What kinds of dizziness are caused by sleep apnea?

Sleep apnea can create different kinds of dizzy spells in the same person.  We know that sleep apnea causes these, because treatment with CPAP can prevent them or stop them from recurring. 

Sudden short spells:

A typical person with sleep apnea will notice sudden, very brief jolts of dizziness on and off during the day.  They can feel a very brief spin but are not brought on by movement like BPPV.  Instead, they come randomly.  Some report feeling as if about to fall momentarily. 

Vestibular migraine:

Many people with sleep apnea have been diagnosed with vestibular migraine, which is dizziness during a  migraine headache or in a person who has previously suffered from migraines.  The feeling is usually an internal feeling of spinning that can occur during the headache but can also happen in between migraines.  If the vestibular migraine is being set off by sleep apnea, usual migraine treatments may not work because CPAP is first needed to restore normal vascular function.

Sudden hearing loss with vertigo:

Sudden sensorineural hearing loss (SSNHL) with acute vestibular syndrome is a damaging form of vertigo.  It usually begins with an abrupt loss of hearing in one ear.  The room begins to spin, and there is often vomiting.   The hearing loss may be permanent.  The spinning sensation gradually slows down over days, but there can be milder residual dizziness that lasts for months.  Tests for inner ear problems (audiogram, VNG) can show permanent damage.  This problem is much more common in people with sleep apnea than in the general population.  It is thought to be caused by a loss of blood flow to the ear.

Meniere’s disease:

The symptoms are repeated spells lasting for hours, going on for many years.  During a spell, the troubled ear may feel stuffy, the hearing declines (especially in the low tones), there is a ringing or roaring sound in the ear, and the room spins for half an hour up to several hours.  Once the spell ends hearing is restored, but over time the ear gradually loses most hearing. If a person with Meniere’s disease is found to have sleep apnea, treatment can result in excellent control of the vertigo attacks. 

In our next post, we will discuss a common form of dizziness in older adults.