Is It Normal to Hear Your Heartbeat While Lying On Your Pillow?
Ever notice your heartbeat thumping in your ears while trying to sleep? This common phenomenon affects millions of Americans.
STORY AT-A-GLANCE
Pulsatile tinnitus, affecting 3 million to 5 million Americans, is characterized by hearing rhythmic sounds that match your heartbeat and significantly impact sleep and daily activities
High blood pressure, caffeine intake and stress intensify the sensation of hearing your heartbeat, with the effect often becoming more noticeable during quiet moments or rest
Research shows that high-pitched pulsatile tinnitus often indicates a shunting lesion, where blood abnormally flows directly from arteries to veins, requiring medical evaluation
Some cases initially mistaken for psychiatric symptoms have turned out to be pulsatile tinnitus, highlighting the importance of thorough medical evaluation for persistent pulse-synchronized sounds
Simple interventions like changing sleep position, reducing caffeine intake and managing blood pressure help manage symptoms, though underlying vascular causes often require specialized treatment
Have you ever laid down in bed only to be kept awake by the constant thudding pulse in your head? Usually, it’s not a cause for alarm, but if it occurs all the time, it could be pulsatile tinnitus, which affects an estimated 3 million to 5 million Americans.1 This condition is characterized by hearing a rhythmic sound in your ears that echoes each heartbeat.
Symptoms include trouble sleeping and a relentless awareness of your own pulse. Untreated pulsatile tinnitus sometimes reveals deeper cardiovascular or vascular anomalies, sparking concern over the broader health implications. Borderline high blood pressure and periods of intense stress often heighten the sensation of hearing your heartbeat.2
That extra thumping in your head might appear during quiet moments or while resting, and it sets off alarm bells when it interferes with your daily activities.
Persistent pulsatile tinnitus warrants a thorough medical evaluation since it points to structural or vascular changes that affect how blood flows near your ears. If you’ve ever heard your heart beating loudly in your ears, it’s important to understand the difference between a harmless annoyance and a more serious underlying cause.
Straight Answers on Why You Hear Your Heartbeat
Hearing pulses while resting is very common, and typically not a concern if other health metrics are stable.3 This should offer a bit of comfort if you find yourself alarmed by this throbbing noise. Intense worry and prolonged focus on the heartbeat often amplifies the loudness, a phenomenon sometimes described as hyperawareness of normal bodily processes. In essence, the more you concentrate on the pulsation, the louder it seems.
Factors such as persistently high blood pressure, caffeine overload or a surge of hormones like adrenaline from fear or anxiety intensify the sensation.4 These factors act like the volume knob on a speaker, magnifying your awareness of what would otherwise remain a soft, barely noticeable hum.
Getting a good night’s sleep often becomes nearly impossible if you’re convinced something sinister lurks behind each thump of your heart. As a result, evaluate and manage these triggers, like moderating caffeine later in the day or using simple relaxation techniques to ease nighttime tension.
In addition, it’s important to monitor patterns and frequencies.5 In other words, if hearing your pulse is an occasional quirk that only pops up a couple of times a year, it’s often a harmless phenomenon. On the other hand, if it’s happening every single night or the beat gets excessively forceful, that often indicates a physiological imbalance. Keep tabs on how often the noise dominates your quiet moments and mention it to your health care provider if it becomes a recurring complaint.
Further, lying still on your side compresses the carotid artery area slightly against the pillow.6 This direct contact heightens a normally faint internal vibration, shifting it into a noticeable beat. It’s reminiscent of placing an ear against another person’s chest — any minor motion suddenly feels and sounds much bigger because of the closeness to the source of the sound.
This effect underscores how physical positioning alone sparks those thuds in your ear, even if there’s nothing amiss in your cardiovascular system or inner ear structure.
Uncovering Vascular Clues in Pulsatile Tinnitus
A study published in the Journal of NeuroInterventional Surgery7 explored pulsatile tinnitus, which happens when you hear a rhythmic sound that matches your heartbeat, a sound that originates from abnormal blood flow near your ears. Unlike the occasional awareness of your own pulse, pulsatile tinnitus is persistent and often indicates that your blood vessels are not functioning normally.
The researchers focused on understanding which signs signal that this sound is a result of a vascular issue, known as a shunting lesion, where blood takes an abnormal shortcut between arteries and veins. The study evaluated 164 individuals who experienced this persistent, heartbeat-synchronized noise in their ears.8
The patients underwent detailed physical examinations and advanced imaging to determine if they had a shunt — an abnormal connection between blood vessels.
The examination included listening for abnormal sounds called “bruits” using a stethoscope and testing how the noise changed with simple head and neck maneuvers. In layman’s terms, the researchers wanted to know which physical clues could alert doctors that your inner ear is picking up more than just your normal heartbeat.
It turned out that patients who described their tinnitus as distinctly high-pitched were more likely to have a shunting lesion.9 In everyday language, if you hear a sharp, whistling or piercing tone along with your heartbeat, this characteristic might signal that your blood is flowing turbulently through an abnormal pathway.
Another important observation was that individuals with some degree of hearing loss were less likely to have this dangerous vascular connection.10 Although it might seem counterintuitive, reduced hearing seems to be associated with less risk for a shunt. In simpler terms, if your hearing isn’t as sharp and you experience less sensitivity to sound, the specific kind of turbulent blood flow that produces a high-pitched noise is less common.
The study also emphasized the role of an “audible bruit” in the diagnostic process.11 When such a sound is present during the exam, it adds significant weight to the idea that your pulsatile tinnitus stems from a vascular cause.
Further details from the research showed that simple physical maneuvers provided additional diagnostic clues. For instance, some patients reported that pressing on the side of their neck reduced the intensity of the noise.12
From a biological standpoint, the researchers explained that a shunt occurs when there is an abnormal channel between an artery and a vein. In normal conditions, arteries carry high-pressure blood and veins carry lower-pressure blood, with a clear separation between them.
However, in a shunt, high-pressure blood from an artery flows directly into a vein without slowing down properly. This turbulent rush of blood creates vibrations that your inner ear picks up as a distinct sound.13 If your pulsatile tinnitus is indeed due to a shunting lesion, identifying it early allows for targeted treatments that prevent more serious complications, such as a stroke or hemorrhage.14
Hallucination or Vascular Clue? A Surprising Case
A report in Psychiatry Research Case Reports sheds additional light on this phenomenon. An individual with a long history of neurologic conditions was admitted to a psychiatric unit for baffling “voices” that turned out to be pulsatile tinnitus.15 The authors of this paper walked through how the patient’s otherwise unexplained auditory perceptions initially led to a mental health assessment, only for doctors to discover a problem related to blood flow.
This case study illustrates the importance of looking at physical factors even when symptoms point to something psychiatric. Describing the case, researchers noted the patient’s numerous neurological surgeries and chronic conditions, including meningiomatosis and severe hearing loss on both sides.16 He had a long history of tumor resections, radiation therapy and significant auditory impairment.
All these overlapping health problems made it challenging for physicians to parse out whether the “voices” he described were truly psychiatric in nature or perhaps had a physical trigger. Despite extensive imaging such as repeated MRI scans, his primary doctors were stumped about why he heard phrases and rhythmic sounds with no apparent external source.
Doctors initially thought the man suffered from auditory hallucinations typical of a psychotic disorder, especially because he recounted specific words like “leave me.” Yet, as the case progressed, clinicians observed that he did not exhibit the expected signs of paranoia or disorganized thoughts.17 In fact, his mental status exam showed generally coherent thinking.
With the patient also had a curious complaint about a continuous “vacuum-like” noise in his ears, particularly when lying down.18 At first, psychiatrists tried adjusting his medications, but he reported no relief from the new prescriptions. Instead, the “whooshing” or “washing machine” sounds continued, and the distinct voice saying “leave me” flickered in and out, mostly at night or during quiet moments.
Then, a specialized CT angiogram (CTA) of his head and neck suggested an abnormality involving the jugular plate. According to the researchers, this structural change — sometimes involving thinning or dehiscence (an opening) in the bony area surrounding the jugular vein — induces turbulent blood flow that translates into sound vibrations.
This new angle compelled the psychiatric and neurology teams to consider that the man’s ear-related illusions were not hallucinations in a classic psychiatric sense but rather pulsatile tinnitus.19
In his case, the CTA findings explained how the rhythmic disturbance got misinterpreted as voices. The severity of his hearing loss also complicated matters: once you have reduced auditory input, your brain sometimes amplifies any internal noises to fill in the gaps, leading to speech-like echoes.
So, what seemed like a verbal hallucination was actually the outcome of his body’s misinterpreted internal noise. In a broader sense, the authors emphasized how important it is for you to push for thorough evaluations if you experience puzzling auditory symptoms.20 If a doctor quickly labels something as a psychiatric phenomenon without investigating other angles, you may never get to the bottom of the problem.
Strategies for Tackling Pulsatile Tinnitus
Another paper in the Journal of NeuroInterventional Surgery laid out a robust approach for managing pulsatile tinnitus when doctors confirm there is a vascular problem behind it.21 The researchers collected and analyzed information spanning from 1975 through 2021 by searching multiple medical databases.
The researchers wanted to understand the risks associated with pulsatile tinnitus. They also looked at which treatments work best to avoid problems. They stressed that when pulsatile tinnitus is caused by blood vessel problems, it needs to be taken seriously since it could lead to dangerous complications like stroke, loss of vision, or severe bleeding.
Among the major highlights of this review was the explanation of how a thorough evaluation helps doctors figure out which specific route to take.22 For instance, if the culprit is a weakened artery forming a dangerous link to a neighboring vein, then targeted interventions addressing that high-pressure connection is advised.
The authors also noted that people living with such problems sometimes deal with very real mental and emotional fallout, including anxiety, depression and sleep disruptions.23 A throbbing hum all day is disruptive and exhausting. The authors recognized that finding a legitimate cause, and then proceeding with the correct treatment, often reassures you that your body is not betraying you without hope for a fix.
The paper also highlighted how certain venous abnormalities are less about catastrophic bleeds and more about chronic discomfort, headaches or dangerously increased pressure inside the skull.24 Picture your blood not draining properly from your brain: it’s easy to see how that buildup triggers headaches or heightened awareness of swirling fluid. In some cases, stenting or surgical correction is recommended.
However, because any intervention inside blood vessels carries a possibility of complications — like local bleeding, infection or clot formation — the authors urged thorough imaging and a risk-benefit analysis before greenlighting aggressive measures. Some individuals with less-threatening forms of vascular pulsatile tinnitus do well with close monitoring and lifestyle modifications.
Practical Ways to Quiet the Noise and Restore Calm
In summary, odd sounds in your ears could be a warning sign from your body, so don’t ignore them. Use these steps to help you identify and address what’s actually driving the beat in your head.
Check your blood pressure — Start by reflecting on your blood pressure readings. If you suspect they're creeping up, keep track of them for a few weeks. Individuals with high blood pressure often do not experience noticeable symptoms, earning it the nickname “the silent killer.” Recognizing and addressing high blood pressure tackles the foundation first.
Identify triggers — Caffeine and intense stress, especially before bedtime, will elevate your adrenaline levels, and the more adrenaline pumping in your system, the louder your pulse gets. Consider swapping that late-day coffee or energy drink for herbal tea or pure water. If you notice improvements in your ability to fall asleep without the thud, then you’ve zeroed in on your triggers.
Try simple sound distractions — In some instances, neutral background audio helps your ears tune out rhythmic beats. A soft fan, low-volume instrumental music or pink noise shifts your focus to a gentler hum. When the rest of your environment is calm, it interrupts the cycle of hyper-listening, so you gradually stop dwelling on the internal pulsation.
Experiment with body position — Lying flat on your back sometimes works better than sleeping on your side, because there’s less external pressure on the artery near your ear. Use pillows in different ways to see if a slight incline reduces the sensation. Paying attention to how your position affects the pulsations is a simple experiment with no extra gear required.
Explore vascular-specific avenues — If routine strategies don’t bring relief, explore more in-depth imaging or tests to see if there’s a structural or vascular cause. As detailed above, minor anatomical changes near a vein or artery can amplify normal flow into a constant noise. Determining whether that’s true in your situation will guide you toward precise remedies, from appropriate dietary changes to specialized therapeutic options.
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