Please help me find reason for vertigo

[Matty332]

I have awoken today with vertigo and have had to take another day off work which I cannot afford to do. I still cannot figure out why I sometimes wake up and feel lightheaded all day with the chance of vertigo if I move my head too fast. I am seeing a doctor today and I am going to ask for a referral to an Ear nose and throat specialist. One thing I have noticed is that although the machine says I have a good AHI of about 1 and a smiley face my data last night said I have leaks.

I haven't tightened my straps in 4 days because I have bruising on the back of my neck and a lump on the bridge of my nose from the tightness (the only tightness that can stop leaks at pressure 20). Although I had a good AHI, could the leaks be related to the lightheadedness and vertigo? Some days I have the lightheadedness and some days not although there seems to be a correlation between leaks and lightheadedness. How could this be?

Could someone in the know please look at my data? I have to get to the bottom of this - I cannot afford anymore days off from work. Thanks in advance

-Matty

[xenablue]

Your problems, IMHO, may well have nothing whatsoever to do with OSA. I get the same issues if my B.P. is low. The one thing I've noticed is that since using CPAP my B.P. has improved greatly and my Dr. keeps reducing my meds for this.

I currently have a consistent 90/60 whether taken at home or at the clinic. Yes, seems low, but due to other health issues including CKD, my medical team love my B.P. around that level, but occasionally it does make me dizzy and woozy - specially in hot weather.

Cheers,
xena

[Matty332]

Hey Xena,

I wish my blood pressure was lower. I just took it then - it is 140/93 which is high. It is always high like that in the morning and normal by about 5pm at 120/80. If high blood pressure can make a person dizzy then that is the reason, but I am not so sure. This does seem to happen when I get mask leaks. I just can't figure it out??

My BP before the doctor set my machine to constant pressure 20 (I think it was on APAP mode in a range 10-20) was normal all the time at 120/80 and my AHI was around 3-5 each day. Before CPAP my BP was high all the time.

Did you used to have high blood pressure?

[zoocrewphoto]

There is a vertigo problem caused by crystals in the ear that break off and move around. My sister had this, and the doctor was able to rotate her head in a specific way to correct the problem.

Perhaps you have something similar, and the pressure from the cpap is affecting your ears. I know some people have mentioned ear problems with cpap treatment.

I had severe vertigo last year, but it was not positional. It was continuous until the medication stopped it. The ENT figured it was probably a virus in my ear. I had to take meclizine for motion sickness for awhile. The doctor explained that my eyes and ears were giving me conflicting information, so that is what was causing the vertigo. My brain wasn't able to make sense of it. I also found that meclizine helped with my fear of heights. The doctors were all surprised. I grew up with ear aches, so I wonder if my ears have been slightly off on the signals all this time, and when I get near edges in high places, that slight difference throws me off. I get shaky and nauseous. With the meclizine, I don't get those physical reactions as bad.

The last two years, my sister and I went to Arches National Park and hiked in a few places with high edges. In 2010, we went to the grand canyon, and I was shaky near edges even with fences, and I was nervous posing for a photo about 15 feet from the edge. The next year, with meclizine, we were at Bryce Canyon, and I was able to get about 5 feet from the edge and feel comfortable. I recently found a book from a psychologist who discovered that a lot of his phobia patients were getting relief when taking medications for ear infections, or motion sickness. In other words, there was probably an ear problem all along causing balance issues.

As for blood pressure, mine has been high for at least a year, until recently with cpap treatment. If I have a bad night, it goes back up. My pre-cpap normal was 160s over 100-106. During the first vertigo incident, it was up to 197. Not sure of the lower number. They did confirm that I was not having a stroke, even though I am at higher risk of stroke. IT happened again 3 days later. That time, I had a CT scan.

[BadBreath]

I suffered from occasional severe vertigo for years with no successful diagnosis as to the cause. I suspected blood sugar, blood pressure and sinus allergies but could never establish a pattern from any of those. After five years of effective treatment of my apnea without a single reoccurrence of vertigo, I have come to believe it was caused by nights of particularly severe oxygen deprivation. That would explain your suspected correlation between vertigo and nights of high leakage, as your therapy would be compromised by the leaks. My guess is that overnight pulse oximetry would confirm that suspicion.

[Pugsy]

The leaks aren't end of the world horrible. The worst the leak ever got to was 30 L/min and only briefly and a little bit of time spent between 24 L/min and 30 L/min....the bulk of the night the leaks were spiky but still below 24 L/min and I doubt that the brief time spent in large leak territory impacted therapy to any great extent. I see no reason to disbelieve the reported AHI. Now if the leaks disrupted sleep and the disrupted sleep acted like a catalyst for feeling crappy or whatever...they might impact how we feel that way.

I tend to think that the high constant pressure is simply aggravating a secondary condition of some sort or the high pressure is aggravating the inner ear fluids in some fashion.

[Matty332]

Thanks all for the advice,

It may be crystals in my inner ear I have wondered about this, it could also be related to the mask leaks or something entirely different. It may also be the constant high pressure..

Bad breath I shall pull out my oximeter and use it again to see if the leaks are causing O2 drop that may be the case. Thanks for the suggestion...

None the less I am conducting an interesting experiment tonight, I shall post tomorrow with the results

It may be interesting for other people on constant pressure 20. Oh wait - I am the only one on a BBS of 62363 members! I cannot believe that my sleep doc doesn't recommend a BiPAP like Pugsy and Avi suggested. It is apparently even in the American sleep assoc. guidelines.

I shall see what the experiment reveals.

[avi123]

Matty, could it be that the 20 cm of pressure went into your ears? Otherwise, it could be from those crystals that zoocrew is talking about (not Pugsy who knows nothing about it but keeps posting as usual). If it is a positional BPPV then it has nothing to do with your OSA treatment. Please Google:

Positional Vertigo.

Usually, it's self limiting (goes away on its own). To get rid of it faster you need to find and audiologist or ENT who deals with it. They put special goggles on your eyes and manipulate your head to move those Otoliths (crystals) away from the wrong loop in your balancing organ in the ear (one of the semicircular canals). When you get those Vertigo attacks, your pupils in your eyes go into a REM like jerking. The goggles show the jerkiness.




Murray, the Aussie physical therapist who treat my back could also do it for me if I need to.

You can learn on your own how to carry out the Epley manouver on yourself.

From John Hopkins:

Causes of BPPV

In many patients, especially the elderly, there is no specific inciting event. As we get older, the otoconia are probably more easily sheared off from their normal positions stuck on the utricle. All of us certainly have a few of these microscopic stones floating around in our semicircular canals, but usually there are not enough of them to cause symptoms. Only when a large clump falls into one of the semicircular canals do the stones create their mischief.

In some patients, there may be a specific cause for the BPPV, including:
•Mild to moderate or severe head trauma
•Head in the same position for a long time, such as in the dentist chair, at the beauty shop or on strict bed rest
•Bike riding on rough trails
•High intensity aerobics
•Labyrinthine conditions – viral or vascular
•Ménières disease
•Vestibular migraines

Source:

http://www.hopkinsmedicine.org/neurolog ... rtigo.html

[DoriC]

Thanks all for the advice,

I cannot believe that my sleep doc doesn't recommend a BiPAP . It is apparently even in the American sleep assoc. guidelines.

I shall see what the experiment reveals.

How about you you recommending a Bipap yourself loud and clear!. it's your therapy and I can't imagine sleeping at a pressure of 20cms all night when there might be another solution. It might be a good idea to check out some of the suggestions made here but I bet if you had the proper machine and proper settings, you'd be on your way. Although Pugsy is right, your leaks are not the end of the world, but certainly no optimal and it looks like your whole setup is not giving you restful sleep. Keep us posted, knowledge is power!

[greatunclebill]

i also have lightheadedness without spinning that is constant. 2 years ago i had my first ever asthma attack and was diagnosed with adult onset asthma. a couple months later i had my only spinning episode and the light headedness started and hasn't stopped. at the time i wasn't really using my cpap. i got serious about the cpap in nfeb 2012. i don't have leaks to speak of. this year i was diagnosed with copd (asthmatic bronchitis and emphysema) in addition to the asthma. through all of this the lighheadedness has never changed. the lightheadedness reminds me of being high many many years ago. i did have a head mri and was told there was no evidence of past stroke. i quit driving completely because it just feels weird. blood pressure is controlled. night time o2 is fine.

[GatorLord]

The vast majority of vertigo cases are the benign BPPV type from otoliths getting loose. I get this from time to time and it is resolved readily by performing an Epley maneuver on myself.

Check Google or YouTube for instruction into how to tell which ear is affected using the nystagmus test, then do the Epley procedure for that ear. It is amazing how effective it is. If you have to do it more than a couple of times, you might want to see an ENT for a workup. I love Dr. Epley...vertigo sucks.

Good luck.

[Todzo]

I have awoken today with vertigo and have had to take another day off work which I cannot afford to do. I still cannot figure out why I sometimes wake up and feel lightheaded all day with the chance of vertigo if I move my head too fast. I am seeing a doctor today and I am going to ask for a referral to an Ear nose and throat specialist. One thing I have noticed is that although the machine says I have a good AHI of about 1 and a smiley face my data last night said I have leaks.

I haven't tightened my straps in 4 days because I have bruising on the back of my neck and a lump on the bridge of my nose from the tightness (the only tightness that can stop leaks at pressure 20). Although I had a good AHI, could the leaks be related to the lightheadedness and vertigo? Some days I have the lightheadedness and some days not although there seems to be a correlation between leaks and lightheadedness. How could this be?

Could someone in the know please look at my data? I have to get to the bottom of this - I cannot afford anymore days off from work. Thanks in advance

-Matty

Hi Matty!

A few questions:

Do you sometimes wake up breathing excessively, possibly with high heartrate?

Do you suffer from cold feet or hands?

When does the feeling of light headedness go away?

Ear infection is always the first suspect with vertigo - you might have them looked at. If a doctor is not available you may find an audiologest who has the instrimentation and is willing.

I hope you find good answers.

Take care,

Todzo

[archangle]

Have you changed anything with your CPAP lately? Sometimes FIXING a problem with CPAP will make you lightheaded for a while as your body readjusts to more O2 or less sleep disturbance.

[Matty332]

Avi, thanks for the info, I shall take this info to the ENT doc that my GP has referred me to. Thanks for the diagram and explanation.

DoriC, I am thinking of doing just that! I will have to settle for a respronics cheaper Bipap though as the Resmed one is a bit pricey here in Australia.

Bill, I hope you get to the bottom of your vertigo..

GatorLord, I am checking out the Epley procedure on Youtube now. I am going to try it next time I have vertigo.

Todzo, I do not wake up with a high heartrate any more but high blood pressure. I think my breathing may increase a bit when I wake but I don't usually notice. Sometimes my heart feels like it is beating strongly but slow. Sometimes I get cold hands in the morning after a bad night but not usually. The lightheadedness sometimes resolves quickly in the morning but other times may last till the evening. Hmm, I have just recovered from a cold lately, perhaps it is viral? The doctor couldn't see an ear infection.. thanks for the kind wishes

Archangle, That is a really good point, it usually happens when I get mask leaks so perhaps the change in treatment caused by the leak could trigger this? interesting.

Thanks all for the support and help on this matter. I really appreciate it..

[Todzo]

Todzo, I do not wake up with a high heartrate any more but high blood pressure. I think my breathing may increase a bit when I wake but I don't usually notice. Sometimes my heart feels like it is beating strongly but slow. Sometimes I get cold hands in the morning after a bad night but not usually. The lightheadedness sometimes resolves quickly in the morning but other times may last till the evening. Hmm, I have just recovered from a cold lately, perhaps it is viral? The doctor couldn't see an ear infection.. thanks for the kind wishes

Thanks all for the support and help on this matter. I really appreciate it..

Hi again Matty!

Your symptoms are consistant with hyperventilation. I used to have panic attacks that produced high heart rates and sleeplessness that would last for days. Through a Dr. Park Web seminar I learned what hyperventilation does (the Wikepedia article is good) and yet better, how to stop doing it.

To begin with they taught a "nose clearing" exercise where the breath control portion consised of (if memory serves - and how I do it from time to time now) breathing out gently, stopping for ten seconds, breathing three shallow slow breaths, stop for ten seconds and continue if needed. I have never needed more than two stops. What happens is a very strong urge to breath during the first stop but after the second stop about the second breath the strong urge to breath evaporates. As well, my feet feel the warm blood and my nose clears. I feel warm and relaxed.

So now I have purchased a little $50.00 pulse oximeter I keep with me on a belt pouch at all times. I use it to do what I call optimal breathing training. Simply, you vary your breathing to produce the lowest heart rate while holding exertion constant. The oximeter portion is very useful in this. First of all it takes considerable concentration to reduce your blood oxygen (SpO2) level a single point. Second, once you find the lowest heart rate in a given situation if you note the SpO2 level you will be well on your way to finding the lowest rate in a similar situation in the future. When I first started I would find the lowest rates while working at my desk around 95% SpO2 and exercising moderately on my treadmill at 97%. Now these rates are found about a percent lower for each situation. While doing this I have found that a stuffy nose means I am breathing too much. It was so nice to smell the flowers this spring! Cold hands or feet are a clue, as is a lack of attentiveness for me. When you slow the breathing down you can feel your feet much better as you walk I find.

When you use a PAP the constant pressure tends to destablize your breathing toward hyperventilation. The higher the pressures the more the likelyhood of problems (hyperventilation, breathing related arousals, UARS, hypocapnic central apneas). To move a way from this, in addition to what I have mentioned above I have found the following useful:

- I moved to a city with a lot less crime and violence
- I did not order and to not have a TV used to watch TV in the house - so no violent media
- I do try to walk my 10,000 steps a day
- I do at least ten minutes of interval training a day (love the pulse oximeter on the belt pouch for that!)
- Much less sugar and carbs in the diet with many more veggies and quality protine and Q3s
- I have joined a health club to learn and do resistance training as I believe it will help with muscle control in general.

Well, those are my thoughts-

May you find very restful nights soon!

Todzo