Persistent Dizziness: When to Seek Further Medical Help

Strange dizziness

Hello Doctor, I have been experiencing dizziness for a year and a half.
It started with a sensation similar to an earthquake and has now progressed to feeling like I'm on a boat swaying up and down.
During this time, I have seen many doctors and undergone numerous tests, including evaluations of my head, neck, heart, gastrointestinal system, liver, and kidneys, all of which showed no significant issues.
I asked a neurologist if I should see a psychiatrist, and he said it wasn't necessary.
I have also consulted several traditional Chinese medicine practitioners, who suggested that I have excessive liver and heart fire and a deficiency of stomach qi.
I took Chinese herbal medicine for several months, but my dizziness did not improve.
Last year, when my dizziness was at its worst, I weighed 118 kg (height 182 cm, with a blood pressure of 155/101).
Since then, I have started exercising and controlling my diet, and I now weigh 92 kg with normal blood pressure.
Currently, the dizziness symptoms have lessened when sitting or lying down, but I still feel unsteady when standing or walking.
Most of the time, I experience a heavy sensation in the back of my head and a foggy feeling, but I do not feel like the room is spinning.
Occasionally, I feel a swaying sensation like being on a boat.
Other symptoms include occasional rib pain, dry and swollen eyes, muscle twitching, and sometimes feeling like I haven't fully emptied my bowels.
I also experience occasional pain in the back of my head and neck.
Mornings are usually better, but the dizziness worsens by noon, and my body feels warm, especially in hot weather, although it improves again by evening.
A previous doctor suggested that my symptoms might be due to severe obstructive sleep apnea.
Eight years ago, I underwent a sleep study that confirmed severe sleep apnea (at that time, I weighed 109 kg), but I have not received treatment since then, and my weight has continued to increase, leading to prolonged brain hypoxia, which may have resulted in my current condition that requires long-term recovery.
I have been using a continuous positive airway pressure (CPAP) machine for a year.
I would like to ask if I need to see a psychiatrist (is this autonomic nervous system dysregulation?), or should I continue with exercise and CPAP treatment? Thank you.

Alvin, 40~49 year old female. Ask Date: 2017/09/29

Dr. Liao Yaopan reply Family Medicine

Hello, regarding your question, it is advisable to have a neurologist conduct further evaluation.
However, sleep apnea, if left untreated, may lead to some nonspecific symptoms.
Consulting with a psychiatrist could also be beneficial for your situation.
Please note that online consultations are not equivalent to in-person visits and cannot provide accurate diagnoses or treatment recommendations.
Changhua Hospital cares about your well-being.

Reply Date: 2017/09/29

More Info

Hello! Thank you for sharing your concerns about your persistent dizziness. It sounds like you've been through a challenging journey over the past year and a half, and it's commendable that you've taken steps to improve your health, including weight loss and regular exercise.
From your description, it appears that you've undergone extensive medical evaluations, including assessments of your neurological, cardiovascular, and gastrointestinal systems, without any significant findings. This can be frustrating, especially when symptoms persist. Your experience of dizziness, particularly the sensation of swaying or feeling like you're on a boat, can be indicative of several underlying issues, some of which may not be easily identifiable through standard medical tests.

Given your history of severe obstructive sleep apnea (OSA) and the fact that you have been using a CPAP machine for a year, it is essential to consider the potential impact of untreated sleep apnea on your overall health. OSA can lead to intermittent hypoxia (reduced oxygen levels during sleep), which may contribute to cognitive and neurological symptoms, including dizziness and fatigue. The fact that your dizziness seems to worsen with certain positions (standing or walking) and improves when sitting or lying down could suggest a vestibular component, but it may also be related to blood pressure changes or even anxiety.

You mentioned that a neurologist suggested you do not need to see a psychiatrist. However, given the complexity of your symptoms and the psychological toll that chronic dizziness can take, it may be beneficial to consult with a mental health professional. Conditions such as anxiety or depression can exacerbate physical symptoms, and addressing these aspects may improve your overall well-being. Additionally, autonomic nervous system dysregulation can manifest as dizziness and other physical symptoms, which a mental health professional can help you explore.

In terms of your ongoing treatment, continuing with your CPAP therapy is crucial, especially since you have a history of severe sleep apnea. Regular follow-ups with your sleep specialist to ensure that your therapy is effective and to make any necessary adjustments is also important.
Moreover, maintaining a healthy lifestyle through regular exercise and a balanced diet can help improve your overall health and potentially alleviate some of your symptoms. Staying hydrated, managing stress, and ensuring adequate sleep hygiene are also vital components of your care.

If your dizziness persists or worsens, or if you develop new symptoms, it is essential to seek further medical evaluation. This may include a referral to a specialist in vestibular disorders or a comprehensive evaluation by a neurologist who specializes in dizziness.
In summary, while it may not be immediately necessary to see a psychiatrist, considering the psychological aspects of your condition could be beneficial. Continue with your CPAP therapy, maintain your healthy lifestyle changes, and keep an open line of communication with your healthcare providers about your symptoms. If you feel that your dizziness is significantly impacting your quality of life, do not hesitate to advocate for further evaluations or referrals to specialists who can provide additional insights into your condition.

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