Non-Specific Dizziness: Causes and Solutions for Patients

Nonspecific dizziness

Hello, doctor.
Seven years ago, I weighed 109 kg and was diagnosed with severe obstructive sleep apnea.
I used a CPAP machine for a month but found it uncomfortable and stopped.
Over the past seven years, my weight has increased to 116 kg.
In early February of this year, I experienced sudden dizziness.
Initially, I thought it was a cold, but after experiencing dizziness for a month and a half, I decided to see a doctor, which led to a series of medical examinations.
During this period, I underwent abdominal ultrasounds for liver and kidney, blood tests, urinalysis, neck CT scan, brain CT scan, brain MRI, EEG, intracranial blood flow studies, autonomic nervous system tests, autoimmune tests, and a 24-hour Holter monitor.
The results showed only mild fatty liver, small bone spurs in the neck, a bilirubin level of 33, and slightly low but still normal levels of B12 and folate.
A stool test for Salmonella was negative, and I previously had a small amount of blood in my stool for about two days; however, a fecal occult blood test was normal.
The doctor suggested it might be hemorrhoids, and later mentioned that my symptoms could be related to my sleep apnea, prompting another sleep study.
Due to significant psychological stress, I managed to lose weight down to 96 kg (losing 20 kg in two months), but this time the results showed severe apnea with an AHI of 54 and oxygen saturation dropping as low as 48%.
The doctor insisted that I must undergo treatment, so on September 16 of this year, I purchased a new CPAP machine 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, which is more noticeable when standing or walking, though less so when sitting.
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 see significant improvement.
Additionally, for the past month, I have been experiencing some discomfort in my stomach.
I have been taking B vitamins for over a month, fish oil for five years, and probiotics for four months.
I previously felt like I had a cold, and my stomach has been inconsistent, leading me to wonder if I am overthinking it.
Should I consider getting an endoscopy? Thank you.

Alvin, 40~49 year old female. Ask Date: 2016/10/12

Dr. He Dongjin reply Cardiology

Hello, I also believe that sleep apnea may be the cause.
If you're concerned about the gastroscopy, let's go ahead and arrange it.
You should continue using the ventilator.
Changhua Hospital cares about you.

Reply Date: 2016/10/12

More Info

Understanding non-specific dizziness can be quite challenging, especially when it is associated with multiple health issues, as in your case. Dizziness can stem from various causes, including vestibular disorders, cardiovascular issues, neurological conditions, and even psychological factors. Given your history of obesity and obstructive sleep apnea (OSA), it is essential to consider how these conditions may contribute to your symptoms.

Firstly, your significant weight loss is commendable and can positively impact your overall health, including your sleep apnea. However, the fact that you have experienced persistent dizziness for over a month suggests that further evaluation is necessary. The tests you've undergone, including imaging studies and blood tests, have ruled out many serious conditions, which is reassuring. However, the presence of mild liver steatosis (fatty liver) and low levels of certain vitamins may warrant further attention.

Dizziness can sometimes be linked to issues with blood flow or oxygenation, particularly in individuals with sleep apnea. Your AHI (Apnea-Hypopnea Index) of 54 indicates severe sleep apnea, which can lead to intermittent hypoxia (low oxygen levels) during sleep. This can result in daytime symptoms such as dizziness, fatigue, and cognitive difficulties. The fact that your oxygen saturation dropped to 48% is concerning and highlights the importance of adhering to your CPAP therapy. As you continue to use the CPAP machine, you may notice gradual improvements in your dizziness as your oxygen levels stabilize and your overall sleep quality improves.

In terms of your gastrointestinal symptoms, the feeling of heaviness in your stomach and the intermittent nature of your discomfort could be related to several factors, including dietary habits, stress, or even the medications and supplements you are taking. While B vitamins and fish oil are generally beneficial, it is essential to ensure they are not causing any gastrointestinal upset. If your symptoms persist or worsen, a gastroenterological evaluation, including an upper endoscopy (gastroscopy), may be warranted to rule out any underlying conditions such as gastritis or esophagitis.

As for the timeline for improvement, it can vary significantly from person to person. Many patients notice gradual improvements in dizziness and other symptoms as they adapt to CPAP therapy, but it may take several weeks to months for full benefits to be realized. Consistent use of the CPAP machine, along with lifestyle modifications such as maintaining a healthy diet and regular exercise, will be crucial in your recovery.

In summary, while your dizziness may be multifactorial, addressing your sleep apnea through CPAP therapy is a critical step. Continue to monitor your symptoms and maintain open communication with your healthcare providers. If your gastrointestinal symptoms persist or worsen, consider discussing the possibility of an upper endoscopy with your doctor. It is essential to take a comprehensive approach to your health, focusing on both your sleep and gastrointestinal issues to achieve the best possible outcomes.

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