Why do you feel shaky after waking up? (+1 reasons)

In this article, we will discuss why you feel shaky after waking up. We will also discuss different factors that may cause shakiness after waking up and how to manage such symptoms.

Why do you feel shaky after waking up?

You may feel shaky after waking up mainly because of the following reasons:

  • Low blood sugar level,
  • Anxiety,
  • Chronic fatigue syndrome,
  • Medication side effects, and
  • Dehydration.

Too much caffeine in your blood (more than 400 mg) may also give a shaky feeling after waking up. You should consult your general physician to take your medical history and identify the possible root cause of morning tremors and shaky feeling after waking up. 

What factors cause a shaky feeling after waking up?

The major reason for having a shaky feeling after waking usually involves hypoglycemia and anxiety. However, other disease conditions may also give a shaky feeling after waking up.


Hypoglycemia refers to low blood sugar levels. In hypoglycemia, the blood sugar level drops below 70 mg/deciliter. Low blood sugar levels may cause tremors, shaking, heart palpitations, dizziness, confusion, blurred vision, and extreme hunger.

Your blood sugar level may drop from the normal value if you had skipped consecutive meals, or had taken too much of insulin. Engaging in intense exercise just before going to bed, or taking excess of alcohol may also cause hypoglycemia (1).


You may get an anxiety or panic attack while sleeping due to nightmares, hallucinations, and unperceived danger. When you wake up, you are often shaking, trembling, and gasping for air. You may also experience heart palpitations and restlessness (2).

Chronic fatigue syndrome

Chronic fatigue syndrome is a heterogeneous condition which may cause sudden onset of shakiness, weakness, tiredness, and fatigue especially after waking up. Other symptoms may include leg weakness, dizziness, and abdominal bloating.

Chronic fatigue syndrome is also known as myalgic encephalomyelitis and can affect anyone, including children. It is more common in females and may appear between the age of 20-40 years (3).


Beta-2-antagonist drugs like albuterol, salbutamol, and terbutaline may cause shakiness and heart palpitations, especially during prolonged use for chronic obstructive pulmonary disease (COPD). They may also cause the symptoms of anxiety and worsen breathlessness (4). 

Another drug used in the treatment of COPD, theophyllines, is also known to cause shakiness, heart palpitations, nausea, and seizures. If you experience any of these symptoms while taking theophylline, immediately go to an emergency department (4).

Some hyperosmolar chemotherapeutic solutions are also reported to cause shakiness. They may simulate solute urinary diuresis causing feelings of shakiness, pressure, and discomfort. They may also cause extreme thirst (5).

Some antidepressants such as fluoxetine and citalopram are known to cause shakiness. Both drugs belong to the class of selective serotonin reuptake inhibitors (SSRIs). The chances of shakiness and tremors increase at high doses.


Dehydration occurs when you lose water more than you consume. This may cause shakiness, profound sweating, nausea, anorexia (loss of appetite), and fatigue. Drink enough water before going to bed, however, do not overdo it.

What does research suggest?

In one of the cross-sectional studies, hypoglycemic patients (n=1709) reported shakiness, hunger, fatigue, drowsiness, and headaches. Amongst these patients, 5% of them reported that their symptoms were severe, whereas 68% of patients reported that these symptoms were mild (6).

In one of the cohort studies, 3041 patients reported shakiness as one of their anxiety symptoms. Anxiety symptoms were more prevalent in females as compared to men. Shakiness was also common in patients who did not have depression (15%) (7).

In one of the case reports, a 65-year-old female being treated with carboplatin (a chemotherapeutic agent) for ovarian cancer complained of shakiness and extreme thirst. The cancer also progressed during the treatment therapy (5).

How to manage shakiness after waking up?

Acute shakiness due to dehydration, alcohol, and caffeine intake rarely needs treatment. You should avoid taking caffeine and alcohol three hours before going to bed. However, you may need to talk to your doctor if shakiness persists for a longer period (8).

  • Beta-blockers: You doctor may prescribe beta-blockers such as propranolol and metoprolol to reduce the occurrence of tremors and shakiness after waking up.
  • Anticholinergic drugs: These drugs are prescribed to control tremors, shakiness, and muscle spasms. Examples include benzhexol and trihexyphenidyl.
  • Benzodiazepines: Drugs like Xanax, valium and ativam may help reduce anxiety, panic attacks, and associated shakiness. It may also help improve sleep.

As a pharmacist, I would advise you to cut off your caffeine and alcohol intake if you experience shakiness after waking up. Although it is not a life-threatening condition, it may decrease the quality of life and sleeping patterns.

Drink water and keep yourself hydrated. Always keep a keen check on your insulin levels if you have diabetes. You should discuss the possible side effects of medication before starting a new therapy.

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Alvarez-Guisasola F, Yin DD, Nocea G, Qiu Y, Mavros P. Association of hypoglycemic symptoms with patients’ rating of their health-related quality of life state: a cross sectional study. Health and quality of life outcomes. 2010 Dec;8(1):1-8. https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-8-86


Roth D, Antony MM, Swinson RP. Interpretations for anxiety symptoms in social phobia. Behaviour research and therapy. 2001 Feb 1;39(2):129-38. https://www.sciencedirect.com/science/article/abs/pii/S000579679900159X


Sabin TD. An approach to chronic fatigue syndrome in adults. The Neurologist. 2003 Jan 1;9(1):28-34. https://journals.lww.com/theneurologist/Fulltext/2003/01000/An_Approach_To_Chronic_Fatigue_Syndrome_in_Adults.3.aspx


Meek P, Lareau S, Fahy B, Austegard E. Medicines for COPD. American journal of respiratory and critical care medicine. 2019 Jul 15;200(2):P3-5. https://www.atsjournals.org/doi/pdf/10.1164/rccm.2002P3


Hoffer LJ, Robitaille L, Zakarian R, Melnychuk D, Kavan P, Agulnik J, Cohen V, Small D, Miller Jr WH. High-dose intravenous vitamin C combined with cytotoxic chemotherapy in patients with advanced cancer: a phase I-II clinical trial. PloS one. 2015 Apr 7;10(4):e0120228. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0120228


Alvarez-Guisasola F, Yin DD, Nocea G, Qiu Y, Mavros P. Association of hypoglycemic symptoms with patients’ rating of their health-related quality of life state: a cross sectional study. Health and quality of life outcomes. 2010 Dec;8(1):1-8. https://hqlo.biomedcentral.com/articles/10.1186/1477-7525-8-86


Mehta KM, Simonsick EM, Penninx BW, Schulz R, Rubin SM, Satterfield S, Yaffe K. Prevalence and correlates of anxiety symptoms in well‐functioning older adults: Findings from the health aging and body composition study. Journal of the American Geriatrics Society. 2003 Apr;51(4):499-504. https://agsjournals.onlinelibrary.wiley.com/doi/full/10.1046/j.1532-5415.2003.51158.x


Elias WJ, Shah BB. Tremor. Jama. 2014 Mar 5;311(9):948-54. https://jamanetwork.com/journals/jama/article-abstract/1835484