Ask the expert

Why do we wake up shaking? Common causes and tips

28 July 2023

Waking up feeling shaky can be quite scary, but it's often not an emergency. The most common reasons for experiencing tremors or shakes when waking up are low blood sugar levels and anxiety. It's hard to know the exact cause without a thorough examination, so you should contact your GP to get checked, as these symptoms could indicate an underlying condition.

Let's explore the common causes of waking up shaking:

1: Low blood sugar (Hypoglycaemia)

Low blood sugar, also known as hypoglycaemia, happens when our blood sugar drops below normal levels. For people without diabetes, normal blood sugar levels range from 4.0-5.9 mmol/L before meals and below 7.8 mmol/L after meals1. Although hypoglycaemia is more common in individuals with diabetes, it can affect anyone.

Symptoms of hypoglycaemia may include2:

  • Shaking
  • Fast heartbeat (tachycardia) and palpitations
  • Dizziness
  • Anxiety
  • Confusion
  • Paleness
  • Sweating
  • Blurred vision
  • Headache
  • Tiredness and irritability
  • Extreme hunger

Hypoglycaemia can occur both during the day and while you sleep. Some symptoms may go unnoticed during sleep. Hypoglycaemia can be caused by:

  • Not eating enough or going without food for a long time
  • Drinking excessive alcohol
  • Engaging in intense exercise
  • Taking too high a dose of medication, like insulin, if you have diabetes and in relation to your blood sugar levels.

2: Anxiety and Panic Attacks

Anxiety can affect us even when we're asleep, leading to frequent awakenings or nightmares. Many symptoms overlap with those of low blood sugar3:

  • Feeling uneasy
  • Lightheadedness or dizziness
  • Sweating
  • Fast heart rate or palpitations
  • Rapid breathing
  • Shaking
  • Pins and needles
  • Restlessness
  • Nausea

Panic attacks can also occur when the body reacts strongly to an unknown fear or perceived danger. These attacks can be very distressing, and sometimes people mistakenly think they're having a heart attack or facing imminent death. While panic attacks are upsetting, they don't pose an immediate health risk4.

For more information on common myths about anxiety, check out our Mythbusters article on Anxiety Myths.

3: Medication Side Effects

Certain medications can cause shaking or palpitations as side effects. If you've recently started taking new medications or changed your dosage, it may be necessary to have a medication review with your pharmacist or GP.

If you're taking medications to treat diabetes, such as insulin, sulphonylureas, or glinides, and frequently experience hypoglycaemia symptoms, it's best to contact your GP or diabetic specialist nurse to review how you're managing your blood sugar5.

There are other conditions that can cause tremors, irregular heart rhythms, or muscle twitches, such as neurological disorders and electrolyte imbalances. Usually, these conditions wouldn't exhibit a common symptom pattern, but your GP might want to investigate further if needed.

Helpful Tips

While the specific treatment for shaking or waking up with a fast heart rate depends on a clinical review, taking care of your physical and mental well-being can make a significant difference. Here are some simple tips:

  • Eat a healthy diet
  • Stay physically active
  • Reduce alcohol and caffeine intake
  • Quit smoking
  • Practice mindfulness and deep breathing exercises

Remember, seeking professional medical advice is crucial for accurate diagnosis and proper management of any health concerns. 

Information provided and reviewed by the AXA Health 24/7 health support line for members.


  1. Blood glucose and target levels - NICE
  2. High and low blood sugar symptoms -
  3. What is a panic attack? - MIND
  4. Get help with anxiety, fear or panic - NHS
  5. What is a hypo? - Diabetes UK

Ask our health professionals

You’re not alone. We’re here to help you take care of your health. 

Our email service allows allows you to ask our team of experienced health professionals, including nurses, midwives, counsellors, pharmacists and dieticians, your health related question. 

You don’t have to be a member, and you can ask for yourself or anyone in your family. We’ll get back to you via email, usually within 24 hours, with clear information and support.

Concerned about hospital waiting times?

Discover how we can support you and your family with new medical conditions after you join.