When your heart pounds as soon as you lie down and you can't fall asleep

What follows combines several people's visits into one reconstructed account. It is not any one person's story, and anything that could identify someone has been removed.

⚠️ There's something to check first

If you have chest pain, shortness of breath, dizziness as if you might faint, or a pulse that is very fast or irregular, heart tests come first.

Have your thyroid function checked as well. It's a common cause of palpitations and sleep problems happening together. Caffeine and the medications you take are also worth looking at.

How do people describe it when they come in?

They're fine during the day, but the moment they lie down to rest at night, they feel their heart pounding and anxiety rises.

Many say it started after something frightening happened. The event has passed, but the body hasn't come down from that state.

Some also mention numbness in the left arm. This can happen when the muscles at the front of the chest stiffen and press on the pathways running beneath them — but we look at this only after the heart has been checked, too.

What do we look at?

We check your pulse and tongue, and press on the chest and sides. We also check whether the muscles in the middle of the abdomen are stiff like a board.

Many people have a tongue that is red and dry at the tip and edges. Their sides feel tight, and pressing on the chest hurts. We see these as the places where emotional tension shows up in the body.

If the skin under your eyes is pale and you tire easily, we also consider that your body may be short on what it needs to recover.

How do we treat it?

We work on bringing down the tension and heat that have gathered in the chest, and on replenishing what's lacking. We also loosen the stiff front of the chest and the back.

If your digestion is poor, we look at that too. The stomach needs to be comfortable for your body to take in what it needs.

We give you a breathing exercise: about ten minutes of slow breathing out before you lie down. The idea is to make the out-breath longer than the in-breath.

How did people do?

First, people say the pounding comes less often, and when it does come, it passes quickly. Sleep follows after that.

For people with strong anxiety, working on the body alone has limits. If nothing changes after a few visits, we recommend getting mental health care at the same time.

What are the limits of this approach?

What we do does not treat the heart itself. It is not a substitute for heart tests.

One more thing: some cases are panic attacks. There are treatments with proven effectiveness for that, and those come first.

If you have the same symptoms

1. Chest pain, shortness of breath or an irregular pulse means heart tests come first.
2. Have your thyroid function, caffeine intake and medications checked too.
3. It often starts after something frightening happens.
4. Try about ten minutes of breathing with a long out-breath before you lie down.
5. If your anxiety is strong, we recommend getting mental health care as well.

We start by sorting out what kind of insomnia it is. Not being able to fall asleep and waking up during the night point to different places to look.

If poor sleep is wearing down your days, come and see us. We'll start by sorting out whether you can't fall asleep or keep waking up. Each points to a different place to look.

Because there are many possible causes, progress differs from person to person, even with the same care.