Vertigo?

[Amazeballs]

I have had vertigo off and on for over ten years. Usually it's very mild to mild and doesn't affect my daily activities; when it occasionally flares up, I know how to take care of myself and get back to normal within a week.

In August I had a blood panel come back with too much carbon dioxide, and my doctor asked if I might have apnea. I hadn't been sleeping well for about a year, but I thought it was just stress, and my husband reported that I don't snore. My doc still wanted to send me to the sleep clinic and I went. The tech woke me after a while and tried on a couple of masks. I did not tolerate the nasal only (gave me claustrophobia) but the full face was fine. I went back to sleep with the mask on and slept fine that night until they woke me in the morning. Later I learned I had 37 events per hour. The sleep clinic prescribed a CPAP and I have successfully used it for 10 nights now.

However, I have been waking up with moderate to severe vertigo every day since I started using the CPAP. I'm struggling with vertigo (which is exhausting and debilitating) even though in the last day or two I finally have started to feel awake and energetic all day long. This doesn't seem like a good trade to me. I've been telling myself that it may just be during the adjustment period.

Does anybody else deal with vertigo? Any suggestions?

[jwerley]

Yes I do.....and I have never associated it with my sleep apnea....I have noticed though that my C02 has been a little high on blood tests (every test).....but no doctor has ever put 2x2 together.
So thank you, I will address this with my doctor....I have had 4 falls this year related to the vertigo!

The best to you,
Janice

[JeffL]

I suffer from positional (aka "top shelf") vertigo. It started well before I started on CPAP. I believe it's caused from tiny "rocks" in the ear. I don't see any connection to CPAP. Interesting that you were claustrophobic, with a nasal mask and not a full face mask. I'd think it would be the other way around.

[Pugsy]

Consult your doctor about this development. Preferably ENT specialist.
Vertigo caused solely by cpap therapy is not a common problem but not totally unheard of nor out of the realm of possibility.
The inner ear is connected to the airway via the Eustachian tubes so it might be possible for therapy pressure to enter the inner ear and cause a problem. It isn't common though and best to be evaluated by ENT to make sure that there isn't some sort of Eustachian tube dysfunction going on. It might be those crystals just moving around a bit and it might be something else. Get it checked out.

[Amazeballs]

To clarify, I already have a diagnosis of benign positional vertigo (also known as top shelf vertigo). I believe the CPAP may be exacerbating it. I rarely have a vertigo episode that lasts longer than a week. I've had the MRI, seen the ENT, been treated by a neurologist, all years ago. There's a relatively simple and very effective treatment for vertigo-it doesn't make it go away, but it makes you feel back to normal rapidly (for me usually within 2 or 3 days), called the Epley procedure--you can find videos on how to do it on YouTube. The first time I was diagnosed, the neurologist did the Epley procedure on me. Now I do the Epley procedure 5 or 6 times a day when I have an episode of vertigo.

I'm wondering whether the air pressure might be exacerbating the vertigo. Another possibility is that I'm sleeping so well now, and therefore lying still all night, and being still too much exacerbates vertigo too. A third, less likely possibility is that catching up on my sleep has led to my noticing already-present vertigo--this is less likely because usually being overtired makes me suffer from vertigo more (more severe, longer duration).

[chunkyfrog]

I'm not sure about a connection with lying still; but with fatigue already a recognized factor,
it makes sense that once you get through the breaking in period, the additional O2 will kick in, and
(hopefully) you should begin to improved. My fingers are crossed for you!
(can't do toes--webbed, you know)

[purple]

I know that with a standard CPAP, I could get air pressed into my TMJ because of pressure. I got rid of that with a bi machine.

What are your machine settings? Might be this problem would go away with a bi machine. Or maybe setting flex, or. . .

[Julie]

Hi - If I missed something, I apologize, but could it be possible that you're covering the CO2 vent (patch of small holes) with bedding or even on purpose overnight, thereby rebreathing the CO2 that's supposed to go out (and could certainly make you feel sick) as air is coming in through the hose? Some people are never told properly to always keep it clear...

[BlackSpinner]

[quote="JeffL" Interesting that you were claustrophobic, with a nasal mask and not a full face mask. I'd think it would be the other way around.[/quote]

It took me several weeks to use and not feel freaked out by my Hybrid. I was fine with the quatro from the first moment. But not with things on my nostrils. If I am not feeling well they are the hybrid is the first thing to get ripped off my face.

[BlackSpinner]

However, I have been waking up with moderate to severe vertigo every day since I started using the CPAP.

Since you say you have been checked out for everything else mentioned already I would suggest playing with your humidifier. The humidity affects your sinuses. Some people don't need it, other require a swamp to handle cpap without there sinus passages getting very inflamed.

[jencat824]

You may want to return to ENT to be checked for Meinere's Disease. I have it bilaterally, had a previous diagnosis of BPV which I had for years until they finally determined it wasn't BPV at all, but Meinere's. Its an unpleasant disease, but totally manageable. I use meclazine, the primary drug in dramamine. I used to get prescription Antevert, until ins co would no longer pay since it was an OTC drug. I do take a higher dose than available OTC, I just adjust myself to the dose I found over the years that works for me. As far as I know, it was not associated with my CPAP therapy or OSA diagnosis. I was diagnosed with Meinere's in 1996, OSA 2000. I really would go to see ENT if I were you, there could be a PAP connection, but it could be something else other than your BPV.
Jen

[archangle]

I think your body does a lot of things to adjust to being strangled all night long with apnea. It adjusts to it. When you stop having apnea, you may be out of balance for a while.

It wouldn't be too surprising to me if you got a little dizzy until you readjust.

Of course, it's also possible that something is wrong, either apnea related or not.

[avi123]

Benign Positional Vertigo is a comorbid (associated with) of Sleep Disorders, because both are effected by the malfunction of the Vestibular System. So is Tinnitus, Balance, etc.

I had my first attack of Benign Paroxysmal Positional Vertigo (BPPV) two years before I came down with OSA.

I went then to the Vestibular Rehab dept of a local large Neurological Center in my town of Raleigh, NC. They fixed my BPPV in 15 min by maneuvering my head. Next, I started rehab there for Balance (while walking) lasting for three months.

Most ENTs don't know how to deal with BPPV.

Your best bet is to find a specialist in your local (could be a physical therapist or audiologist who specializes in BPPV ) from this Association:

http://vestibular.org/finding-help-supp ... -directory

[twasbrillig]

Vertigo can also be caused by a fistula, which is a gap in the structure of the inner ear bony covering (and/or the membraneous windows) that allows pressure from outside the inner ear to be communicated to the inner ear. Fistula can also cause hearing issues. There are several different kinds of fistulas, but the one that might be impacted by CPAP would probably be perilymphatic fistula. Unfortunately, a lot of doctors don't believe this type of fistula exists. So if you want to be evaluated, you need to find a doctor who isn't idealogically opposed to the existence of a perilymphatic fistula. Some doctors will tell you it's due to migraine, which is certainly a possibility.

[avi123]

Problem

General agreement exists that perilymphatic fistula (PLF) occurs and that leakage of perilymph from the inner ear into the middle ear can cause acute hearing loss, paroxysmal vertigo, disequilibrium, and tinnitus. Virtually no consensus exists regarding how frequently perilymphatic fistula (PLF) occurs, how it should be diagnosed, or how it should be treated when suspected. A high degree of controversy surrounds the appropriate indications for surgical exploration and operative repair of perilymphatic fistula (PLF).

Source: http://emedicine.medscape.com/article/856806-overview