5 Reasons You're Waking Up Shaking and What to Do About It

Ever wake up with tremors? Shaking or trembling in the morning can be a troubling experience, especially when you don’t know what’s causing it. And it can be a sign of a more serious condition.

“There are lots of kinds of shaking, such as trembling, shivering, voluntary versus involuntary, and violent versus subtle,” says Carl W. Bazil, MD, PhD, a neurologist and a professor of neurology at Columbia University Irving Medical Center in New York City. “Knowing whether movements began during sleep and caused awakening or if awakening happened first can also be challenging.”

Here’s what might be going on if you wake up shaking uncontrollably, 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.

“Wake up feeling like you are having tremors if your blood sugar is low,” says Margot L. Savoy, MD, MPH, a physician and the chief medical officer of the American Academy of Family Physicians.

In addition to shaking, other symptoms of hypoglycemia to look out for include:

• An irregular or fast heartbeat
• Hunger
• Irritability
• Tingling or numbness of the lips, tongue, or cheek
• Anxiety
• Fatigue

If you don’t have those on hand, soft drinks or candy could do the trick. However, you’ll need to make sure they’re not low-sugar or sugar-free.

Insulin and other diabetes medications may also cause your glucose levels to drop.[1] Your doctor can help adjust the timing of your meals and medications to keep your blood sugar stable.

2. You’re Having a Panic Attack

Symptoms of nighttime panic attacks are similar to those that occur during the day, and include:

• Sweating
• Trembling
• 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 women. If you think you might be having a heart attack, get immediate medical help by dialing 911.

3. You Have Anxiety

Everyone experiences anxiety on occasion. However, if your shaking coincides with feeling anxious, it could be a cause for concern.

• Heart palpitations
• Shortness of breath
• Nausea
• Muscle tension
• Dry mouth
• Numbness in hands or feet
• Insomnia
• Restlessness
• Difficulty concentrating
• Feeling irritable or on edge

Many anxiety relief methods are available. “Anxiety and panic attacks can be very limiting to quality of life without treatment, but you don’t always need medication,” 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 if you’re feeling shaky after waking up. “Some medications can also make you feel jittery or shaky, like albuterol or those containing caffeine,” says Savoy.

• Headache
• Throat or nasal irritation
• Muscle aches
• Feeling nervous or shaky

• Corticosteroids, such as prednisone
• Certain antidepressants like fluoxetine (Prozac), nortriptyline (Pamelor), paroxetine (Paxil), sertraline (Zoloft), and others
• Nicotine
• Alcohol (with chronic use)
• Methylphenidate (Ritalin)
• Pseudoephedrine (Sudafed)
• Cyclosporine

5. You’re Drinking Too Much Caffeine

• Jitteriness
• Sweating and restlessness
• Anxiety
• Nausea and diarrhea

Excessive caffeine intake can also cause irregular and fast heart rhythms in people with preexisting heart conditions.

• Have a break from caffeine
• Make sure to drink enough water
• Replace your electrolytes (for nausea or diarrhea)
• Practice deep breathing

When to See a Doctor

Concerns about waking up shaking or trembling are valid. 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 visit to a healthcare professional, consider the following questions from Savoy:

• 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, such as headache, blurred 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 these questions can help your doctor determine (and manage) the reason for your shakiness, Savoy says.

The Takeaway

• Potential reasons for waking tremors include low blood sugar, anxiety, caffeine, and prescribed medications.
• If you wake up shaking or trembling, a more serious condition can be behind it, but that’s not always the case.
• If shaking happens regularly, see a healthcare professional to get to the bottom of it.