If you’ve ever wondered why your hands are shaking during a terrifying job interview, first date, or other extremely inopportune time, well, welcome to the club. We’ve all been there, wanting to shake our...well, shaky fists at our bodies for the poor timing, or the simple WTF-ness of it all.
The interesting thing is that your hands actually shake way more than you might realize. In fact, you’re experiencing a teeny hand tremor all the time. “If you put electrodes onto people’s fingers...you can record a very, very fine, tiny tremor,” Andrew S. Feigin, M.D., co-executive director of the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Health, tells SELF.
A tremor is when your muscles contract rhythmically and unintentionally, and one or more of your body parts end up shaking, according to the National Institute of Neurological Disorders and Stroke (NINDS). It’s most likely to occur in your hands, but it can also affect your arms, head, torso, legs, and vocal cords. (Hi, shaky voice! So nice of you to show up, usually when you’re not at all welcome.)
Even as you read this, you’re experiencing what’s called a physiologic tremor. That may sound a little worrisome, but it’s really not. It just means that your body, that endless source of surprises, trembles a bit as a result of the physical work required to keep you alive, like your heart beating, the NINDS explains.
The issue comes when your tremor gets to the point that your hands are basically vibrating in a way that concerns you. Here are a few potential reasons that might happen—and when you should see a doctor for evaluation.
Sleep deprivation can heighten your body's usual tremor, Pinky Agarwal, M.D., a fellow of the American Academy of Neurology and a clinical professor of neurology at the University of Washington, tells SELF.
This is what experts often call an enhanced physiologic tremor, which is when your body’s normal inconspicuous quivering becomes more noticeable for some reason (as opposed to your body shaking perceptibly because of an underlying health condition, which we’ll get to in just a bit).
When you think about it, it makes total sense that sleep deprivation might result in an obvious tremor. Sleep is a cornerstone of your health, and not getting enough (that’s at least seven hours a night for people 18 and over) can greatly affect your autonomic nervous system (ANS). Also called your involuntary nervous system, your ANS governs how your internal organs work, according to the U.S. National Library of Medicine, doing so much to keep you alive that it basically deserves a medal. Your ANS regulates processes like your heartbeat and blood pressure, which may rise if you’re sleep-deprived. This can ultimately result in more noticeable tremors.
In that case, getting rid of the tremor may just require sleeping more, says Dr. Agarwal, who is also a movement disorders neurologist at Evergreen Health in Kirkland, Washington. This is obviously easier said than done for some people. If you were cutting way back on sleep because of something like a huge work project and can get back to your normal routine ASAP, definitely do that. If you’re dealing with a larger sleep problem, like chronic insomnia, talk to your doctor for help.
Just like excessive fatigue, having too much caffeine can enhance a normal physiologic tremor. Nicotine can do the same thing. This comes down to their nature as stimulants, Dr. Feigin explains. Since factors like your heartbeat can cause an enhanced physiologic tremor, overdoing it on stimulants that affect those processes might make your tremor more noticeable.
There are actually a lot of medications that can cause drug-induced tremors, according to the U.S. National Library of Medicine, which explains that these tremors typically happen when you move or try to hold your hands, arms, or head in a specific positions.
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A wide range of drugs can cause these tremors by affecting your nervous system and muscles, the U.S. National Library of Medicine says. This includes some anti-seizure medications, asthma drugs, selective serotonin reuptake inhibitors (SSRIs, the most commonly prescribed kind of antidepressant), and more. If you’ve started taking a new medication and are experiencing tremors that concern you, chat with your doctor about your options.
If you’ve ever delivered a presentation and noticed your notes trembling like a leaf in your hands, this one won’t surprise you. Anxiety can enhance normal physiologic tremors, Dr. Feigin says. In addition to controlling your body’s involuntary processes, your autonomic nervous system also affects your flight or fight response, which can get activated in response to nerves.
When you’re stressed, your sympathetic nervous system (part of your autonomic nervous system) releases norepinephrine, a neurotransmitter that can do things like can raise your heart rate. That, in turn, can make your hands shake in an obvious way.
There are a lot of tremors that don’t fall into that enhanced physiologic category. The most common type is essential tremor, Dr. Agarwal says. Essential tremor is a movement disorder with an unknown cause, according to the NINDS, though some experts think it might be due to a slight deterioration in the parts of the brain that command movement. There may be a genetic component; the NINDS notes that if one of your parents has essential tremor, you have a greater chance of having it, too.
The biggest sign of essential tremor is noticeable shaking in both of your hands and arms, which may start on one side or be more intense in your dominant arm and hand. The tremor can be apparent whether you’re doing something or standing still. With that said, “In some people, it can be very action specific,” Dr. Agarwal says. That means an essential tremor may get worse when you’re doing an action like bringing up a cup of water to your mouth, writing a note, or using your computer. (This is a major way to differentiate an essential tremor from Parkinson’s, when shaking is at its worst if your hands are at your sides or in your lap, according to the Mayo Clinic.) An essential tremor might also cause your head to make a “yes” or “no” motion, or lead to a shaky voice.
While an essential tremor usually isn’t harmful to your health, it can get worse as you age, making it hard to do everyday things like eat or hold things properly, according to the Mayo Clinic. If you think you have an essential tremor, see your doctor for testing and a diagnosis. There are various medications that may help to keep your tremors at bay, or at least relieve their intensity.
This kind of tremor is a bit of a mystery. People with a psychogenic tremor typically have an underlying psychiatric disorder like depression or PTSD. When someone with this kind of condition experiences a psychogenic tremor, it’s what’s known as a conversion disorder, which is when a psychological issue causes physical symptoms for unknown reasons.
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A psychogenic tremor might affect your entire body, including your hands. It can also come and go abruptly, potentially getting worse when you’re feeling stressed and better when you’re feeling distracted, according to the NINDS. "A person might have a tremor, and then you have them do some other task that requires their attention, and the tremor can disappear,” Dr. Feigin says. “Usually if anything is actually distracting someone with a physiological type of tremor, it will actually enhance the tremor.”
If you think you’re dealing with a psychogenic tremor, the biggest form of relief will likely come in treating the underlying issue, Dr. Agarwal says. That might be via therapy or medications—your primary care physician or a mental health professional can help you figure out what’s best.
Yes, we’re going to talk about Parkinson’s, because that’s what often comes to mind when thinking of tremors. In reality, though, it’s a very rare cause of shaky hands for young people.
Parkinson’s disease is a neurodegenerative disorder that impacts movement. It happens when nerve cells in your brain degenerate or die, according to the Mayo Clinic. A specific cause isn’t clear (researchers believe genetic and environmental factors could play a role, among others), but the biggest identified risk factor for Parkinson’s disease is age. It’s by far most common in people over 60.
It’s important to note that not every person with Parkinson’s disease has a tremor. But if they do, it might start in just one finger or limb and eventually affect one or both hands, typically when they’re at rest. It’s sometimes called a pill-rolling tremor because it might look like you’re rolling a small object in your hands, according to the NINDS.
Besides a tremor, Parkinson’s disease affects balance and coordination and can cause stiffness and slow movement. The disorder can also bring about non-movement-related symptoms, such as cognitive impairment, depression and other mood disorders, sleep issues, and more.
Parkinson’s can obviously be a frightening illness, but a wide range of treatments to treat symptoms is available, and lifestyle changes may help alleviate some signs of the condition as well. If you’re concerned you may have Parkinson’s, see your doctor as soon as possible.
If you can tell your tremors are tied to something you think you can tackle on your own, like sleep deprivation or your caffeine intake, go for it. Otherwise (or if you try to solve the problem on your own and it doesn’t work), schedule an appointment with your primary care provider. In the time leading up to your visit, keep track of whether you become tremulous when using your hands, when they’re resting, or a mix of both, Dr. Agarwal says. You should also note if it seems like your tremors are related to things like your latte habit or sleep patterns. Beyond that, ask around to see if anyone in your family has a tremor and, if so, what their diagnosis is and what medications they use, if any.
When you go to your doctor, take your notes along with a list of any meds you’re on and anything else you think they need to know to fully understand your tremors. Based on your medical history and your symptoms, they may recommend you see a specialist like a neurologist to find the cause of your shaky hands and best course of treatment, Dr. Feigin says. The right medical professional can help you quell the problem at hand.
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