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Why Are My Hands Shaking? Nerves or Medical Problem?

You’re nervous about a big presentation. Your heart begins to race, your throat gets dry and your hands start to tremble. Deep breaths can help calm your nerves, but what if you can’t shake off your trembling hands?

Nerves aren’t the only thing that can make your hands tremble. There are a number of reasons hands shake, but interesting fact: Your hands actually shake way more than you realize.

“To be certain, everyone’s hands have a little movement even when we’re trying to keep them very still,” said Ryan Barmore, MD, a movement disorders specialist with Banner Health Clinic in Colorado. “This is broadly known as a physiologic tremor, and while some have subtle movement, others can have a little more.”

According to the National Institute of Neurological Disorders and Stroke, a tremor is a rhythmic or unintentional muscle contraction that can cause shaking in one or more parts of the body. It most often can affect your hands but can also occur in your arms, head, vocal cords, torso and legs.

Our bodies are sure full of surprises, but if your shakiness concerns you, here are eight potential reasons it’s happening and when you should talk to your health care provider.

1. You have a movement disorder.

Essential tremor, also referred to as “action” tremor, is the most common cause of tremor in adults. Although essential tremor is neurological, it is a distinct disorder and different than Parkinson’s disease.

“Noticeable shaking occurs when using your muscles to hold out your limbs up against gravity or moving them from Point A to Point B,” Dr. Barmore said. “Your hand might shake while holding up your hands or trying to do movements like eating, drinking, pouring and writing.”

You may first notice a tremor in one or both hands that then gradually progresses over time. It primarily causes tremors, usually just in the hands (though it can occur elsewhere) and have little to no other neurological symptoms.

Experts don’t know why essential tremor occurs, but there seems to be a strong genetic component and it often runs in families.

2. You have Parkinson’s disease or another brain disease.

Other than essential tremor, there are many diseases that can cause your hands to shake. Parkinson’s disease is what often comes to mind when thinking of tremors. But unlike essential tremors, the shaking with Parkinson’s disease is often worse when you’re at rest and not while using your hands.

“This tremor is most prominent when your hands are completely at rest, such as when watching TV, while walking with your arms loose at your side and so on,” Dr. Barmore said. “This tremor usually stays on one side of the body for a few years, and the other side often begins a little later.”

There are other degenerative brain diseases, such as multiple system atrophy, progressive supranuclear palsy or corticobasal degeneration, that may look like Parkinson’s disease at first but later progress differently. “These are generally much rarer than Parkinson’s disease,” Dr. Barmore said.

Other diseases of the brain, such as multiple sclerosis, stroke, traumatic brain injury and so on, may also cause tremor.

3. Your blood sugar is low (hypoglycemia).

When your blood sugar dips, it can leave you feeling hungry, lightheaded and shaky. When this occurs, it’s called hypoglycemia. It can happen to anyone who’s not eaten in a while but can be life-threatening for diabetics if it gets too low.

4. You’re consuming too much caffeine or alcohol.

If you’ve had a little bit too much coffee or other stimulants, they can leave you feeling jittery. Caffeine can stimulate your body, causing muscles to move out of sequence.

While occasional alcoholic beverages won’t make you develop a tremor, if you’re a heavy drinker, your body can become dependent on the effect of the alcohol. Because your body has adjusted to having it around much of the time, when the alcohol wears off the balance in the brain is thrown off.

“Think of it like having a balance of ‘gas’ and ‘brakes,’” Dr. Barmore said. “When the alcohol wears off there is too much gas and not enough brakes. Tremors can then occur and more dangerous things after, if the alcohol withdrawal is not treated appropriately.”

5. You might be taking a certain medication.

Many medications may cause your hands to shake as a side effect—from mild to severe.

“Some of the most common medications include those used for various aspects of mental health treatment, such as antidepressants of various types,” Dr. Barmore said. “As well, inhalers used for asthma and other lung diseases can also cause tremors.”

6. Your thyroid could be off.

Your shaky hands may be a sign of hyperthyroidism, an overactive thyroid gland. This means your thyroid is working overtime and kicking your heart rate into high gear. Along with shaky hands, you may also lose weight without trying, be sensitive to light and have trouble sleeping.

7. You have anxiety.

Uncontrollable shaking or trembling of the hands or other parts of the body can be a symptom of anxiety. Tremors caused by anxiety aren’t dangerous, but they can be uncomfortable.

When your body is under stress, it goes into fight-or-flight mode, causing stress hormones to flood your body and speed up your heart, blood pressure and breathing. This can cause your muscles to tense which can lead to a trembling sensation or shaking.

8. You’re not getting enough sleep

Your body needs sleep to reset and repair cells, so if you’re not getting your recommended hours of sleep, you’re forcing your body to function in a stressful situation. As a result, sleep deprivation can leave you feeling foggy-headed and shaky.

Bottom line: If you have a tremor that worries you, talk to your health care provider.

If you can tie your tremor to something you can tackle on your own, like over-caffeination, hunger or lack of sleep, most likely some minor lifestyle changes can rectify it.

“But it’s always appropriate to discuss a new tremor with your health care provider, even if it seems to come and go,” Dr. Barmore said.

Before your appointment, pay attention and jot down when during the day your tremor tends to happen, what you’re doing with your hands when the tremor seems to be the worst and the best. Take note of any medication changes in the time before your tremor began and pay attention to see if the tremor gets better or worse after taking medication doses during the day.

This information can help guide your health care provider in identifying the cause of your shaky hands and direct any further evaluation and treatment. To find a health care provider near you, visit bannerhealth.com.

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