Why do I shake when I wake up?

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Why do I shake when I am sleeping? Is it a jerk reflex or something else?

When you wake up shaking, this may sometimes be confused with hypnic jerks (hypnagogic jerk) or myoclonic jerks. It is often referred to as the sleep-wake starter, which may actually make you more sleepy. These kinds of feelings are common, which occur when we enter sleep.

Hypnagogics or hypnic jerks are described as “transitional stage between wakefulness and sleep, in which sensory perceptions can be experienced.”1 At this point the body may be interpreting this wakeful stage as stimuli in which it is required to move, triggering a movement type response. It is believed to be a common occurrence in all ages and sexes with a prevalence of around 60-70% of people according to some research.2

It is believed that treatment of night starts or hypnic jerks are not necessary, however if it is giving you anxiety symptoms it may be worth looking at some causative factors. These may include things like:

  • Sleep hygiene: Cool, dark room for sleeping, clean bed sheets, comfortable mattress and pillow combos and decreasing exposure to blue light

  • Stimulants: like energy drinks, caffeinated beverages or nicotine products

  • Late exercise: Being too active close to bedtime is potentially one of the common reasons for this jerk response

  • Anxiety: stress response caused by high anxiety levels is something that may have a correlation with muscle twitches of this nature.

You have low blood sugar levels

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Low blood sugar may be your answer as to why do I shake when I wake up. This may also happen whilst you are napping. A fall below 70mg/dl in your blood sugar during the night is referred to as Nocturnal hypoglycaemia as stated by Hopkins Medicine.

There are a variety of causative factors that may contribute to this:

  1. Infection

  2. Exercise before bedtime

  3. Night time alcohol intake

  4. Skipping meals (particularly around the afternoon or night)

It would be advised that you seek medical advice if you believe you fit into these categories. Doctors may prescribe certain medications or interventions to help with this. With nocturnal low blood sugar, often the medication prescribed is known as NPH insulin (neutral protamine hagedorn). Other interventions may include things such as changes in habits like drinking or meal timing.

Can anxiety cause tremors while sleeping?

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Night-time panic attacks may arise without any obvious triggers and wake you up, resulting in body tremors, also known as anxiety tremors. In some cases, panic attacks are more intense than others and can cause sweats, rapid heart rates or heart palpitations, shaking caused by the body’s muscles, breathing problems, and sometimes heavier respiratory distress and ultimately have an affect on the whole body and the nervous system.

Panic attacks are not lethal, however can be very disconcerting to the person experiencing them. This may lead to sleep deprivation, further triggering anxiety symptoms or whats known as anxiety disorder.

BUT there is something you can do about that heart racing anxiety! There are some common ways to treat this by using cognitive behavioural therapy or medications to reduce the anxiety symptoms. Feeling anxious sometimes is normal but when it causes you to wake up shaking or anxiety and panic attacks it may be time to do something proactive to help yourself.

Immediate things you can do include:

  1. Using a book to wind down

  2. Listening to calming music. We have collated some music on our youtube channel, along with some calming scenic views. You can find the link here.

  3. Ensure before you go to bed you have planned out what you are doing in the morning. i.e. Clothes are laid out, transportation is organised, breakfast is either prepared or food is available.

  4. Meditation before bed, this may involve some deep breathing.

  5. Lower your stimulant intake. i.e. remove caffeine, like energy drinks or coffee from your pre-bedtime routine

  6. Lower or remove alcohol consumption

  7. Make your bedroom a stress free environment, removing any obvious trigger.

  8. Reducing intense exercise close to bedtime

If you are a somewhat anxious person, you will do well to reduce your stress hormones using these techniques. It may take days to a few weeks but relaxing your entire body through not only physical but mental stimuli reduction can help you fall asleep; without releasing that stress hormone known as cortisol. Decreasing stress response on the whole body!

If you continue experiencing body tremors it may be worthwhile consulting family physicians or medical practitioner. It never hurts to listen to the way your body feels and what your routine is when falling asleep.

Is it my medication?

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Your medication may effect your whole body in various ways, leading to feeling shaky when you wake up or during the middle of the night. It may be noting down any new medications you have started taking prescribed by your doctor that may be contributing to your night shaking.

Medications or common drugs that may contribute to these include:

  • Corticosteroids (i.e. prednisone, dexamethasone, methylprednisolone, etc.)

  • Alcohol

  • Nicotine (whether is a cigarette or various quitting aids)

  • Ritalin (used for ADHD)

  • Pseudoephedrine (i.e. Sudafed)

  • Cyclosporine (used as an immunosuppressant)

  • Antidepressants

Any of these may have an effects on the nervous system and may lead you to feel shaky when waking up. However, it is highly recommended that if you consult with your doctor about the way you are feeling.

Don’t feel like you can’t be open about any symptoms you experience, your physician will appreciate knowing if you have any issues with body tremors or adverse side effects commonly or uncommonly experienced with any medications. ESPECIALLY if you wake up shaking, this can influence not only the quality and duration of your sleep but also falling asleep. And as we know, good sleep is a strong influence on good health, which is the goal of any physician or medical practitioner.

When do I see my doctor? And what should I expect if I am experiencing trembling while sleeping?

Your doctor may ask you some questions and perform a medical assessment. Some things you may expect are:

  • They may ask questions about how many symptoms you are experiencing beyond feeling shaky, the duration and strength of the shaking, the timing of the shaking or body tremors, your current stress and lifestyle factors (this may include, work and home stress levels) and if that plays into your stress response. They may also ask about your nutrition and hydration habits.

  • A blood sugar test, also known as blood glucose monitoring or even a full blood examination (FBE)

  • A blood pressure assessment, using a blood pressure monitor or cuff. This may determine low blood pressure or high blood pressure, which would be of interest to the doctor.

  • They may undergo basic neurological testing for the central nervous system. If anything is determined they may refer you further to a neurologist. (The type of doctor who would deal with things like multiple sclerosis or other various brain and nervous system disease)

In summary, it’s not always doom and gloom, but it may be worth taking the time to assess the reasons as to why you are experience shaking or body tremors during your sleep state. Your health is important and can impact many factors in your life.

The Research:

  1. https://pubmed.ncbi.nlm.nih.gov/36017720/

  2. https://www.sciencedirect.com/science/article/abs/pii/S1389945716301198