Waking up shaking or trembling can be a troubling experience, especially when you don't know what's causing it. Experiencing body tremors when waking up might be a sign of a more serious condition, although that's not always the case.
"There are lots of kinds of shaking (trembling, shivering, voluntary versus involuntary and violent versus subtle)," says Carl W. Bazil, MD, PhD, neurologist and professor of neurology at Columbia University Irving Medical Center. "It's also sometimes difficult to know whether movements began during sleep and caused awakening or if awakening happens first."
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Here's what might be going on if you're shaking after waking up — and what you can do about it.
1. Your Blood Sugar Is Low
Low blood sugar could be the culprit for your morning shakes (or shaking when you wake up from a nap).
"It is possible to wake up feeling like you are having tremors if your blood sugar is low," says Margot Savoy, MD, physician and senior vice president for the American Academy of Family Physicians.
Also known as hypoglycemia, low blood sugar occurs when your glucose levels drop below normal, per the Mayo Clinic. In addition to shaking, other symptoms of hypoglycemia to look out for include:
- An irregular or fast heartbeat
- Tingling or numbness of the lips, tongue or cheek
Fix it: To address hypoglycemia, turn to fast-acting carbohydrates. You should eat or drink 15 to 20 grams of foods that the body can easily convert into sugar, like fruit juice or glucose tablets or gel, per the Mayo Clinic.
If you don't have those on hand, soft drinks or candy could do the trick, but make sure they're not of the low-sugar or sugar-free variety.
Insulin and other diabetes medications may cause your glucose levels to drop, per the Mayo Clinic. Your doctor can help adjust the timing of your meals and medications to help keep your blood sugar stable.
2. It's a Panic Attack
Panic attacks could be a possible cause for waking up shaking, although it's not super common, Dr. Savoy says. Still, nighttime panic attacks can happen without an obvious trigger, per the Mayo Clinic.
Symptoms of nighttime panic attacks are similar to ones that occur during the day, and include:
- Rapid heart rate
- Shortness of breath
- Flushing or chills
- Sense of impending doom
Many of these symptoms are similar to signs of a heart attack, especially in people assigned female at birth. If you think you might be having a heart attack, get immediate medical help by dialing 911.
Fix it: If panic attacks are in fact the cause behind you shaking after waking up, then treatment options include cognitive behavioral therapy and medication, per the Mayo Clinic. Addressing the underlying cause of your anxiety or panic attacks can also help.
Finding the right therapist can help you address the root causes of your anxiety or panic attacks.
3. You Have Anxiety
While experiencing anxiety on occasion is a fact of life, if your shaking coincides with feeling anxious, it could be a cause for concern.
Some common symptoms of anxiety, per the Mayo Clinic, include:
- Feeling nervous, restless or tense
- Feeling weak or tired
- Experiencing gastrointestinal problems
- Having trouble sleeping
- Trouble concentrating
Fix it: There are many ways to help ease anxiety.
"Anxiety and panic attacks can be very limiting to enjoying life if they are left untreated, but you don't always need a medication," Dr. Savoy says. "Therapy and breathing or grounding exercises can make a huge difference."
4. It's a Medication Side Effect
Certain medications may be to blame for feeling shaky after waking up. "Some medications can also make you feel jittery or shaky, like albuterol or caffeine," Dr. Savoy says.
Indeed, albuterol — which is often prescribed to people with asthma — has the following side effects, per the Mayo Clinic:
- Throat or nasal irritation
- Muscle aches
- Feeling nervous or shaky
Other drugs or medications that may cause you to feel shaky, per the Cleveland Clinic, include:
- Corticosteroids (like prednisone)
- Certain antidepressants like Paxil, Prozac, Zoloft, Pamelor and others
- Alcohol (with chronic use)
Fix it: If you suspect your medication is the reason for your shakiness, talk to your doctor about changing the delivery method, finding alternative ways to manage your condition and lowering your dosage, per the Mayo Clinic.
5. You're Drinking Too Much Caffeine
While too many cups of coffee can make you feel jittery, having too much caffeine via soda, snack bars and energy drinks can also have side effects, per the University of Washington School of Medicine (UW Medicine). And any amount of caffeine greater than 400 milligrams per day is considered excessive for adults (that's about four cups of home-brewed coffee).
But if smaller amounts of caffeine make you feel bad, then it's important to be mindful of your individual limits. Too much caffeine can cause the following, per UW Medicine:
- Sweating and restlessness
- Nausea and diarrhea
Excessive caffeine intake can also cause irregular and fast heart rhythms in people with pre-existing heart conditions.
Fix it: If you wake up feeling shaky and you think too much caffeine is the cause, taking a break from caffeine, drinking enough water, replacing your electrolytes (for nausea or diarrhea) and practicing deep breathing may help, according to UW Medicine.
When to See a Doctor
It's valid to be concerned if you wake up shaking or trembling. And if you regularly wake up shaking, it's best to see your doctor to get to the bottom of it.
To help make the most of your doctor visit, Dr. Savoy recommends considering following questions:
- How often does the shakiness happen and how strong is it?
- Does it happen at other times of the day or just in the morning?
- Are you having other symptoms like headache, blurry vision or muscle weakness?
- Did you eat and hydrate enough the previous day?
- Have you started any new medications, vitamins or supplements?
Your answers to all of the questions above can help your doctor determine (and treat) the reason for your shakiness, Dr. Savoy says.
Is this an emergency? If you are experiencing serious medical symptoms, please see the National Library of Medicine’s list of signs you need emergency medical attention or call 911.