This blog is a transcription of the video linked above.
My mission as a healthcare provider is to rescue mismanaged and misunderstood people with dizziness, vertigo, imbalance and chronic falls. In this blog we will go over the following learning objectives:
- Differentiate between the terms dizziness and vertigo
- Learn how to track and report symptoms
- Understand how to manage an episode that occurs while lying down or rolling over in bed
- Learn how to manage an episode that occurs while standing
- Understand when to seek medical care and how to find a provider
Dizziness vs. Vertigo
First, we are going to start off with the terminology. Dizziness is the general term that the general public uses to describe what we as medical professionals may call dizziness, vertigo, or disequilibrium. The general public uses the term dizziness for all three of those categories, so I am going to define them for you the way we define them in the medical world.
Dizziness is a sort of light headed feeling. The feeling you might have if you have not eaten anything all day, or you feel dehydrated, or the feeling you might get right before you pass out.
Vertigo, on the other hand, is a feeling that is associated with a false sense of motion. There are two times that vertigo can occur. Vertigo can occur when you feel like you are moving but you are actually sitting or lying still. An example of that would be if you roll over in bed and you are lying in bed on your right side but you feel like you are rolling in a barrel off the edge of a cliff. Another example would be if you lie back at the dentist and you feel like you are falling backwards into a black hole. That would be the definition of vertigo. It is a feeling of motion when you are otherwise sitting still. The feeling can be a rocking, a rolling, a tilting or a sliding feeling. The other way that vertigo presents is with a false perception of otherwise normal movement. For example, if you are walking down a hall but you feel like you are walking down a flight of stairs into the floor, that would be vertigo.
The third thing that people may experience that they describe as dizziness would be disequilibrium. Disequilibrium means that you feel off balance. You feel unsteady when you are up, when you are walking and sometimes even when you are lying down.
When to Seek Medical Care
Sometimes, dizziness or vertigo indicates a medical emergency and it is really important that you recognize when you need emergency medical care for a new sudden severe onset of dizziness or vertigo or for a recurrent onset that has these accompanied symptoms:
- Sudden severe headache
- Shortness of breath
- Rapid or irregular heartbeat
- Chest pain
- Neck or arm pain
- Double vision or blurry vision
- Numbness in your arm or leg
- Difficulty moving your arm or leg (paralysis)
- Facial numbness or weakness
- Slurred speech
- Mental confusion
It is also recommended that you seek emergency care if you have any of the following symptoms with or without dizziness:
- Uncontrolled vomiting
- Suddenly unable to sit up on your own, stand or walk on your own when you were able to do that before
- Sudden hearing loss or a sudden dramatic change in your hearing
It also important to seek medical care even when it is not an emergency. One of the reasons it is important to seek medical care from your primary physician and any specialists that they recommend is because dizziness and vertigo can cause falls. We know statistically that when people fall, they may get seriously injured. They may fracture a bone, or they may just get bruised or tear their skin. But these things can all cause pain, fear and loss of independence. This is why we want to deal with the dizziness and vertigo in order to prevent falls.
Dizziness and vertigo can also trigger anxiety if they go unaddressed. When people have existing anxiety problems, dizziness and vertigo can make them feel worse, and it can cause anxiety for people who have never had a history of it before. Dizziness and vertigo are very interestingly linked to anxiety because sometimes anxiety causes dizziness if people hold their breath or if they breathe too fast.
For all of those reasons, it is important to seek medical care even if the dizziness or vertigo you experience is not necessarily a medical emergency. It is still important to report your symptoms to your primary care doctor, and follow up on any referrals that they make for you. It is important for people to figure out why. Why do you feel dizzy? Why do you have vertigo? That is the question that I really emphasize with my patients. The first visit I have with my patients is called a Root Cause Analysis where we look at their medical history, the onset of their dizziness and vertigo symptoms, and we do a very extensive head to toe exam to answer the question of why.
A lot of times what happens when people seek medical care for dizziness or vertigo is that they are given pills to take that mask the symptoms. These pills all have side effects and interestingly one of the most common side effects of medicine that is prescribed for dizziness or vertigo is dizziness. These medications can contribute to falls because they actually can cause dizziness, drowsiness or blurry vision as side effects and they don’t address the underlying problem of why. Therefore, the person is likely left with a residual balance problem even if the symptoms of dizziness or vertigo are no longer an issue.
To read more about this topic, check out my blog, Vertigo Emergency: What You Need to Know.
Learn How to Track and Report Symptoms
The approach that I like to take and that I like to advocate for my patients is to take a look at the symptoms and the underlying problems and look at the root causes. You can help your healthcare provider by making a note of your symptoms. Do this by tracking your symptom onset, trigger and duration. Those are really the three pieces of data that a healthcare provider would need in order to properly analyze your symptoms of dizziness and vertigo. We need to know: when did the symptom occur, what might have been the trigger, and how long did it last. Other symptoms that are important for you to track would be any change in your hearing, like ringing in your ears, loss of hearing, roaring sounds, or rushing sounds. Note anything relating to hearing that comes a long with the dizziness or the vertigo, and any headache that you may experience with the dizziness or vertigo. You can track your symptoms on paper in a journal format, or use a smart phone or a tablet.
If you want more information on this learning objective on how to track and report your symptoms, check out my blog post, Vertigo: Evidence & Analysis.
How to Manage Dizziness While Sitting or Standing Up
The next learning objective is how to manage dizziness while you are sitting or standing up.
For dizziness when you sit up, one of the important things to do is to hold your head still if you feel dizzy when you first get up. The technique that I teach my patients is to use what I call calf pumping action. What this means is to keep your toes planted on the floor, and lift your heels off the ground as you are sitting on the edge of the bed. You can lift both heels at the same time while you are sitting down or you can alternate lifting one heel at a time. This may or may not be safe for you to do while you are standing so I definitely recommend for you to hold onto something sturdy like a table, a counter or a chair if you choose to lift your heels after you stand up and definitely alternate one heel at a time if you lift your heels after you stand up. However, do that with some amount of caution because it may not be safe for you to lift your heels up while you are standing but certainly most people should be able to do it if they sit on the edge of the bed and get dizzy. This calf pumping action will help pump the blood back up from your ankles, your feet and your lower legs up into your body and bring the blood back up to your heart, which is typically one of the main causes people get dizzy when they get up. This is also something that a physical therapist can work with you to manage.
What to do if you get dizzy when you lie down or roll over in bed
The next learning objective is what to do if you get dizzy when you lie down or roll over in bed. There are two answers to this learning objective. The first answer is to avoid the position for the short term. One thing you can do is to prop up on two or more pillows to avoid the dizziness you feel when you lie down or roll over in bed.
The term Benign Paroxysmal Positional Vertigo means: it is not a disease or a pathology (benign), it comes and goes (paroxysmal), and it is positionally triggered (positional). Some common examples of positions that may trigger dizziness or vertigo are: laying down in bed, rolling over in bed, bending forward to put shoes on, leaning back to look in the upper cabinet, turning quickly to talk to somebody, leaning your head back to put in eye drops, and leaning back at the dentist in the dental chair.
BPPV happens when the crystals inside your ear have been displaced in the vestibular system, which is our inner ear balance system. Sometimes through just normal aging, the crystals come loose and they float around in your ear canals and are most commonly found in the posterior canal. BPPV is the most common cause of positional vertigo that is caused by the vestibular system.
For more strategies to avoid dizziness when lying down or rolling over in bed, take a look at my blog post, Vertigo with Lying Down or Rolling Over. In this post I also describe a technique that I call the Active Resting Technique, which you can use anytime you get dizzy, no matter what position you are in.
How to find a vestibular provider that can help with dizziness and vertigo
Here is an important thing for you to know: simple BPPV (which as I described is a very common cause of dizziness or vertigo while lying down or rolling over in bed) can be resolved in 1 to 2 sessions of treatment about 85-90% of time. Because of this excellent result when you find a skilled provider, this type of treatment for BPPV is considered one of the most clinically valuable treatments available in modern medicine today. Once the BPPV is resolved, meaning the crystals have moved back to where they came from in the utricle through treatments by a skilled vestibular healthcare provider, there is a rate of recurrence which is about 35% for the general population. If the positional vertigo comes back, it is important to get care again to get it resolved again.
Many people that I meet with BPPV have never been diagnosed with it before and have seen all kinds of doctors including specialty doctors such as ENTs or neurologists. Some of them have even gone to physical therapy, and no one has identified so far that they have BPPV. Many people that I have seen who are suffering with dizziness and vertigo turn out to have BPPV and they never knew it, no one identified it, and one of the reasons is because it does not show up on an MRI.
The following is important information in terms of advocacy. A lot of people are familiar with physical therapists. The general way to understand what physical therapists do is that we improve the way you move. You may have worked with a physical therapist if you had a back injury, you had a knee or a hip replacement, or if you were in the hospital at some point. There are general physical therapists that can provide that kind of general care that any new graduate should be able to offer when they come out of physical therapy school. Then within the field of physical therapy there are what are called “vestibular” physical therapists. That is what I am, and the physical therapists on my team are, and we specialize in working with people with falls of unknown cause, balance problems, and dizziness and vertigo, in order to resolve those complaints.
One study found that 80% of patients with falls of unknown cause had symptoms of vestibular problems when they were tested. What that tells you is there are a lot of people who are having vestibular problems who do not even know it, and that may be the reason why they are falling. Maybe they are on medication so they are no longer feeling dizzy, but they are still having problems with their balance, because the root cause was never addressed.
Another study found that vestibular rehabilitation exercises, which is what I do with and prescribe to my patients, can improve walking and balance in older adults even in the absence of inner ear problems. So, say for example you have gone to physical therapy for your balance problem, for your walking, or for your fall prevention, and you have not gotten any better. Well the next step is to go to a vestibular physical therapist. The reason for that is because even if you are not one of the 80% of the people in the last study I described that had vestibular problems when tested, they found that vestibular rehabilitation exercises improve walking and balance in older adults with unexplained falls even if they do not have an inner ear problem.
It is really important for you to know this information so that you can prevent a downward spiral. As I just described, unaddressed dizziness and vertigo can lead to falls, anxiety, depression, lack of physical activity, lack of exercise, and just less fun in your life. This is why it is really important to have a root cause analysis for your symptoms to figure out the cause instead of just treating the symptoms to mask them.
If you want to find a provider who is specially skilled at vestibular care, such as myself, you can look at the website for the Vestibular Disorders Association. This is where 1500 vestibular professionals have registered with their business information and you can search for a provider in your area who offers specialized vestibular care. This is important because this is a sub-specialty within both medicine and physical therapy. General providers are not going to have the skills you need for a full vestibular assessment which could discover the root cause of your dizziness, your vertigo, your balance problems or your falls.
In my blog post, How to Find a Vertigo Doctor in your Area, I also have a link to a map of vestibular physical therapists across the United States. This along with the Vestibular Disorders Association website are two resources you can use to search for providers in your area.
If you are interested in learning more on this topic, I have three lectures on UCTV that are available online: Taking Steps to Prevent Falls, Part 1 – Research in Aging and Dizziness and Vertigo, Part 2- Research in Aging.
All three lectures combined have a total viewership of at least half a million views.
I hope this blog post was valuable to you as we seek to ensure that your quality of life is good, and you enjoy getting older without suffering from dizziness, vertigo, balance problems, or unexplained falls.
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.