Non-Specific Dizziness: Causes and Management in Primary Care

Nonspecific dizziness

Hello, doctor.
Seven years ago, I weighed 109 kg and was diagnosed with severe obstructive sleep apnea.
I used a ventilator for a month but stopped because it was uncomfortable.
Over the past seven years, my weight increased to 116 kg.
In early February of this year, I experienced sudden dizziness.
At first, I thought it was a cold, but after a month and a half of dizziness, I decided to see a doctor, which began my journey of medical examinations.
During this period, I underwent liver and kidney ultrasounds, blood tests, urine tests, neck CT, brain CT, brain MRI, EEG, intracranial blood flow studies, autonomic nervous system tests, autoimmune tests, and a 24-hour ECG.
The results showed only mild fatty liver, a small bone spur in the neck, a bilirubin level of 33, and slightly low B12 and folate levels, but still within normal ranges.
The blood tests also ruled out Salmonella.
The doctor suggested that my dizziness might be related to my sleep apnea and recommended another sleep study.
Due to significant psychological stress, I managed to lose weight down to 96 kg (a loss of 20 kg in two months).
This time, the results showed severe sleep apnea with an AHI of 54 and a blood oxygen saturation that dropped to 48%.
The doctor insisted that I need treatment, so on September 16 of this year, I purchased a new ventilator and started using it.
Over the past two weeks, my dizziness has slightly improved, but I still feel a sensation of blockage in my head and some heaviness in the back of my head, especially when standing or walking, although sitting does not exacerbate it.
I exercise for half an hour every day.
The doctor mentioned that improvement would not be immediate, but I would like to know how long it might take to feel better.
Additionally, for the past month, I have been experiencing some discomfort in my stomach, which seemed like a cold at first, and my stomach symptoms have been intermittent.
I am unsure if I am overthinking this.
Should I consider getting an endoscopy? Thank you.

Alvin, 40~49 year old female. Ask Date: 2016/10/06

Dr. Liao Yaopan reply Family Medicine

Hello, respiratory arrest may lead to hypoxia, which could be related to dizziness; this cannot be ruled out, so efforts should be made to maintain and improve the situation.
As for the gastrointestinal symptoms that have not improved, it is still recommended to seek evaluation from a gastroenterologist.
Changhua Hospital cares about you.

Reply Date: 2016/10/06

More Info

Understanding non-specific dizziness can be quite complex, especially in patients with a history of obesity and obstructive sleep apnea (OSA), as you have described. Dizziness can arise from various causes, and in your case, it appears to be multifactorial, potentially linked to your OSA, weight fluctuations, and possibly other underlying health issues.

Causes of Dizziness
1. Obstructive Sleep Apnea (OSA): OSA can lead to intermittent hypoxia (low oxygen levels) during sleep, which may contribute to daytime fatigue and dizziness. The high Apnea-Hypopnea Index (AHI) of 54 indicates severe OSA, which can significantly affect your overall health and well-being. The low oxygen saturation levels you experienced (down to 48%) can lead to neurological symptoms, including dizziness.

2. Weight Changes: Rapid weight loss, such as the 20 kg you lost in two months, can also lead to dizziness. This can be due to changes in blood volume, electrolyte imbalances, or even dehydration if fluid intake is not adequately maintained.

3. Vestibular Issues: Dizziness can also stem from inner ear problems, which affect balance. While your extensive testing did not reveal any specific vestibular disorders, it’s still a possibility that could be explored further.

4. Anxiety and Stress: Psychological factors, including anxiety and stress, can manifest physically as dizziness. Your mention of psychological pressure during your weight loss journey could contribute to your symptoms.

5. Nutritional Deficiencies: You noted low levels of vitamin B12 and folate, which can lead to neurological symptoms, including dizziness. Ensuring adequate nutrition is crucial, especially during weight loss.

Management Strategies
1. Continuous Positive Airway Pressure (CPAP) Therapy: Since you have started using a new CPAP machine, it is essential to adhere to this treatment. Improvement in your sleep quality can lead to better oxygenation and potentially reduce dizziness over time. It may take several weeks to notice significant changes as your body adjusts.

2. Regular Follow-ups: Continue to work closely with your healthcare provider to monitor your OSA and any other health issues. Regular follow-ups can help adjust your treatment plan as needed.

3. Hydration and Nutrition: Ensure you are well-hydrated and consuming a balanced diet rich in vitamins and minerals. If you suspect deficiencies, consider discussing supplementation with your doctor.

4. Physical Activity: Engaging in regular, moderate exercise can improve circulation and overall health. However, listen to your body and avoid overexertion, especially if you feel dizzy.

5. Stress Management: Incorporate stress-reducing techniques such as mindfulness, meditation, or gentle yoga, which can help alleviate anxiety and its physical manifestations.

Gastrointestinal Symptoms
Regarding your gastrointestinal symptoms, such as the feeling of heaviness in your stomach and intermittent discomfort, it may be worthwhile to discuss these with your physician. A gastroscopy (upper endoscopy) could be beneficial, especially if symptoms persist or worsen. It can help rule out conditions such as gastritis, ulcers, or other gastrointestinal issues that may be contributing to your discomfort.

Conclusion
In summary, your dizziness is likely multifactorial, primarily influenced by your history of OSA, recent weight loss, and possibly nutritional deficiencies. Adhering to CPAP therapy, maintaining a balanced diet, staying hydrated, and managing stress are crucial steps in your recovery. If your gastrointestinal symptoms continue, discussing the need for further evaluation, such as an endoscopy, with your healthcare provider would be prudent. Remember, recovery can take time, and it’s essential to be patient with yourself as you navigate these health challenges.

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