Solving the Mystery: Why Do I Feel Nauseous When I Wake Up?

When you think of morning nausea, maybe you may think of pregnancy, but that sick stomach feeling isn’t just reserved for expecting individuals. More than 50% of adults report at least one episode of nausea in a year’s time. Anyone can experience nausea in the morning due to natural bodily processes, certain lifestyle choices, and also medical conditions. Learning the cause of your nausea can help you address it and feel better.

In this article, we’ll discuss the most common causes of morning nausea and what you can do about it.

Reasons why you may feel nauseous in the morning

When you rest overnight, your digestion slows down, so it makes sense that when you wake, and your body systems reactivate, you will feel the effects of anything affecting your digestion. In addition to nausea, you may also notice stomach pain in the morning, bloating, or bowel changes.

Stress

Your body produces a stress hormone called cortisol, which is part of your body’s normal wake-up process in the morning. However, when released in excess in response to increased stress, cortisol may activate your body’s 'fight or flight' response. This may slow down digestion and may result in an upset stomach.

You may notice this type of morning nausea as that 'butterflies in your stomach' feeling when anticipating a particularly stressful or exciting event coming up during the day, such as a big presentation at work. Chronic stress and anxiety may also cause you to wake up feeling uneasy as a result of an activated 'fight or flight' response.

Hormonal changes

In addition to stress hormones, there are other hormones that can contribute to morning nausea. For those assigned female at birth, this often is experienced during pregnancy and perimenopause.

Menopause, in which ovaries begin to function less effectively, is also commonly met with nausea in the morning or throughout the day, especially in individuals undergoing hormone replacement therapy. Again, the scientific community doesn’t fully understand the mechanism, but it may be due to changing estrogen and progesterone levels. Other symptoms frequently experienced with menopause, including sleep issues and stress, can also make nausea worse.

Nausea and vomiting affect about 70% of human pregnancies. Though termed 'morning sickness,' it can actually occur at any time during the day and last a few weeks or the entirety of pregnancy. Scientists are not fully sure what causes morning sickness, but common suggestions are that it is related to an increase in human chorionic gonadotropin (HCG), a hormone produced primarily during pregnancy, and estrogen, or due to changes in blood pressure and metabolism.

A recent 2023 study also explores the role of GDF15 — a hormone produced by the fetus and suggests that the fetus may impact the production of this hormone, thus triggering nausea.

Dietary habits

Irritating foods and overindulgence, but also a lack of adequate intake of food and water, which can lead to low blood sugar, increased hunger, and dehydration, are all common dietary triggers for morning nausea.

You may experience upset stomach in the morning if you:

• Eat late at night or eat close to bedtime
• Eat spicy and/or high fat foods in the evening
• Eat to the point of being uncomfortable
• Overindulge in alcohol
• Don’t drink enough water (dehydration)
• Eat infrequently (hunger pains)

Much of this relates to night-time eating habits, but your breakfast routine matters, too. Skipping breakfast can lead to low blood sugars and resulting nausea, as can overeating at breakfast or consuming certain foods if you have a tolerance or sensitivity.

Fatigue

The relationship between sleep deprivation and nausea isn’t fully understood, but sleep is essential for all of your bodily systems to be able to function normally. This includes digestion but also the control of mood, hormones, inflammation, blood sugar levels, and even dietary choices, which directly impact the gastrointestinal system, especially in those with pre-existing health conditions.

Some research suggests that even as little as waking up once a night four times a month is significantly associated with nausea. Research also links poor sleep with types of gastrointestinal disorders.

Side effects of medications or supplements

Several medications include nausea as a side effect. Some of the most common culprits, especially when taken on an empty stomach in the morning, are:

• Antibiotics
• Antidepressants
• NSAIDs
• Chemotherapy drugs or cancer medications
• Opioids
• Metformin
• GLP-1 drugs
• Iron supplements

Health conditions linked to morning nausea

In addition to certain lifestyle factors, pre-existing or acute health conditions may also contribute to morning nausea. This is not an exhaustive list but contains several common contributors.

Digestive conditions

Nausea and vomiting are common symptoms of digestive conditions, especially in the morning when your digestive system is activated, due to how they affect the structure and function of your gastrointestinal tract. Some conditions that may impact morning upset stomach may be:

• Gastroesophageal reflux disease (GERD)
• Inflammatory bowel disease (IBD) such as Crohn’s disease or ulcerative colitis
• Irritable bowel syndrome (IBS)
• Peptic ulcer disease
• Gastroparesis
• Gastroenteritis (stomach flu)
• Food poisoning

Diabetes

Diabetes may contribute to that sick morning feeling as the result of too high or too low blood sugar, side effects of common diabetes medication (metformin, GLP-1 drugs), or because of a potential complication called diabetic gastroparesis, which impairs your stomach’s ability to empty.

Mental health conditions

Of the various mental health conditions, anxiety, in particular, initiates a flight or right response, which slows down your digestive system and contributes to nausea. The anticipatory worry associated with anxiety is also a reason for nausea in the morning.

Both anxiety and depression may include drug treatments, which are known to include nausea as a side effect.

Vertigo

Vertigo is a condition of the inner ear that can make you queasy or experience motion sickness from a false sensation of motion. Your sleeping position can sometimes contribute to mild vertigo in the morning, especially when rolling over or getting out of bed quickly.

How to relieve nausea in the morning

For those experiencing morning nausea, ideally, your strategy for relief addresses the underlying cause of nausea. For instance, if eating spicy foods in the evening leaves you feeling icky in the morning, try limiting those foods to earlier in the day. Of course, if you suspect a medical condition or medication to be tied to your nausea, be sure to speak with a healthcare provider for guidance before making any changes.

Generally, once you are able to treat the cause, then the symptom of nausea will resolve as well.

How to diagnose the cause

If you are unsure what is causing your nausea or have concerns about the frequency or intensity of your nausea, consult with your healthcare provider. You may also keep a symptom diary to keep track of when your nausea occurs.

Medical consultation

In general, morning nausea is common to experience from time to time. However, if you feel sick on a regular basis or have severe nausea that’s affecting your daily activities and ability to maintain proper nutrition and hydration, it’s a good idea to seek the advice of a medical professional.

Be prepared to describe your symptoms — when they started, the intensity, and what makes them better or worse. In addition to the history you provide, your physician may also perform a physical exam or order tests, which can examine digestion speed, stomach acid levels, pressure, and more to help with a diagnosis.

If you experience any of the following symptoms along with morning nausea, seek immediate medical attention:

• Repeated vomiting or vomiting with blood in it
• Black, tarry stools
• Severe abdominal pain or abdominal cramps
• A fever
• A severe headache
• Confusion

Self-monitoring

Another way to gain insight is to keep a symptom diary where you track your nausea and the details surrounding it to help you identify patterns and triggers. For instance, you may track when your nausea occurred, the severity, how long it lasted, and other factors such as stress, what you ate, and similar.

Understanding the various causes of morning nausea is the first step in being able to address it. Stress, hormonal changes, dietary habits, sleep disturbances, fatigue, and certain medications or supplements, along with a variety of potential health conditions, can all lead to an upset stomach in the morning. Addressing which is affecting you is the way to feel better. Dietary changes, stress management, and sleep hygiene may all be effective strategies to help relieve occasional morning nausea.

If you have concerns about what is causing your nausea or how to address it, especially if you are experiencing morning nausea, which is severe, impacting your daily activities, or is accompanied by other symptoms, speak to your healthcare provider.