Unexplained Dizziness: Causes, Symptoms, and Solutions

Q: Unexplained Dizziness: Causes, Symptoms, and Solutions

Hello： It seems that you have undergone many examinations, yet you still experience poor sleep. <br>I wonder if you have had a sleep study done? Many symptoms such as dizziness, elevated blood pressure, and difficulty concentrating could potentially be explained by obstructive sl

Unknown dizziness

Hello doctor, I have been experiencing dizziness for over two years.
In 2016 and 2017, I underwent numerous tests, including brain MRI, CT scans, neck CT, EEG, intracranial blood flow studies, eye movement tests, ECG, 24-hour Holter monitoring, exercise ECG, echocardiogram, and many other examinations.
While there were some minor issues, the doctors said they wouldn't cause dizziness.
On Monday, I experienced a feeling of pressure in the back of my head, fever, and suddenly felt palpitations while sitting in the afternoon, which led to some panic.
At night, lying on my pillow gave me a sensation of falling, making it difficult to sleep.
I finally fell asleep at 2 AM on Monday night and felt very uncomfortable the next day.
My blood pressure was measured at 135/80, and after resting, it changed to 128/78.
I still had trouble sleeping on Tuesday night, so I took a sleep aid (a health supplement) and managed to fall asleep.
However, on Wednesday, I still felt heat and pressure in the back of my head, and I experienced dizziness while walking, along with gastrointestinal discomfort.
In the afternoon, I visited a traditional Chinese medicine practitioner who said my blood circulation was poor and that I had insufficient blood supply to the brain due to overthinking.
He performed acupuncture and prescribed medication, advising me to run for ten minutes every morning.
Despite having dizziness for over two years without finding a solution, I still had trouble sleeping at night, although it wasn't as uncomfortable as the previous night.
I took a herbal sleep aid, which is a health supplement containing magnesium, valerian root, licorice root, hops, and poria.
Recently, I have been experiencing heat in the back of my head, and when I lay on my pillow, I feel a sensation of falling.
I reluctantly took this health supplement, and last night I took it at 10:30 PM and fell asleep by 11 PM, waking up at 4 AM.
I felt okay when I first got up, but an hour later, I started feeling pressure in my head and dizziness again.
This morning, I measured my blood pressure on an empty stomach.
After sitting for five minutes, the first reading was 147/70.
After resting for ten minutes, it was 138/78, and after twenty minutes, it was 135/77.
Is this blood pressure normal? I have been feeling more anxious lately due to poor sleep and dizziness.
What should I do? I still have to go to work every day.
Thank you.

Alvin, 40~49 year old female. Ask Date: 2018/04/26

Dr. Jiang Junyi reply Neurology

Hello: It seems that you have undergone many examinations, yet you still experience poor sleep.
I wonder if you have had a sleep study done? Many symptoms such as dizziness, elevated blood pressure, and difficulty concentrating could potentially be explained by obstructive sleep apnea.
This condition can lead to daytime drowsiness and lack of focus.
The most common type in middle-aged men is obstructive sleep apnea, which occurs when the soft tissues near the throat block the airway, causing the upper airway to become narrower, leading to snoring and breathing interruptions.
Abnormalities in the upper airway structure, excessive relaxation of the airway muscles, and obesity are also common triggers.
Patients with this condition are at increased risk for cardiovascular issues due to sleep interruptions and hypoxia, making them more susceptible to diseases such as hypertension, arrhythmias, coronary artery disease, myocardial infarction, heart failure, and stroke.
Clinically, patients with poorly controlled diabetes and hypertension often have underlying obstructive sleep apnea syndrome.
I recommend that you consult a sleep medicine specialist to discuss testing and treatment options.
Wishing you good health and peace.
Dr.
Tao cares about you.

Reply Date: 2018/04/26

More Info

Understanding unexplained dizziness can be quite complex, especially when it has persisted for an extended period, as in your case of over two years. Dizziness can stem from various causes, including vestibular disorders, neurological issues, cardiovascular problems, and even psychological factors such as anxiety and stress. Given your extensive medical history and the numerous tests you've undergone, it seems that a multifaceted approach may be necessary to address your symptoms effectively.

Causes of Dizziness
1. Vestibular Disorders: Conditions affecting the inner ear, such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis, or Meniere's disease, can lead to dizziness. These conditions often present with episodes of spinning or a sensation of movement.

2. Neurological Issues: Although your MRI and CT scans have not indicated significant problems, conditions like migraines or even atypical migraines can cause dizziness without clear structural abnormalities. Other neurological conditions, though less likely given your tests, could also be considered.

3. Cardiovascular Factors: Fluctuations in blood pressure, as you noted in your readings, can contribute to dizziness. Your blood pressure readings, while generally within normal limits, show some variability. It's essential to monitor these changes, especially if you experience symptoms like lightheadedness or fainting.

4. Psychological Factors: Anxiety and stress can manifest physically, leading to symptoms such as dizziness, palpitations, and a sense of impending doom. Your recent experiences of panic and anxiety, particularly in relation to your sleep disturbances, may suggest that psychological factors are playing a role in your dizziness.

Symptoms and Their Implications
The symptoms you've described—such as the sensation of your head feeling heavy or "blocked," the feeling of falling when lying down, and the accompanying gastrointestinal discomfort—warrant a comprehensive evaluation. The fact that you have experienced these symptoms for an extended period suggests that they may not be due to a single cause but rather a combination of factors.

Solutions and Recommendations
1. Continued Monitoring: Keep a detailed diary of your symptoms, noting when they occur, their duration, and any associated factors (like stress levels, sleep quality, and dietary habits). This information can be invaluable for your healthcare provider.

2. Consultation with Specialists: Given the complexity of your symptoms, consider consulting with a neurologist or an ear, nose, and throat (ENT) specialist. They may offer additional insights or tests that could clarify the underlying causes of your dizziness.

3. Psychological Support: Since anxiety appears to be a contributing factor, working with a mental health professional could be beneficial. Cognitive-behavioral therapy (CBT) has been shown to help individuals manage anxiety and its physical manifestations.

4. Lifestyle Modifications: Incorporating regular physical activity, such as the running suggested by your acupuncturist, can improve circulation and overall well-being. Additionally, practicing relaxation techniques, such as mindfulness or yoga, may help reduce anxiety and improve sleep quality.

5. Medication Review: If you are taking any medications or supplements, discuss them with your healthcare provider to ensure they are not contributing to your symptoms. Some supplements can interact with other medications or exacerbate dizziness.

6. Sleep Hygiene: Prioritize good sleep hygiene practices to improve your sleep quality. This includes maintaining a consistent sleep schedule, creating a restful environment, and avoiding stimulants before bedtime.

Conclusion
Dizziness can be a challenging symptom to manage, especially when its origins are unclear. A comprehensive approach that includes monitoring, specialist consultations, psychological support, lifestyle changes, and a review of medications can help you find relief. It's crucial to communicate openly with your healthcare providers about your symptoms and concerns, as this collaboration is key to finding an effective management strategy. Remember, you are not alone in this journey, and with the right support, you can work towards alleviating your symptoms and improving your quality of life.

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