Sleep apnea is not a recognized direct cause of a true tremor, but it can make you shaky. Untreated obstructive sleep apnea (OSA) causes repeated adrenaline surges and chronic sleep loss, and both can amplify the normal, barely visible tremor everyone has. Apnea arousals can also produce sudden jerks or thrashing that look like shaking. A persistent rhythmic tremor, though, usually has another cause — such as essential tremor, an overactive thyroid, medication or low blood sugar — and should be checked by a doctor.
Key takeaways
- There is no strong evidence that sleep apnea directly causes tremor disorders, and claims that it “damages the brain and causes tremors” overstate the research.
- What sleep apnea can do: fragment sleep and trigger stress-hormone surges, which may make the normal (physiologic) tremor more noticeable, especially on waking.
- Many “night tremors” are actually something else: hypnic jerks, periodic limb movements, REM sleep behavior disorder, low blood sugar or, rarely, seizures.
- OSA is common in people with Parkinson’s disease, and apnea-related arousals can mimic dream-enactment behavior — one reason a full sleep study matters.
- See a doctor for any tremor that persists, worsens or comes with other neurological symptoms.
How sleep apnea can make you feel shaky
Everyone has a tiny, fast tremor called physiologic tremor. Usually you can’t see it, but certain triggers turn it up enough to notice — this is called enhanced physiologic tremor. Northwestern Medicine lists stress, caffeine, nicotine, alcohol withdrawal, some medications, an overactive thyroid and low blood sugar as common amplifiers. Fatigue and sleep loss are widely cited too.
Untreated OSA feeds several of these at once:
- Adrenaline surges. Every time the airway closes and oxygen drops, the brain fires a “fight or flight” response to wake you just enough to breathe. Heart rate and blood pressure jump, and the same stress hormones can leave you jittery — especially if you wake mid-event with a pounding heart.
- Chronic sleep deprivation. Dozens of arousals an hour keep you out of deep sleep, so you can feel wired and tired at once.
- More caffeine. People with untreated sleep apnea often lean on coffee or energy drinks to get through the day (see caffeine and sleep apnea), which itself amplifies tremor.
This kind of shakiness is typically fine, fast and fairly symmetrical, and it should ease once sleep improves and the triggers are removed.
Is it really a tremor? Common look-alikes at night
A tremor is a rhythmic, back-and-forth movement. Many people who search “sleep apnea tremors” are actually describing jerks or kicks, which point to different conditions:
| What you notice | Likely explanation | Linked to sleep apnea? |
|---|---|---|
| A single whole-body jolt as you drift off, sometimes with a falling sensation | Hypnic jerk (sleep start) | Not directly; more common with stress, caffeine and sleep deprivation |
| Repetitive leg kicks or flexing every 20–40 seconds; urge to move legs in the evening | Periodic limb movements / restless legs syndrome | Can coexist; see sleep apnea and RLS |
| Thrashing, punching or shouting during dreams | REM sleep behavior disorder — or “pseudo-RBD” caused by apnea arousals | Yes: severe OSA can mimic RBD, and those episodes usually stop with CPAP |
| Waking shaky, sweaty and hungry, often with diabetes medication | Nocturnal low blood sugar | No, but symptoms overlap with apnea awakenings |
| Rhythmic jerking, a bitten tongue, wet bed, confusion on waking | Possible nocturnal seizure | Separate condition; see sleep apnea and seizures |
| Hand tremor during daily tasks (writing, holding a cup) | Essential tremor, thyroid, medication or another cause | Not a known cause |
Sleep apnea that mimics REM sleep behavior disorder
Normally your muscles are paralyzed during REM (dreaming) sleep. In REM sleep behavior disorder (RBD), that paralysis fails and people physically act out dreams. Sleep specialists have described patients with severe OSA whose violent movements and vocalizations happened only during arousals from apneas, while normal REM paralysis was preserved — so-called pseudo-RBD. In those cases the behaviors largely resolved once the sleep apnea was treated. True RBD, by contrast, is considered an early warning sign of Parkinson’s disease and related conditions, so telling the two apart with a video sleep study matters.
Sleep apnea and Parkinson’s disease
Tremor at rest is a hallmark of Parkinson’s disease, and sleep problems are extremely common in Parkinson’s. Studies report OSA in a wide range of people with Parkinson’s (estimates vary a lot by study method). That’s an association, not proof that sleep apnea causes Parkinson’s or its tremor. If you have a resting tremor, slowness or stiffness, see a doctor or neurologist — and if you also snore or stop breathing in your sleep, ask about a sleep study too, since treating OSA can improve sleep quality and daytime energy.
Can sleep deprivation cause tremors?
It can make an existing physiologic tremor more noticeable, and one study of soldiers in prolonged training found that sleep loss combined with heavy physical exertion changed tremor amplitude for more than 24 hours. That fits most people’s experience of feeling shaky after an all-nighter. The fix is the same as for apnea-related shakiness: restore normal sleep and cut back on caffeine and nicotine. If the tremor persists after you’ve caught up on sleep, it’s worth getting checked.
What to do if you think sleep apnea is behind your shaking
- Look for the other signs of OSA: loud snoring, witnessed breathing pauses, gasping awakenings, morning headaches and daytime sleepiness. Our STOP-BANG calculator is a quick screen, and our list of warning signs of sleep apnea covers the rest.
- Get a sleep study. A home sleep apnea test can diagnose straightforward OSA, but if movements, dream enactment or seizures are part of the picture, an in-lab polysomnogram with video and muscle (EMG) monitoring is better. See how to test for sleep apnea.
- Treat the apnea. CPAP is the first-line treatment for moderate to severe OSA (compare options in our best CPAP machines guide); oral appliances, weight loss and positional therapy help some people.
- Remove tremor amplifiers: cut caffeine after noon, avoid nicotine and alcohol, and keep a regular sleep schedule.
- Keep a symptom diary — when the shaking happens, which body parts, how long it lasts — and a phone video if possible. It helps your doctor enormously.
When to see a doctor
- A tremor that lasts weeks, gets worse, or interferes with eating, writing or work
- Tremor at rest, slowness, stiffness, shuffling walk or a softer voice (possible Parkinson’s)
- Acting out dreams, or injuring yourself or a bed partner during sleep
- Night shaking with sweating and hunger, especially if you take insulin or sulfonylureas
- Loud snoring with breathing pauses and daytime sleepiness
Get emergency care for a first-time seizure, shaking with confusion that doesn’t clear, sudden weakness or numbness on one side, trouble speaking, or chest pain.
This article is for general information and is not a substitute for medical advice. Talk to a doctor about any new or persistent tremor.
Frequently Asked Questions
Can sleep apnea cause tremors?
Sleep apnea is not a recognized direct cause of tremor disorders. It can, however, make the normal physiologic tremor more noticeable through sleep loss and repeated adrenaline surges, and apnea arousals can cause jerking movements that look like shaking. A persistent tremor should be evaluated for other causes.
Why do I wake up shaking?
Common reasons include waking suddenly from an apnea event with an adrenaline surge, low blood sugar overnight, anxiety or panic, alcohol withdrawal, caffeine, and an overactive thyroid. If it happens often, especially with snoring or night sweats, talk to a doctor.
Can lack of sleep cause tremors?
Yes, sleep deprivation can amplify normal physiologic tremor, making your hands look shaky. It usually settles once you catch up on sleep and cut back on caffeine. A tremor that persists after good sleep needs checking.
Is jerking in my sleep a sign of sleep apnea?
It can be. Sleep apnea often causes restless sleep with sudden movements as you rouse to breathe, and severe apnea can even mimic REM sleep behavior disorder. But jerks can also be harmless hypnic jerks or periodic limb movements. A sleep study can tell these apart.
Will CPAP stop tremors?
CPAP won’t cure essential tremor or Parkinson’s. It can reduce shakiness caused by poor sleep and apnea-related arousals, and dream-enactment behavior caused by apnea (pseudo-RBD) typically improves once the apnea is treated.
Sources
- Northwestern Medicine — What Causes My Hands to Shake?
- MedlinePlus (U.S. National Library of Medicine) — Tremor
- Sleep Foundation — Hypnic Jerks
- MedlinePlus — Restless Legs Syndrome
- Mayo Clinic — REM sleep behavior disorder
- Iranzo A, Santamaría J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 28(2):203-206, 2005
- Biology of Sport — Changes in physiological tremor resulting from sleep deprivation during prolonged military training
- National Heart, Lung, and Blood Institute — Sleep Apnea
