Ending Vertigo Today

Can mild dizziness turn into severe vertigo?

This week I spent 2 days in the hospital due to BPPV. I had a pronounced bilateral presentation. I feel good now via Epley, Hall Pike, supine roll. For years I have been very sensitive to carnival rides, exiting a dentist chair, getting up too fast following sit-ups. I wrote this all off as “normal.” Is it possible that I have had these out of place crystals for months/years and have just now reached a threshold triggering the “attack?”

The Fear of Vertigo is Worse than the Disease

Your first attack of vertigo is often terrifying. The feeling is so very alien. Your body feels out of control, and it can be impossible to focus or hold yourself up. Many people think they are about to die or that they are having a stroke. After the spinning stops it leaves you with the intense fear that it will strike you again. What if you’re driving, or out in public? The fear of humiliation, a fall or an accident adds to the terror. Is it possible to get over that terror and come to terms with vertigo?

Learning not to fear vertigo is critically important when you have an inner ear disorder. There are two steps you need to take: first, you need to learn what vertigo is and why it is happening to you; and second, you need to teach yourself how to balance even though you have vertigo.

What is vertigo?

Seeing the room spin is frightening, and it can also make it impossible to focus. It happens when the two inner ears are not sending coordinated signals into your brain. It is caused by the electrical firing in your ears. When you are still, the signals are exactly equal in both ears. When you normally turn your head, one ear turns up to signal the turn, while the other turns down to reinforce the same turn, and your brain allows you to feel rotation.

If you have sudden loss of function in an ear, your brain senses the good ear firing and the other ear off, so it mistakenly thinks you are turning toward the good ear. It generates the sensation of a continuous turn—that is what vertigo is. At the same time, it makes your eyes counter-roll in the opposite direction, which is why the room spins. A similar thing happens if an ear suddenly turns on inappropriately, which is what happens with BPPV. The brain gets a signal that the bad ear is on, so it generates the sensation that you are turning toward the bad ear. The drifting of the eyes, nystagmus, makes the world spin. The entire problem is in the inner ear, but it causes the wrong responses in the brain, eyes, and balance system because these systems fully believe whatever the ears signal.

So, you don’t have to fear the feeling of spinning or seeing the room spin—that is just a side effect of the brain mistakenly reacting to the wrong impulse from your ear. Your brain is fine; you just have a malfunctioning ear. No matter how many times it happens, the vertigo does not harm the way your brain works or the reflex responses. Think of it like a bad party trick gone wrong. Your inner ears are lying to your brain, and your brain goes right along with the joke. You won’t die or get brain damage; it’s just an illusion.

Once you know you have vertigo, you can learn about it from online sources, and you should also see a physician to determine the source. They can tell you whether it is just a simple inner ear problem like BPPV or if it is more serious.

How to get your balance back

The next step is to learn how to balance despite the vertigo. You feel an intense spinning, and your body reacts as if this is really happening, but it is just an illusion. Your bodily reactions are wrong, and that is why you tend to fall. If your brain is telling you that you are falling to the right, you will want to tilt left to correct for that. If your brain is lying, tilting to the left will make you fall over to the left—exactly what you don’t want to do. When vertigo hits, if you are not moving you don’t need to correct for that weird, false feeling of movement.

The second vertigo hits, stop any movement that you are doing, especially head movement. Get as much of your body and your hands and feet in contact with a solid surface as you can. Grab a railing or counter, a bed or the seat of a chair. Lie down or sit with both feet flat on the floor and try to keep your head perfectly still. You can tell this by concentrating on your head, neck, hands, and feet. They won’t be signaling a turn or a tilt, and they are telling the truth. Try to ignore the spinning and only believe what your body, hands and feet tell you about the world. Closing your eyes can help once you are seated or lying down.

Once you are beginning to trust the signals from your body, open your eyes to see how fast the spinning is. If you can’t focus at all, it’s better to keep your eyes closed. If you can see what is in front of you but it’s drifting a bit, you can use vision to help overcome some of the vertigo. Focus on a large object in front of you while concentrating on the stillness of your arms, legs, and body. Try not to let your body tilt to one side.

If you are lying down and can focus well enough, try sitting up to see if you can keep your trunk upright. You will still feel you are falling or spinning, but it’s easier than you think to sit up. There is nothing wrong with the rest of your body, only the inner ears. Trust what your body says about your position, not what the inner ears are telling you.

When I suffered from vertigo, I was dizzy almost every day. Closing my eyes for just a second could make me fall over like a log. I had to learn how to walk and continue my life despite that. By touching stable surroundings with my hands, I could walk around even during quite intense vertigo. If you have someone acting as a spotter, you can usually stand and walk even when the room is spinning, but it takes practice. You will want to lean on the spotter at first, but with time you can walk while just using a wall or counter for touch support. You must learn how to trust your vision and your body for signals about your position in space, and rely less on your inner ears, which can no longer be trusted.

None of this is likely to be permanent. If your vertigo improves, you can gradually learn to trust your inner ears again and stop relying as much on the rest of your body for balance.

Drinks: Coffee, Alcohol and Vertigo

Common dietary advice for vertigo sufferers often calls for restrictions not just for what you eat, but also what you drink. Alcohol is often singled out as particularly likely to cause dizziness. Information sources frequently suggest that you should also avoid caffeine if you suffer from dizziness, including coffee, tea, and caffeinated soft drinks. As mentioned in Part 1 of this diet series, even too much water can cause dizziness. When you reach for a drink, how careful should you be?

Let’s start with our daily cup of joe. Caffeine does not damage the inner ears or the balance system. Its effect on these systems is fairly minor, certainly not enough to account for the common recommendation to avoid it. A few cups a day will not cause dehydration, for example. Fainting worsens with excessive caffeine ingestion, but that is a separate problem from inner-ear dizziness or brain-related imbalance.

The main problem with caffeine happens if you are currently having a dizzy spell when you drink it. Caffeine is a stimulant; it increases the sensations that you feel. If you are in the midst of an attack of dizziness, it will worsen the severity of the attack. You will be more dizzy and off balance. The increase in dizziness during an attack is not an indication that the caffeine is harming your balance system. It is merely magnifying the unpleasantness of the spell temporarily.

In between spells coffee is unlikely to have any effect and it won’t make an attack happen. If you are having a flare-up with many spells or if you have constant dizziness, cutting back on caffeine makes sense since avoiding it will turn down the intensity of each spell a bit.

Alcohol is in a different category entirely. Unlike caffeine, alcohol can cause permanent damage to the brain balance system. It has short-term, reversible effects on the inner ear. It magnifies any underlying balance system damage you may have. Over time, with heavy drinking, severe permanent dizziness and imbalance can develop.

The short-term, reversible effect is the sensation of being tipsy. This is a direct effect of alcohol on the inner ear. It is best to have a meal along with your drinks to help slow down how quickly the alcohol is absorbed.

If you drink too much too quickly, you may even have spinners. This is a strong feeling of spinning and nausea when you lie down that persists as long as you are reclining and lasts for up to several hours. This is another short-term effect of alcohol on the inner ear. In most people this resolves completely and does not progress. If you have experienced spinners, try to remember how much alcohol you had and stay well below this threshold in the future.

If you have a permanent loss of function or a constant vertigo problem in an inner ear, or if you have damage in your cerebellum (brain balance organ), this short-term effect of alcohol may greatly worsen your balance. Some people are very susceptible to alcohol effects and this can result in progressive symptoms that are not necessarily reversible. If you fall into this group and notice worsening with alcohol, it is best to skip drinking.

Heavy alcohol intake can deplete the body of key nutrients (thiamine and B vitamins for example) and this can damage the balance system permanently. Alcohol is also directly toxic to the brain when used excessively. You don’t have to feel drunk to get this damage. Some people are very tolerant to the immediate effects of alcohol and this makes it easy for them to drink larger amounts. However, these large amounts can still do permanent damage. Current recommendations are to restrict alcohol to no more than one daily drink for women and two for men. At that level permanent balance damage is unlikely. This restriction, however, does not prevent other complications of alcohol. For example, breast cancer is increased in women who drink as little as one drink per day (1.5 ounces of hard liquor, 5 oz wine, 12 oz beer), so the general rule is that you should try to keep your alcohol intake even lower.