Persistent Dizziness: Causes and Management Strategies

Dizziness for over a year?

Hello Doctor, I have been experiencing dizziness for over a year.
I have undergone numerous tests, which revealed severe obstructive sleep apnea and mild fatty liver.
Since the onset of dizziness last year until January of this year, my dizziness has worsened, manifesting as a sensation of swaying up and down.
Recently, it seems to have intensified, and I am unsure why.
The weather in Australia is cold, and the dizziness tends to worsen after noon each day, becoming more pronounced at night, especially after taking a hot shower, as if the blood vessels in the back of my head are dilating.
I walk every morning, but I spend most of my time sitting.
The symptoms lessen or disappear when sitting or lying down.
Since my head feels uncomfortable, I believe it is primarily a head issue.
Sometimes I experience tremors, numbness in my hands and feet, occasional gastric burning sensations, and moments of impatience.
I wonder when I will recover.
At night, I cannot press on the back of my head while sleeping; it feels swollen, but if I avoid pressure, I can sleep well, although I can press on it once I fall asleep.
I have undergone a CT scan of the brain, X-rays, MRI, intracranial ultrasound, EEG, balance tests, eye movement tests, echocardiogram, ECG, 24-hour Holter monitoring, exercise ECG, cervical CT, autoimmune tests, liver and kidney ultrasound, colonoscopy, blood tests, and urinalysis.
Aside from severe obstructive sleep apnea (which I have had for seven years), there are no significant issues, just mild fatty liver and small bone spurs in my neck that do not compress nerves.
This year of dizziness has significantly impacted my life, and I am currently walking daily for exercise and taking traditional Chinese medicine for two months.
The dizziness does not seem to have improved, and I feel somewhat irritable.
Doctor, could you please tell me what is happening to me? Thank you.

Alvin, 40~49 year old female. Ask Date: 2017/06/16

Dr. Chen Taicheng reply Family Medicine

● You have undergone a comprehensive evaluation for your dizziness, addressing common issues related to the heart, ears, head, or other medical concerns.
● Dizziness is an annoying symptom that may be slightly alleviated with medication; however, it is advisable to first address severe obstructive sleep apnea, as it can lead to poor sleep quality, hypertension, and other cardiovascular diseases, which may also contribute to fatigue or dizziness.
● Obstructive sleep apnea can be treated with continuous positive airway pressure (CPAP) therapy, dental appliances, or surgical intervention.
Please seek care at a sleep center.
By resolving your sleep issues, your dizziness should improve as well.
● Wishing you good health, Dr.
Chen Tai-Cheng from Taoyuan Hospital, Department of Family Medicine, cares about you.

Reply Date: 2017/06/16

More Info

Persistent dizziness can be a challenging symptom to manage, especially when it has been ongoing for over a year, as in your case. The complexity of your situation is compounded by the presence of obstructive sleep apnea and mild fatty liver disease, both of which can contribute to feelings of dizziness and fatigue. Understanding the underlying causes and management strategies is crucial for improving your quality of life.

Possible Causes of Persistent Dizziness
1. Obstructive Sleep Apnea (OSA): OSA can lead to fragmented sleep and reduced oxygen levels during the night, which may result in daytime fatigue and dizziness. The lack of restorative sleep can also exacerbate feelings of dizziness and disorientation.

2. Fatty Liver Disease: While mild fatty liver disease may not directly cause dizziness, it can be associated with metabolic syndrome, which includes obesity, insulin resistance, and dyslipidemia. These conditions can lead to systemic symptoms, including dizziness.

3. Cervical Spine Issues: The presence of small bone spurs in your neck could potentially affect blood flow or nerve function, leading to dizziness. If these spurs are pressing on nerves or blood vessels, they could contribute to your symptoms.

4. Vestibular Disorders: Dizziness can also arise from issues within the inner ear, which is responsible for balance. Conditions such as benign paroxysmal positional vertigo (BPPV) or vestibular neuritis could be considered, especially if your dizziness is positional or associated with changes in head position.

5. Anxiety and Stress: Chronic dizziness can lead to anxiety, which in turn can exacerbate dizziness. The feelings of frustration and irritability you mentioned may be related to the stress of dealing with persistent symptoms.

Management Strategies
1. Sleep Apnea Treatment: It is essential to address your obstructive sleep apnea. Continuous positive airway pressure (CPAP) therapy is often the first-line treatment. Proper management of sleep apnea can significantly improve daytime symptoms, including dizziness.

2. Lifestyle Modifications: Regular physical activity, a balanced diet, and weight management can help improve both fatty liver disease and overall health. Avoiding alcohol and maintaining a healthy weight can also be beneficial.

3. Vestibular Rehabilitation: If a vestibular disorder is suspected, vestibular rehabilitation therapy (VRT) may help. This involves exercises designed to improve balance and reduce dizziness.

4. Cervical Spine Management: If your dizziness is related to cervical spine issues, physical therapy focusing on neck strength and flexibility may be beneficial. In some cases, further imaging or intervention may be necessary.

5. Medication Review: Review any medications you are taking with your healthcare provider, as some medications can contribute to dizziness. Additionally, if you are taking herbal supplements or traditional Chinese medicine, discuss these with your doctor to ensure they are not interacting with other treatments.

6. Mental Health Support: Given the impact of chronic dizziness on your mood, consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) can be effective in managing anxiety and stress related to chronic health issues.

Conclusion
Persistent dizziness can stem from multiple factors, and a comprehensive approach is necessary for effective management. It is crucial to work closely with your healthcare providers to address each potential cause systematically. Regular follow-ups and open communication about your symptoms and treatment responses will be key in finding relief. If your symptoms continue to worsen or significantly impact your daily life, consider seeking a second opinion or referral to a specialist, such as a neurologist or an ear, nose, and throat (ENT) specialist, for further evaluation.

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