POTS: Waking Up with a Racing Heart – Causes, Symptoms, and What to Do

Waking up with a racing heart can be frightening, especially when your heartbeat feels unusually fast before you even get out of bed. For people with Postural Orthostatic Tachycardia Syndrome (POTS), changes in heart rate and blood circulation can cause uncomfortable symptoms, particularly when moving from lying down to sitting or standing.

However, waking up with a racing heart does not automatically mean you have POTS. Several other conditions, including sleep disorders, dehydration, anxiety, medication effects, and abnormal heart rhythms, can cause similar symptoms.

Understanding why your heart races in the morning, how POTS affects the body, and when to seek medical attention can help you take the right next steps.

Can POTS Cause You to Wake Up with a Racing Heart?

Yes, POTS can be associated with a racing heartbeat in the morning. However, the timing and circumstances of the episode are important.

POTS is a condition involving the autonomic nervous system, which helps regulate automatic body functions such as heart rate, blood pressure, and circulation.

In people with POTS, the heart rate often increases excessively after moving from a lying or sitting position to standing. This happens because the body has difficulty regulating blood flow and maintaining normal circulation when upright.

Some people also report palpitations, disturbed sleep, or a racing heartbeat around the time they wake up. Symptoms may become more noticeable when they sit up, stand, or begin walking.

An important distinction: A racing heart while you are still lying down is not the classic diagnostic pattern of POTS. It may have another explanation and should not automatically be attributed to the condition.

Why Is POTS Often Worse in the Morning?

Many people with POTS experience more noticeable symptoms in the morning than later in the day.

Several factors may contribute to this pattern:

1. Overnight Fluid Loss

Your body continues to lose water through breathing and sweating while you sleep. You also go several hours without drinking fluids.

For someone with POTS, reduced fluid volume can make it harder to maintain normal blood circulation after waking up.

2. Changes in Blood Circulation

When you move from lying down to sitting or standing, gravity causes blood to shift toward your lower body. In people with POTS, the body’s normal response may not be sufficient to maintain circulation, leading to a significant increase in heart rate.

3. Morning Hormonal Changes

Normal daily changes in hormones and autonomic nervous system activity may influence heart rate and blood pressure. Research and clinical observations suggest that orthostatic tachycardia can be more pronounced in the morning.

4. Dehydration

Not drinking enough fluids throughout the day, excessive sweating, or illness can worsen POTS symptoms and make morning palpitations more noticeable.

5. Poor Sleep Quality

Sleep disturbances are commonly reported by people with POTS. Poor sleep may contribute to fatigue, increased sensitivity to symptoms, and difficulty managing heart rate changes during the day.

These factors can overlap, making mornings particularly challenging for some people with POTS.

What Does POTS-Related Morning Tachycardia Feel Like?

The experience varies from person to person, but common symptoms include:

Waking up with a pounding or racing heartbeat.
Feeling dizzy when sitting up or getting out of bed.
A sudden increase in heart rate after standing.
Shakiness or internal trembling.
Shortness of breath during everyday activities.
Weakness or unusual morning fatigue.
Brain fog or difficulty concentrating.
Feeling faint or experiencing near-fainting episodes.

Some people notice that their symptoms improve after lying down again. This positional relationship is an important feature doctors consider when evaluating possible POTS.

Can POTS Cause a Racing Heart While You Are Still Lying in Bed?

Yes, some people diagnosed with POTS experience palpitations while resting or lying down. However, POTS is primarily characterized by an excessive heart rate increase after assuming an upright position.

If your heart starts racing while you are still lying flat and before you move, it is important to consider other possible explanations.

These may include:

Abnormal heart rhythms, such as supraventricular tachycardia (SVT).
Anxiety or nighttime panic attacks.
Sleep apnea or other sleep-related breathing problems.
Dehydration or electrolyte imbalances.
An overactive thyroid.
Iron-deficiency anemia.
Medication side effects.
Fever or an underlying infection.

Recurring episodes of unexplained nighttime or early-morning palpitations deserve medical evaluation, even if you have already been diagnosed with POTS.

How Is POTS Diagnosed?

POTS cannot be diagnosed based on a racing heartbeat alone. A healthcare professional evaluates symptoms, heart rate changes, blood pressure, and other possible causes of tachycardia.

1. Medical History and Symptom Assessment

Your doctor may ask:

Does your heart race when you stand up?
Do symptoms improve when you lie down?
How long have you experienced these symptoms?
Do you experience dizziness, fatigue, or fainting?
Are symptoms worse in the morning?
Have you recently had an infection or illness?

2. The 10-Minute Standing Test

One commonly used assessment is the active stand test.

During this test, your heart rate and blood pressure are measured while lying down and then repeatedly after standing.

For adults, a sustained heart rate increase of at least 30 beats per minute within 10 minutes of standing may support a POTS diagnosis. For adolescents aged 12–19, the required increase is at least 40 beats per minute.

The heart rate increase must occur alongside typical symptoms, without significant orthostatic hypotension, and other possible causes must be considered. Symptoms must generally have been present for at least three months under commonly used diagnostic criteria.

3. Electrocardiogram (ECG)

An ECG records the electrical activity of the heart. It can help identify certain heart rhythm abnormalities and is commonly included in the initial evaluation.

4. Blood Tests

Your doctor may request blood tests to check for conditions that can cause a racing heart, including:

Anemia.
Thyroid disorders.
Electrolyte abnormalities.
Other metabolic or medical conditions.

5. Holter Monitor or Tilt Table Test

Depending on your symptoms, your doctor may recommend:

Holter monitoring: Records heart rhythm over an extended period, often 24–48 hours or longer depending on the device.
Tilt table testing: Monitors heart rate and blood pressure while the examination table gradually changes your body position.

Not everyone needs every test. The appropriate evaluation depends on the symptoms and initial findings.

What Should You Do When You Wake Up with a Racing Heart?

If you have diagnosed POTS or suspect that your symptoms may be related to orthostatic intolerance, certain steps may help you manage morning symptoms.

1. Avoid Standing Up Too Quickly

Give your body time to adjust after waking up. Move slowly from lying down to sitting, and remain seated briefly before standing.

2. Drink Water

Maintaining adequate hydration can help support blood volume and circulation.

Some people with POTS are advised to increase their daily fluid intake, but the appropriate amount depends on their medical history and other conditions.

3. Consider Compression Garments

Compression stockings or waist-high compression garments may help reduce blood pooling in the legs and abdomen, improving blood return to the heart.

4. Eat Smaller Breakfast Portions

Large meals, particularly meals high in carbohydrates, may worsen symptoms in some people with POTS.

Eating smaller, more frequent meals may help reduce post-meal symptoms.

5. Avoid Excessive Caffeine

Coffee, energy drinks, and other stimulants can trigger or worsen palpitations in some individuals.

6. Track Your Heart Rate and Symptoms

Keeping a record of your morning heart rate, blood pressure if available, symptoms, and body position can help your healthcare provider identify patterns.

If you feel faint, sit or lie down safely. Raising your legs may also help relieve symptoms.

These measures can be useful, but they do not replace medical assessment or an individualized treatment plan.

Does Drinking More Water Help with POTS Morning Symptoms?

Hydration is an important part of managing POTS because inadequate fluid intake can reduce circulating blood volume and worsen orthostatic symptoms.

Some POTS treatment plans recommend approximately 2–3 liters of fluid per day, depending on the individual’s needs.

Doctors may also recommend increasing dietary sodium to help the body retain fluids. However, increasing salt intake is not appropriate for everyone, particularly people with certain kidney, heart, or blood pressure conditions.

Do not start high-salt diets or salt supplements without medical guidance. Your healthcare provider should determine whether increased fluids and sodium are appropriate for you.

What Is the Best Treatment for POTS-Related Morning Heart Racing?

There is no single treatment that works for everyone with POTS. Treatment usually focuses on reducing symptoms, improving circulation, and helping patients return to their daily activities.

Depending on the individual’s condition, treatment may include:

Lifestyle Modifications

Maintaining appropriate hydration.
Increasing salt intake when medically appropriate.
Avoiding sudden changes in body position.
Wearing compression garments.
Avoiding excessive heat.
Eating smaller meals.
Maintaining a consistent sleep routine.

Exercise and Physical Rehabilitation

A gradual exercise program may help improve cardiovascular conditioning and circulation.

Many patients begin with exercises performed while lying down or sitting, such as:

Recumbent cycling.
Swimming.
Rowing.
Lower-body resistance exercises.

Exercise should be introduced gradually and adjusted according to symptom severity and medical advice.

Medications

When lifestyle changes are insufficient, doctors may consider medications based on the patient’s heart rate, blood pressure, and symptoms.

These may include:

Beta-blockers to reduce heart rate.
Ivabradine in selected patients to help control heart rate.
Midodrine to improve blood vessel constriction.
Fludrocortisone to support sodium and fluid retention in selected cases.

Not all medications are appropriate for every patient, and treatment should be supervised by a healthcare professional.

When Should You Worry About Waking Up with a Racing Heart?

Although palpitations can occur with POTS, certain symptoms may indicate a more serious medical problem.

Seek emergency medical care

Get immediate medical attention if a racing heartbeat occurs with:

Chest pain, pressure, or tightness.
Severe shortness of breath.
Fainting or loss of consciousness.
Severe dizziness or feeling like you may pass out.
Unusual sweating accompanied by chest discomfort.
A persistent racing heartbeat that does not settle, particularly with other concerning symptoms.

Do not assume these symptoms are caused by POTS or anxiety. They may indicate a heart rhythm problem or another urgent condition.

Frequently Asked Questions About POTS and Waking Up with a Racing Heart

1. Why does my heart race as soon as I wake up?

A racing heart after waking may be related to dehydration, autonomic nervous system activity, sleep disturbances, anxiety, or an abnormal heart rhythm. In people with POTS, symptoms may become more noticeable when they sit up or stand.

2. Is POTS worse in the morning?

Yes. Many people with POTS report more severe orthostatic symptoms in the morning. Changes in fluid balance and normal daily variations in heart rate regulation may contribute.

3. Can POTS cause heart palpitations during sleep?

Some people with POTS report palpitations or sleep disturbances at night. However, a racing heartbeat during sleep is not specific to POTS and may require evaluation for other causes, including sleep-related breathing disorders and arrhythmias.

4. Is it normal for my heart rate to increase when I get out of bed?

A small increase in heart rate when standing is normal. However, a sustained increase of at least 30 beats per minute within 10 minutes of standing in adults, together with typical chronic symptoms, may warrant evaluation for POTS.

5. Can dehydration make POTS symptoms worse?

Yes. Dehydration can reduce circulating blood volume and make it harder for the body to regulate circulation when standing, potentially worsening dizziness and tachycardia.

6. Does POTS go away?

POTS can improve over time, and many people experience better symptom control with appropriate treatment. However, the course varies, and some individuals continue to experience symptoms for years.

7. Should I check my heart rate immediately after waking up?

Tracking your heart rate can provide useful information, especially when comparing measurements while lying down and standing. However, home measurements alone cannot confirm POTS. A clinician should interpret the results alongside your symptoms and medical history.

Final Thoughts

Waking up with a racing heart can be associated with POTS, particularly when symptoms become worse after sitting up or standing. Morning dehydration, changes in blood circulation, and autonomic nervous system dysfunction may all contribute to these episodes.

However, not every morning palpitation is caused by POTS. Persistent symptoms, especially those occurring while lying down, should be evaluated to rule out other medical conditions.

With an accurate diagnosis and an individualized treatment plan, many people with POTS can improve their symptoms and quality of life.

Feeling Weak and Shaky Immediately After Eating: Causes

American College of Cardiology – Managing POTS

POTS: Waking Up with a Racing Heart – Causes and Treatment