti-arrhythmic drugs such as amiodarone can help treat arrhythmia. Aspirin, nitroglycerin, and metoprolol can treat coronary heart disease. Methimazole and propylthiouracil can help treat hyperthyroidism. Moreover, insulin and metformin are vital to treat diabetes. Finally, individuals can use sex hormone supplements to treat the menopausal syndrome.



Intervention

Psychological Care

For palpitations and insomnia caused by nervousness, anxiety, and mental stress, family members should help individuals minimize their stress and doubts, relieve their psychological pressure, and record sleep diaries during the treatment. For individuals taking medication, family members should encourage them to follow medical advice and adhere to the treatment.


Sleep Hygiene Education

The individuals with palpitations should maintain a regular work and rest schedule. They should not change their sleep schedule on weekends. For instance, they should not sleep up late and wake up late. They should not over-eat or under-eat at dinner and not go to bed on a full or empty stomach. Avoid drinking tea, coffee, alcohol, and smoking before bedtime. Avoid strenuous exercise 3-4 hours before bedtime. Do not spend too much time in bed during the daytime. Maintain a regular nap schedule and limit the nap time to 60 minutes. Do not take any naps after 3:00 p.m.


Improve the Sleep Environment

Individuals should maintain a quiet and noise-free sleep environment. They must maintain appropriate room temperature, humidity, and brightness. Moreover, they should choose a comfortable bed, bedding, and pillow.


Moderate Exercise

Individuals should not do too strenuous exercise 2 hours before going to bed. Regular physical activity can help improve the quality of sleep at night. Outdoor exercise in the morning can help individuals with difficulty in falling asleep sleep better at night.


Healthy Diet

Individuals, especially senior people, should maintain a healthy and light diet, avoid fried food and junk food, and eat more fruits, vegetables, whole grains, and fish.



Prognosis

A subjective complaint of insomnia appears to increase the risk of a future coronary event for the persons, for which the increasing cannot be explained by age nor classic coronary risk factors. However, confounding by other health-related conditions and medications need to be more strictly ruled out. Because a subjective insomniac may be either a part of the larger syndrome that includes poor health and depression, or it may be related to continual stressors, reduced slow-wave sleep, and autonomic dysfunction, which can increase the risk of heart problems.



Sources:- shuteye

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