I wake up shaking uncontrollably . . .
September 19, 2009 11:22 AM   Subscribe

I wake up in the middle of the night shaking uncontrollably - what might be causing this?

I will be making a doctor's appointment first thing on Monday, but I haven't been in years and don't have a regular physician, so I'm guessing it'll be a few days before I can get in. I'm asking here in case anyone has had a similar experience and has any suggestions for things I can do in the meantime to make things easier.

Three nights out of the last four, I've woken up about an hour after initially falling asleep. I feel a sense of growing panic/claustrophobia (not tied to anything in particular), then increasing nausea and my entire body starts shaking. It's violent enough that I can't get out of bed or even pick up a glass of water at its worst. It comes in waves, lasts for about an hour altogether, and eventually subsides and I feel tired, but generally fine. After the initial panic, I'm relatively calm thoughout the episode - worried of course, but thinking clearly.

In addition to these three recent episodes, I've had this happen twice more in the last couple months, and once a little over a year ago. The first time it happened, I went to the ER and was treated for "syncope and collapse" and given potassium and IV fluids. (I was under a huge amount of stress at that time, barely sleeping and definitely not eating properly, so it seemed pretty clear that that was the cause.) Other than managing the symptoms, they didn't really do anything, so I have not wanted to spend the money to go again when I know that things will resolve on their own.

I'm worried now because of the increased frequency. I've been exhausted, sore (from the muscle convulsions), and haven't been able to eat much (don't want to trigger the nausea) for the past few days, and it's been very difficult to focus at work.

My internet research has turned up very little as far as causes. The shaking is the main symptom, so it doesn't seem like a panic attack (no breathing issues, no real cause). I've tried to start eating more potassium, since that was one of the issues in the ER visit, but either I'm not getting enough or that's not the root cause, because it has not had any effect.

I've never had any other medical issues, and nothing runs in my family. I'm generally healthy, maybe a bit underweight (I don't eat meat and can't have dairy, and I'm not a big eater anyway.)

I realize that nobody can diagnose me over the internet, but if this sounds familiar to anyone, please let me know so that I can at least look into it. I'd feel better if there's SOMETHING I can do while waiting to see the doctor other than, well, waiting.
posted by Fifi Firefox to Health & Fitness (10 answers total) 3 users marked this as a favorite
Have you started eating anything new and interesting in the evenings or as a bedtime snack?
posted by Lyn Never at 12:28 PM on September 19, 2009

Are you also sweating a lot during these episodes?
posted by tristeza at 12:32 PM on September 19, 2009

You mentioned that you are not a big eater. Google "insulin spike" for a possible explanation.
posted by Cookbooks and Chaos at 1:10 PM on September 19, 2009

Since you say you're in your first hour or two of sleep, that implies to me that this is happening in deep levels of sleep. I would probably look at these as possibilities:
1) sleep apnea... you say "no breathing issues" but most people are unaware they snore or have breathing problems. If the breathing is interrupted severely enough you would be prone to waking up with panic attacks.
2) a form of night terror (i.e. from deep non-REM sleep) that you're waking out of, and note that this I mean "night terrors"; this is not nightmares nor bad dreams. The causative factors would be most important and could be from overtiredness or #3 below:
3) sleep disturbances from neurotransmitter imbalance, which looks to me to be either an overactive adrenergic system from too much caffeine, Adderall, PTSD, etc, or low serotonin.

So I figure it could be #1, #2, #3, or a mixture.

If this were me, I would do the following in order, and trying only one thing each night to isolate the issue:
- As long as you aren't already physically exhausted every day, I would try exercising for a week -- this is good for your body and improves the dopaminergic, serotonergic, and aminergic balance in your system; it's why you feel better and sleep better after a workout.
- Try to enlist a partner to monitor the first couple of hours of sleep to see if it's snoring or apnea; a low budget idea would be to try a microphone + recorder or webcam with IR light to see what's going on just before awakening.
- I would try a dose of Benadryl in the evening, assuming I am not on any SSRI. This would mediate my serotonin levels if they were low, and for some people who have anxiety problems before bed it does help with sleep.
- I would try 5-HTP from a nutrition store; it is relatively harmless in low doses and might help, though there is debate over whether oral 5-HTP actually works on the serotonergic system.
- If anxiety is an issue at all I would take a low off-label dose of a beta blocker like Betaloc; as that dampens an overactive adrenergic system. This is really the only class of medications that works directly on adrenaline.
- Prescription SSRIs might help, too, but this is getting out of my depth. Unfortunately not only are they the big guns but they're the front line of shotgun diagnosis, so I'd reserve that as an avenue of last resort; they do have the potential to make things worse if the doctor doesn't know what they're doing.

The above is not so much to fix it as to try a remedy each night and try to isolate what the problem is. This and the findings can be discussed with a doctor to narrow the avenues of approach. I know there are those who will say flat out to see a doctor. Frankly I have mixed feelings about trying to get this fixed at the doctor's office as my wife and I over the years have received too many shotgun diagnoses and shotgun prescriptions over the years for various minor ailments, and with what you described I am very skeptical the average practitioner would be willing or able to give accurate, effective help. But still, I would suggest going to the doctor anyway as (1) you might luck out and get a competent doctor who will listen, and (2) things like high blood pressure or systemic problems could conceivably be a contributing factor here.
posted by crapmatic at 1:17 PM on September 19, 2009

I've had panic attacks that were almost entirely shaking. IANYD, but your description sounds very much like a panic attack--and as a counselor once told me, if there were a "real cause", it wouldn't be a "panic attack." I'm also more prone to them when stressed, generally.
posted by PhoBWanKenobi at 1:19 PM on September 19, 2009

Sounds like a classic panic attack to me, but it also sounds like you could benefit from a complete physical to rule out important other possibilities. If you ever feel like you're going to faint, or you start to or do faint, (I say this because of the "syncope" diagnosis you were given at the ER) be sure to tell the doctor. That doesn't match with my experience of panic attacks, which tend more toward the OHMYGODTHISISAHEARTATTACKFORSURE end of the spectrum. But everyone's panic attacks are different, so I'm only one data point.
posted by ImproviseOrDie at 1:24 PM on September 19, 2009

1) sleep apnea... you say "no breathing issues" but most people are unaware they snore or have breathing problems. If the breathing is interrupted severely enough you would be prone to waking up with panic attacks.

This sounds like me. I have sleep apnea PLUS panic disorder. Fortunately, I have a CPAP for the former and medication for the latter. I'd get a sleep study done if I were you.
posted by desjardins at 2:17 PM on September 19, 2009

What's going on in your life? Work, money, debt, family, etc. stress and worries?
posted by Thorzdad at 2:19 PM on September 19, 2009

Doctor here. It's definitely something. I can think of half a dozen diagnoses to consider off the top of my head just reading your description, but there's just not enough information to make a worthwhile guess here. Yes, it *could* be panic, but no one should jump to that conclusion, and I would not recommend trying to figure this out on your own. Your symptoms are non-specific enough that you are going to lead yourself down some crazy road researching this on the internet. You need a discussion with a medical practitioner, an examination, and most likely some blood tests.
posted by Slarty Bartfast at 2:54 PM on September 19, 2009 [5 favorites]

Thank you, everyone, for the responses - I will definitely see a doctor as soon as I can, but all your suggestions at least give me things to monitor until then.

I had not considered sleep issues - I am a very light sleeper but have never snored or had any breathing issues that I know of. Prior to a few of these episodes, I have actually gone downstairs to get water and talked a bit with my boyfriend (who keeps late hours and is usually still awake) BEFORE going back to bed and having the shaking begin - would sleep apnea/night terrors still be a cause if there is a delay?

To answer other questions, I do not sweat much during the episodes, though I do feel alternately overheated and chilled. I have not changed anything in my diet, and have cut down my food to the bare minimum in the past few days (all pretty bland and basic), so that shouldn't be causing problems. I have the same stressors that so many do right now - job security, money - but I'm pretty used to that by now and it's more of a low-level stress than an active freaking-out worry. Maybe I'm underestimating though, because based on the responses here, some type of panic disorder does seem likely.

I managed to 'thwart' the episodes last night by staying up way, way later than usual - not a great solution, but I guess I was too exhausted to wake up? I'm not ready to self-medicate quite yet, but I will try exercising in the evenings to see if that helps.
posted by Fifi Firefox at 8:14 AM on September 20, 2009

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