For the last 8 months I have been woken every night with a pounding heart (usually between 3am and 6am) after vivid dreams.

The first of these started a few days after taking Levothyroxine.  I was advised to discontinue taking this by my GP and had my Thyroid levels re-checked and they are now 4.something and well within range according to the endocrinologist and my GP.  I have a slight goitre (and a nodule according to the hospital ultrasound scan)

Usually I am woken from a sound sleep 3 times a night and, after 8 months, this has become VERY distressing - and it's very frightening at the time although I relax and drift back to sleep

I have been suffering with panic disorder/anxiety for the last year connected with an inner ear disorder/tinnitus/imbalance problem

I have been doing meditation which helps me overall and, generally, am feeling better during the daytime.

I should also mention that I've had palpitations during the day too, which seem to be lessening.  They are heavy thumpy ones whereas at night it's a fast pounding beat.

I am 60 years old and have had a normal ECG and 2 x 24 hour ECGs and they showed no abnormality (apart from fast heart rate).  I take no medications.

I would so appreciate some help with this.

I am considering going back to my GP and being referred for a sleep study.

Thank you.

Dear RLR

Thank you for your prompt response - I shall feel a little more comfortable sending my medical information by private message to you.

I hope this is in order.

Dear RLR

Thank you so much for your response with regard to my Sleep Apnea/Nocturnal Panic query. (I did send you a personal message but may not have done this correctly)

I'm not sure what further information to give you.

Yes, I have had labrynthitis I think.  This was some years ago although I didn't get a formal diagnosis of that since the doctor I saw at the time said it wasn't as I never suffered from nausea (I put it down to the fact that I have never been troubled with travel sickness or nausea in general).  

In 2002 when I had these symptoms (felt like I was falling down even though I was in bed etc) I started to have tinnitus emanating from my left ear, although I can hear it in my whole head.  Initially it was distressing but I acclimatised to it over time.  

(When I was a child I had an abscess and perforated ear drum in my left ear)

With my current night time episodes, my tinnitus is extremely loud indeed when my heart rate is going fast. Once I get up and have showered and get into the day then I notice it hardly at all.

My current panic/anxiety started after a trip to a cranial osteopath who was treating me for a frozen shoulder (now fine).  During the visit, whilst laying down, I felt pretty dizzy.  On my way back to my car in the car park, I was unable to walk in a straight line to get to the car.  Once inside, I felt fine to drive the short distance home.

I have become  panicky and agoraphobic - although I am working on that and managed a trip to the local shop on my own yesterday.

Daytime palpitations occur from time to time, particularly when I am tired.   They are very heavy thumps which I feel more in the stomach area.

I have been prescribed Valium (diazepam) for occasional use.  I take half a 2mg tablet when I feel I need one.  A pack of 28 tablets has lasted me 3 months as I am well aware of their addictive qualities.

Any guidance would be much appreciated.

Thank you.

Well, there are several considerations here but I'm sure you realize that I'm unable to provide you with any type of diagnosis via the internet.

Since tinnitus is present, Meneire's disease is a possibility if it has not already been ruled out. The second common presentation for persons with symptoms similar to your own is Benign Paroxysmal Positional Vertigo, which is often found to co-exist with significant stress or anxiety. Either of these two conditions have an acute onset that typically remits within 20 to 30 minutes or less and nausea or vomiting need not be present.

The palpitation events are non-cardiac in origin and actually occur as a result of inappropriate stimulation of the heart by the vagus nerve more commonly observed in persons suffering stress/anxiety and panic. This type of disturbance is entirely incapable of causing any type of cardiac event and will not damage or weaken your heart in any manner. Many persons have experienced this type of palpitation event subsequent to being suddenly startled or frightened, oftentimes exclaiming "That made my heart skip a beat!" or "That made my heart stop for a second!"

The only difference here is that chronic anxiety or panic can cause the same physiological changes observed in persons who are suddenly frightened, with the exception that it is more of a constant low-level fear rather than a brief instant. Many persons misconstrue these physiological changes as symptoms of disease, particularly heart disease as a result of the presence of benign palpitation events.

Also, I'm not certain what medications you are presently taking, but some classes of drugs can produce tinnitus, vertigo or both.

I see nothing of your symptoms, however, that would warrant immediate concern that something serious is wrong with you.

Best regards and Good Health

Greetings, Hope this reaches you before you see the GP.

"Sleep apnea — Atrial fibrillation can be caused by sleep apnea, a condition where patients stop breathing for prolonged periods of time while sleeping. Patients with atrial fibrillation who are overweight, or have a history of snoring or excessive sleepiness during the daytime, should be evaluated with a sleep study. Treatment for sleep apnea can eliminate atrial fibrillation in some patients. (See "Patient information: Sleep apnea in adults".)"  go to (no spaces) up to date.com/contents/patient-information-atrial-fibrillation.
If A-Fib only happens at night definitely ask your GP to send you to a sleep specialist to determine if you have sleep apnea but it appears highly likely that you do.