Non-Specific Dizziness: Causes and Management Strategies

Nonspecific dizziness

Hello doctor, I have been experiencing dizziness for over two years (a floating sensation, like being on a boat, without tinnitus or vertigo, and I feel dizzy every day).
I have undergone many tests previously, which have ruled out issues with my head and internal organs.
The doctor suspects I have autonomic nervous system dysfunction.
Eight years ago, I underwent a respiratory examination and was diagnosed with severe obstructive sleep apnea, but I stopped using the CPAP machine after a month.
Since then, I have gained weight (118 kg).
In 2017, I started experiencing dizziness, and I managed to lose weight down to 96 kg.
That same year, I had another sleep study, which indicated that my condition had worsened to severe, with an AHI of 54 and blood oxygen saturation at 48%.
I began using a CPAP machine in September 2016 and have been using it for over a year, wearing it for seven to eight hours each night without removing it.
However, I am still experiencing dizziness.
I have always suspected that the pressure on the CPAP machine is insufficient; my pressure setting is 5, but my daily AHI readings are below 5.
Many of my friends who use CPAP have higher pressure settings than I do.
When I returned to an Australian sleep center, the pressure values measured there seemed correct.
I am unsure whether the issue lies with the CPAP machine or with autonomic nervous system dysfunction.
Thank you.

Alvin, 40~49 year old female. Ask Date: 2018/06/13

Dr. Zheng Jueyi reply Otolaryngology

Hello, there are many factors that can cause dizziness.
If you have already undergone numerous examinations, more serious factors can be ruled out, but it is currently difficult to determine the cause of your dizziness.
Regarding the adjustment of the positive pressure ventilator, you may coordinate with the ventilator manufacturer or consult relevant physicians at a medical center or a hospital with a sleep center for pressure adjustments.
Wishing you safety and good health.
Sincerely, Dr.
Jue-Yi Cheng, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2018/06/13

More Info

Understanding non-specific dizziness can be quite complex, especially when it has persisted for an extended period, as in your case. Dizziness can manifest in various forms, including a sensation of floating, lightheadedness, or a feeling akin to being on a boat, as you described. Given that you've already undergone extensive testing to rule out significant neurological or visceral issues, we can explore potential causes and management strategies.

Potential Causes of Non-Specific Dizziness
1. Vestibular Disorders: While you mentioned that you do not experience vertigo (the sensation of spinning), some vestibular disorders can cause a persistent sense of imbalance or floating. Conditions like vestibular migraine or benign paroxysmal positional vertigo (BPPV) might not always present with classic symptoms.

2. Autonomic Nervous System Dysregulation: Your history of suspected autonomic dysfunction could indeed contribute to your dizziness. Dysautonomia can lead to symptoms like lightheadedness, especially when standing up (orthostatic hypotension), and can be exacerbated by factors such as dehydration, prolonged sitting, or standing.

3. Obstructive Sleep Apnea (OSA): Given your history of severe obstructive sleep apnea, it is crucial to consider its potential impact on your overall health. OSA can lead to intermittent hypoxia during sleep, which may contribute to daytime fatigue and dizziness. Although you are using a CPAP machine, the pressure settings and overall effectiveness should be regularly evaluated by a sleep specialist.

4. Weight Changes: Your significant weight loss may have altered your body's physiology, potentially affecting blood pressure regulation and contributing to dizziness. Rapid weight loss can sometimes lead to electrolyte imbalances, which can also cause dizziness.

5. Medication Side Effects: If you are taking medications for any underlying conditions, it is essential to review them with your healthcare provider, as some medications can cause dizziness as a side effect.

Management Strategies
1. Regular Follow-Up with Specialists: Since your symptoms are persistent, it would be beneficial to maintain regular follow-ups with both your primary care physician and specialists, such as a neurologist and an ENT specialist. They can help monitor your condition and adjust treatment plans as necessary.

2. Re-evaluation of CPAP Therapy: Given your concerns about the CPAP pressure, it would be prudent to have a sleep study conducted to assess the effectiveness of your current settings. The AHI (Apnea-Hypopnea Index) should ideally be below 5 for optimal treatment efficacy. If your symptoms persist despite appropriate AHI levels, further investigation into your CPAP settings or equipment may be warranted.

3. Lifestyle Modifications: Maintaining a healthy lifestyle can significantly impact your overall well-being. This includes staying hydrated, engaging in regular physical activity, and following a balanced diet. Gradual changes in position (e.g., standing up slowly) can help mitigate dizziness related to orthostatic hypotension.

4. Vestibular Rehabilitation Therapy (VRT): If vestibular issues are suspected, VRT can be beneficial. This therapy involves exercises designed to improve balance and reduce dizziness.

5. Cognitive Behavioral Therapy (CBT): If anxiety or stress is contributing to your symptoms, CBT can help address these psychological factors, potentially alleviating dizziness.

6. Monitoring and Managing Autonomic Symptoms: If autonomic dysfunction is confirmed, strategies such as compression garments, increased salt intake (if not contraindicated), and medications to stabilize blood pressure may be considered.

Conclusion
In summary, non-specific dizziness can arise from various underlying causes, including vestibular disorders, autonomic dysfunction, and complications from obstructive sleep apnea. A comprehensive approach involving regular follow-ups, re-evaluation of CPAP therapy, lifestyle modifications, and possibly vestibular rehabilitation can help manage your symptoms effectively. It is essential to work closely with your healthcare team to tailor a management plan that addresses your specific needs and concerns.

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