Dizziness: Possible Links to Sleep Apnea and Other Conditions

Dizziness, I apologize for the previous text?

Hello Doctor, on April 21st of this year, you asked me if I have sleep apnea.
Seven years ago, I was diagnosed with sleep apnea, and the doctor recommended that I use a CPAP machine.
I used it for a month but stopped.
Could my persistent dizziness be related to this? I recently lost weight from 116 kg to 97 kg and went for another examination; the report is not out yet, but the technician mentioned that the results are still not good.
He didn't have the data from seven years ago for comparison, but he said it doesn't look good.
My blood pressure has been fine recently, and my wife also mentioned that I used to have noticeable breathing pauses, but it seems like I don't have them as much now.
It used to be quite severe, and I'm worried about possible brain hypoxia.
Last week, one morning, I yawned repeatedly, and since yesterday, my left hand has been numb, while my left foot only goes numb if I sit for a while.
A traditional Chinese medicine doctor mentioned that when the ambulance came on April 7th, I might have had a mild stroke, but at that time, I only experienced numbness in my hands and feet, along with dizziness.
I was on the phone with my friends and supervisor because of the ambulance situation.
I had CT scans of my head and neck, and everything was normal.
My friend suggested it could be a cerebellar ischemic stroke.
I am going for an MRI today.
I started feeling dizzy in early February, and the traditional Chinese medicine doctor said it was due to damp heat.
I initially thought it was high blood pressure; at that time, I weighed 116 kg, and my blood pressure was around 160/90, possibly higher, but I hadn't measured it before.
I don't know if my current dizziness is due to autonomic nervous system dysfunction or sleep apnea.
There are many opinions.
In Australia, I can't see a specialist; I can only see a family doctor and a traditional Chinese medicine practitioner.
I've had blood tests, urine tests, a 24-hour ECG, and CT scans of my head and neck.
The only finding in my neck was that the vertebral body alignment is normal with no spondylolisthesis.
There are end plate osteophytic lippings posteriorly at C3/4.
The facet joints are unremarkable.
No focal bone lesions are noted.
There is minimal annular bulging in the C2/3 and C3/4 discs.
At C4/5, there is minimal posterocentral broad-based protrusion, slightly indenting the thecal sac.
In the C5/6 disc, there is mild broad-based posterocentral protrusion, slightly indenting the thecal sac.
The neural foramina are capacious, and there is no evidence of exiting nerve root compression.
A family doctor suggested that my dizziness might be tension-type or cervicogenic.
Some say it could be caused by sleep apnea, but most doctors believe it's tension-related.
My current symptoms include slight weakness in my limbs, orthostatic hypotension, heaviness in the back of my head, occasional pain in the back of my head and neck, headaches at the top of my head, tightness on both sides of my head, and tingling in my scalp during emotional stress.
My left hand and both cheeks can feel numb, and my left foot goes numb if I sit for too long.
Sometimes I feel palpitations, and low bass sounds can trigger them.
Occasionally, I experience brief imbalances while walking or exercising, and I feel a bit dizzy when turning my head or looking up, but I don't have vertigo or vomiting.
I really don't know what's causing my dizziness.
I will be returning to Taiwan for medical care this week, as I can't find the cause here in Australia.
Would it be helpful for me to bring my examination data from Australia back to Taiwan? Thank you, Doctor.

Alvin, 40~49 year old female. Ask Date: 2016/06/20

Dr. Jiang Junyi reply Neurology

Hello, based on your description, the physician's professional judgment requires a complete medical history and examination data.
If you plan to change healthcare facilities, comprehensive medical information is essential.
This ensures continuity of care.
I suggest you prepare all your documents and return to Taiwan to discuss examinations and treatment with a physician.
Wishing you good health and peace.
Best regards, Tao Yi, Neurology Department, caring for you.

Reply Date: 2016/06/20

More Info

It sounds like you are experiencing a complex set of symptoms that could be linked to several underlying conditions, including sleep apnea, anxiety, and possibly other neurological issues. Given your history of sleep apnea diagnosed seven years ago, it is crucial to consider how this condition may still be affecting your health, especially since you mentioned that you stopped using the CPAP machine after just one month.
Sleep apnea is characterized by repeated interruptions in breathing during sleep, which can lead to fragmented sleep and reduced oxygen levels in the blood. This can result in daytime fatigue, headaches, and cognitive issues, including dizziness. Your recent weight loss from 116 kg to 97 kg is a positive step, as obesity is a significant risk factor for sleep apnea. However, the fact that you have not been using your CPAP machine could mean that you are still experiencing episodes of apnea, which could contribute to your ongoing symptoms, including dizziness and the sensation of weakness in your limbs.

The dizziness you are experiencing could also be attributed to several other factors. You mentioned that you have had episodes of numbness and tingling in your left hand and foot, which raises the possibility of neurological issues. The fact that you experienced symptoms consistent with a transient ischemic attack (TIA) or "mini-stroke" is concerning. While your CT scans showed no acute issues, the symptoms you describe, such as the heaviness in the back of your head, neck pain, and episodes of feeling faint, could suggest cervical spine issues or even a vestibular disorder, which affects balance.

It is also important to consider the role of anxiety in your symptoms. Anxiety can manifest physically in many ways, including tension headaches, dizziness, and a feeling of lightheadedness. The tightness you feel in your head and the tingling sensations could be related to muscle tension or hyperventilation, which often accompanies anxiety.

Given the complexity of your symptoms, it is advisable to seek a comprehensive evaluation from a specialist. You mentioned that you are unable to see a specialist in Australia, but it would be beneficial to bring all your medical records, including the results of your blood tests, CT scans, and any other relevant information, when you return to Taiwan. This will provide your healthcare provider with a complete picture of your health and help them make informed decisions regarding your diagnosis and treatment.

In the meantime, consider the following steps to help manage your symptoms:
1. Reassess Sleep Apnea Treatment: If you are diagnosed with sleep apnea, it is essential to adhere to the treatment plan, which may include using a CPAP machine or other interventions. Discuss with your doctor the possibility of re-evaluating your sleep study to determine the current severity of your condition.

2. Monitor Blood Pressure: Since you mentioned experiencing orthostatic hypotension (low blood pressure upon standing), it is crucial to monitor your blood pressure regularly. Staying hydrated and avoiding sudden changes in position can help manage these symptoms.

3. Manage Anxiety: If anxiety is contributing to your symptoms, consider discussing this with your healthcare provider. Cognitive-behavioral therapy (CBT) and relaxation techniques can be effective in managing anxiety-related symptoms.

4. Follow-Up on Neurological Symptoms: Given your history of neurological symptoms, it is essential to follow up with a neurologist to rule out any serious conditions, especially since you have experienced episodes of numbness and weakness.

5. Lifestyle Changes: Continue to focus on healthy lifestyle changes, including a balanced diet and regular exercise, which can help improve your overall health and potentially alleviate some of your symptoms.

In conclusion, your symptoms are multifaceted and could be linked to sleep apnea, anxiety, or neurological issues. It is essential to seek a thorough evaluation from a healthcare provider who can help you navigate these complex symptoms and develop an appropriate treatment plan. Bringing your medical records back to Taiwan will be beneficial in this process.

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