What could be causing me to hear my heartbeat loudly in my ears while lying down at night?

Hearing Your Heartbeat in Your Ears While Lying Down at Night

You are most likely experiencing pulsatile tinnitus, which requires evaluation for underlying vascular abnormalities, particularly when it occurs in a positional manner such as lying down. 1

Understanding Your Symptom

Pulsatile tinnitus is a repetitive sound that coincides with your heartbeat and is often vascular in origin, requiring thorough evaluation. 1 This differs from regular tinnitus (ringing or buzzing) because it synchronizes with your pulse and suggests a specific set of underlying causes that need investigation. 1

Why It Happens When Lying Down

The positional nature of your symptom—occurring specifically when lying down at night—is clinically significant:

• Changes in blood flow dynamics occur when you transition from upright to supine position, which can make vascular sounds more audible. 1
• Increased awareness in quiet nighttime environments amplifies the perception of internal body sounds that are masked during daytime activities. 2

What Could Be Causing This

Vascular Causes (Most Important to Rule Out)

Pulsatile tinnitus should prompt evaluation for underlying vascular abnormalities, which include: 1

• Venous sinus abnormalities: Transverse sinus stenosis, sigmoid sinus diverticulum, or dehiscence of the sigmoid sinus wall 1
• Arterial conditions: Arterial dissection, fibromuscular dysplasia of carotids, or carotid-cavernous sinus fistulas 1
• Dural arteriovenous fistulas or arteriovenous malformations 1
• Vascular tumors: Paragangliomas (glomus tumors) or other vascular middle ear tumors 1
• Anatomical variants: High jugular bulb, prominent mastoid or condylar emissary veins 1

Other Structural Causes

Bony abnormalities can also produce pulsatile tinnitus, including: 1

• Superior semicircular canal dehiscence 1
• Paget disease affecting the temporal bone 1

Systemic Conditions

Neurologic causes must be considered, particularly: 1

• Intracranial hypertension (can cause venous sinus stenosis and pulsatile tinnitus) 1
• Spontaneous intracranial hypotension 1

What You Should Do

Immediate Action Required

You need a thorough clinical evaluation because pulsatile tinnitus, unlike common subjective tinnitus, often has an identifiable and treatable underlying cause. 1

1. Schedule an appointment with an otolaryngologist (ENT specialist) who can perform a comprehensive head and neck examination. 1

2. Expect imaging studies: MRI with heavily T2-weighted thin-section sequences can detect neurovascular abnormalities and is the key diagnostic tool. 3, 1

3. Cardiovascular assessment may be warranted, particularly if you have risk factors like hypertension, as there are established links between cardiovascular disease and auditory symptoms. 4

Important Clinical Pitfall to Avoid

Do not dismiss this as "just stress" or "normal aging." While common subjective tinnitus (ringing/buzzing) is often benign and related to sensorineural hearing loss 1, pulsatile tinnitus specifically requires investigation for vascular abnormalities that may need treatment. 1

Additional Considerations

Sleep and Cardiovascular Health

Nocturnal symptoms warrant particular attention because nighttime cardiovascular events and arrhythmias are more common than previously recognized. 2

• Sleep apnea is associated with nocturnal bradyarrhythmias (slow heart rhythms) and should be screened for if you have symptoms like snoring, witnessed apneas, or daytime sleepiness. 2
• Screening for sleep apnea syndrome is recommended in patients with documented or suspected cardiac rhythm abnormalities during sleep. 2

When to Seek Urgent Care

Seek immediate medical attention if you experience:

• Sudden onset of severe headache with the pulsatile tinnitus
• Visual changes or neurological symptoms
• Hearing loss accompanying the pulsatile sound
• Severe anxiety or depression (as these require prompt intervention due to increased risk) 1

Bottom Line

Your symptom of hearing your heartbeat loudly in your ears while lying down is pulsatile tinnitus that requires medical evaluation to identify and treat any underlying vascular or structural abnormality. 1 This is not a symptom to ignore or self-manage—it needs proper diagnostic workup including imaging studies and specialist evaluation.