I almost always wake up symptomatic... You would think that after a good nights sleep you would feel calm but nope. My doc did say that the cortisol levels (stress hormone) in the blood tend to be higher in the then AM so maybe that's the culprit. My morning cup of coffee doesn't help but I feel the symptoms before the coffee for sure. Coffee and Xanax...what a way to start the day! I hate that but it's come to be my morning regimen!