It turns out that alcohol is much less dense than the fluid of the inner ear. If you drink a lot of alcohol over a short period of time, it can enter the cupula quickly through the bloodstream. This lightens the cupula fairly quickly, in as little as 30 minutes. The inner ear fluids don’t have a way to pick alcohol up from the bloodstream that fast, but only very slowly adjust over hours until the cupula and the fluids again have matching density.
This means that for a couple of hours after heavy drinking, the six cupulae become less dense than the surrounding fluids and tend to float, causing positional nystagmus. Lying on either side will bring this out, and you will see the room spinning. If you let this go on too long, it can make you vomit.
Over the next few hours the amount of alcohol gradually rises in the inner ear fluids. The cupula and fluids equalize in density and the symptoms of vertigo disappear. Unfortunately, like being in the eye of a hurricane, this equilibrium does not last very long. You have about 1 ½ hours of improvement.
Over the next several hours the level of alcohol in the bloodstream begins to fall rapidly. The alcohol leaves the cupula quickly, but still remains in the fluids, making the cupula relatively heavy. This causes a reappearance of vertigo and is one cause of the nausea of a morning hangover. If you pay attention, you’ll notice the spinning has reversed direction.
The dizziness tends to be most noticeable when lying down, especially lying flat on your back or on one side. It is improved when sitting up with the chin tipped downward. Sitting leaning forward over your desk with your chin on your hands is a good way to reduce the spinning.
The traditional morning treatment for a hangover is “the hair of the dog that bit you”. This means drinking a little more of the alcohol you enjoyed the night before, but is usually taken in the form of a Bloody Mary. If you’re still spinning in the morning, it means your blood alcohol and the alcohol in your cupulae is low, but the alcohol in the inner ear fluids is still high. Drinking a shot evens it back out and can make you feel less dizzy. Of course, this has the disadvantage of being a step on the road to alcoholism. It’s much better to learn how to prevent it in the first place.
Avoiding PAN is simple. It’s a matter of how much you drink, how strong the drinks are and how quickly you pour it down. If you only drink a single low-alcohol drink, and you sip it slowly, you won’t get PAN.
Spacing out drinks so that your body has time to detoxify the alcohol also helps. Some people detoxify faster than others, so one person may get PAN from drinking two drinks in an hour, while another can have several in the same time period. Know your limitations.
If you slow down how quickly the alcohol is absorbed by eating food to keep your stomach filled while drinking, it will help prevent it even if you have a few drinks.
The strength of the drink matters. A shot of pure alcohol leads to PAN. Drinks mixed with fruit juices and non alcoholic mixes or wine are better tolerated.
In our next post we’ll discuss other forms of intoxication that can cause dizziness.