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Sleep and Vestibular Issues


#1

I’ve been thinking quite a bit about the relationship between sleep and an increase in dizziness and ear symptoms. I recall reading posts from people who believe their dizziness IMPROVES when they sleep LESS. This seems counter-intuitive at first glance. I’m wondering, however, if some of these people have undiagnosed sleep apnea, which can cause a cascade of vascular events possibly resulting in vestibular problems.

I know that there is a clear association between sleep apnea and Meniere’s Disease, and, in some cases, symptoms improve with treatment via CPAP. Sleep apnea may cause an increase in blood viscosity (thickness) by stimulating production of more red blood cells, the cells that carry oxygen in the blood. (Lack of oxygen during sleep apnic events triggers the body to create additional RBCs to facilitate transportation of more oxygen.) Sleep apnea has also been linked to platelet activation, further increasing the blood’s viscosity. I’m speculating that the increased viscosity of the blood prevents proper perfusion (flow) of the blood into the small blood vessels in the inner ear causing faulty signals to the brain, resulting in dizziness and tinnitus.

Moreover, I’ve also read about chemical reactions that occur upon awakening that increase platelet aggregation. If someone has sleep apnea and repeated micro-arrousals due to lower oxygen levels, snoring, or whatever, I wonder if the platelets in the blood tend to clump repeatedly during the night leading to ischemic (blocked vessels) events in the blood vessels in the inner ear. In those with this tendency, perhaps NOT sleeping prevents these ischemic events indirectly and allows continued and appropriate blood flow to the inner ear.

Again, this is all just my theory. I found recent posts by folks on this board fascinating, especially the ones regarding polycythemia (increased hemoglobin/hematocrit) and its association with dizziness/tinnitus, and the post regarding Dr. Carol Foster’s (ENT in Colorado) theory regarding a possible intersection of two events as a cause of Meniere’s Disease: 1) hydrops; and 2) a vascular event.

As an aside, I have an appt on Monday with my ENT to discuss sleep apnea as a possible explanation of my increased red blood cell and H and H counts for the past two years. (I’ve further been told I snore like a freight train, despite my petiteness.) As nutty as it sounds, as an experiment, yesterday I donated a pint of blood for the first time to see what, if any, impact it would have on my symptoms. (My hypothesis was that donating blood would decrease the viscosity- thickness- of the remaining blood by ridding the body of red blood cells, thus allowing the blood to perfuse the inner ear blood vessels properly.) This morning, I woke up without tinnitus for the first time in almost two weeks! Perhaps a coincidence, but I’m really starting to not believe in coincidences!

Anyway, sorry for my ramblings. Not sure if any of this helps anyone at all, but just thought I would throw my speculations out there in case it gets someone else thinking creatively regarding the etiology of their symptoms.


#2

Very interesting thoughts!

The otoneurologist I saw long ago, when I told him about the weird thing of being better with less sleep, actually wondered aloud if I could have sleep apnea, thinking that maybe I wasn’t getting enough oxyen while sleeping and thus felt better with less sleep. He said it would “interesting” to do a sleep study, but he never mentioned this again.

I don’t think this theory makes complete sense for me, though, because when I get “too much” sleep I don’t WAKE UP dizzier and foggier–I only get that way after I’ve been moving around more than a little bit. So, it’s a matter of more MOTION SENSITIVITY, and the resulting fog/dizziness due to movement, when I get more sleep.

My husband says I snore, but that I don’t wake up gasping. AFAIK, I don’t have sleep apnea.

I remember that on the dizziness mailing list I was a member of (this was also many years ago), one woman who’d had unexplained dizziness for a long time got complete relief from starting Plavix. Maybe she added aspirin, too. They apparently concluded her problem was too many platelets, or sticky platelets, or something.

Re blood donation, until last year I donated blood fairly regularly for quite a few years, and I never noticed any change whatsoever in my symptoms after a donation. I DID always have a reaction of suddenly becoming very hot/sweaty, woozy, nauseated, and faint near the end of the donation, but I learned that if I just asked them to put my head down as soon as they got the needle in and taped up, that reaction wouldn’t happen. (I learned to bring my own pillow, and of course to sit up slowly, in stages, afterwards.)

I hope we hear more about this more sleep–worse dizziness thing. There’s definitely something going on there.

(Although I will say that I have been considerably less dizzy/foggy/woozy even with plenty of sleep lately–possibly because of being on nortriptyline, now two months into the trial. We’ll see if this keeps up!)

Thanks for posting this info!

Nancy


#3

Nancy, I don’t believe sleep apnea is the entire cause of my issues either. But, I do wonder if it plays a supporting role. I know without any doubt that injury to the facet joints in the upper part of my neck also plays a huge part.

If Dr. Foster’s theory is correct, I may have caused the perfect storm creating a Meniere’s-like condition (secondary hydrops??) by 1) injuring my neck starting a chain reaction of inflammation resulting in hydrops in the inner ear, per the theory set forth by Dr. Franz, an Australian ENT, **AND **2) a vascular event (viscous blood caused by sleep apnea).

Who knows if I’m right? I do feel, unfortunately, that it is up to me to keep looking at it from different angles and trying new approaches since most doctors don’t have the time or energy or vested interest in my specific problems to really get creative and try to put the pieces of the puzzle together…


#4

Hi KennedyLane,

I have also been pondering how sleep may be affecting my migraines. I am one of those people that feels better with less sleep. Sleep Apnea runs in my family, which makes me at-risk for having it. I also have enlarged tonsils, which is another factor that puts me at-risk for Obstructive Sleep Apnea. I actually had an at-home sleep test done a couple of weeks ago and will be finding out the results soon.

-Kristyn


#5

— Begin quote from “KennedyLane”

Who knows if I’m right? I do feel, unfortunately, that it is up to me to keep looking at it from different angles and trying new approaches since most doctors don’t have the time or energy or vested interest in my specific problems to really get creative and try to put the pieces of the puzzle together…

— End quote

Boy, ain’t that the truth… so many of us have to figure things out pretty much on our own.


#6

Wow, this thread is really interesting Kennedy.

Thanks for bringing it up.

Kristyn, I’m really interested to learn what your test results say too.

— Begin quote from “Kristyn”

Hi KennedyLane,

I have also been pondering how sleep may be affecting my migraines. I am one of those people that feels better with less sleep. Sleep Apnea runs in my family, which makes me at-risk for having it. I also have enlarged tonsils, which is another factor that puts me at-risk for Obstructive Sleep Apnea. I actually had an at-home sleep test done a couple of weeks ago and will be finding out the results soon.

-Kristyn

— End quote


#7

Here is an excerpt from Dr. Carol Foster’s website. (She is a neuro-otologist in Colorado) I bolded for emphasis a few sentences below:

"A large percentage of people with Meniere’s disease also have migraine, and this is particularly true for those with a family history of Meniere’s disease. Migraine is genetically mediated (see Migraine and dizziness) and rarely causes permanent damage to the ear. However, in some migraine cases a typical Meniere’s syndrome develops. One autopsy specimen on a migraine patient with Meniere’s disease showed that endolymphatic hydrops was present in the affected ear . This suggests that the combination of hydrops with migraine, and not migraine alone, can cause Meniere attacks. ** Sleep apnea, a snoring problem with pauses in breathing during the night, is strongly associated with Meniere’s disease. This disease, like migraine, is a vascular risk factor. Many other vascular risk factors, such as autoimmune disease, hypertension, and diabetes, have also been associated with Meniere attacks. It is probably a combination of hydrops with vascular risk factors of many different types that set off these attacks.
**
Treatment is aimed at either reducing the hydrops, reducing vascular risk factors, or accelerating the process of vestibular damage so that vertigo spells cease sooner. No treatment has been shown to stop the progression of the hearing loss. Patients suspected of having the migraine-associated type may be managed with migraine prophylactic medications. A low-salt (reduced sodium) diet has been used for decades and seems helpful in many sufferers. Diuretic medications help remove sodium from the body, and are felt to be useful in reducing the fluid pressure in the ears associated with endolymphatic hydrops. They also help control hypertension, a vascular risk factor. When symptoms flare, steroids may be given by mouth or injected behind the eardrum to calm the process**. Patients with sleep apnea often improve once their condition is treated with CPAP, an assisted breathing machine. "**

mariondowns.com/menieres-disease


#8

Not to be obsessed by the concept :), but I have another thought about the possible connection between sleep and dizziness. I recall a conversation with a head-pain dentist specialist who told me that micro-arrousals in sleep (possibly caused by sleep apnea or acid reflux?) are associated with an increase in bruxism- teeth grinding.

I wonder if bruxism can cause issues with the eustachian tube due to over-use/tightening of muscles that control the tubes. I have read many accounts of people with dizziness who also complain of crackling or popping, possibly due to eustachian tube dysfunction. There are many who believe ETD causes dizziness.

I do know that for me, when I take a muscle relaxer or phenerghan, which puts me out, I am MUCH less likely to have tinnitus the next morning. Perhaps a deep sleep decreases my bruxism, which I’ve been told I have, and allows a night for those ET muscles to relax.

A couple months ago, I told my ENT how my tinnitus resolves when I drug myself into a good night’s sleep. She told me she experiences tinnitus on her surgery days due to jaw clenching.


#9

I have MAV and was diagnosed with mild obstructive sleep apnoea a couple of years ago. I had a nasal septoplasty (operation to correct a deviated nasal septum) last year and it seems to have cured my snoring. I’m having an overnight sleep study next week to see if I still have apnoea.

I also tend to feel better (although tired) on less sleep.


#10

Hi!

So my at-home sleep test came back negative. My doctor wants me to do an at-clinic sleep test though just in case my tonsils are interfering with sleep. It’s good news that I do not have Obstructive Sleep Apnea, but I still have to figure out why I am getting migraines everyday.


#11

I have my sleep-study scheduled for tomorrow night. I am such a light sleeper, I am concerned about not falling into a deep sleep and not getting a valid test.

On another note, I had another CBC drawn yesterday to test my red blood cells and H and H after my blood donation a week ago. As expected, my RBC and H and H are now in the normal range, where they had been elevated for the past couple of years. I have had a headache and been short of breath ever since. Apparently, my body had accommodated to the higher levels, and I am now feeling the effects even though my counts are now in the “normal” range. They are obviously low for what my body is used to…

I have a vacation to Cusco/ Machu Picchu, Peru coming up -elevation 11,200 feet (3,400 meters), and I am eager to regenerate my RBCs to avoid altitude sickness. Great timing!


#12

I had my sleep study over the weekend and received a phone call this morning from the sleep center confirming the test showed moderate obstructive sleep apnea. I was not at all surprised by the results since I’ve felt for some time I have breathing issues during sleep. However, I am ecstatic to have objective confirmation and now a treatment plan in the works.

I’m going back to the sleep center for another night later in the week so the tech can titrate the CPAP pressure to my needs. Hopefully, the device won’t be so uncomfortable to interfere further with my sleep.

I had a sleep study done about a year ago, but that test was negative. The problem then was that I woke up almost 100 times during the night and spent only a few minutes in REM sleep. The environment was so foreign that every little thing woke me up. I knew at the time the test was not valid. This time, I took 10 mg Ambien and slept soundly all night. I’m going to do the same for the study scheduled at the end of this week.

Now, I do not know if using a CPAP and getting sound, uninterrupted sleep will help my dizziness (although I suspect it will to some degree), but I am forever grateful for the sharing of information this board facilitates. I’ve known for a couple years that my red blood cell count and hemoglobin and hematocrit have been elevated, yet no doctor has ever mentioned the possible significance of this. After reading a post from RobertGreen (?) a couple weeks ago discussing his diagnosis of polycythemia, I started reading regarding the possible causes for this condition. That’s when I put together my abnormal CBCs and my sleeping issues (snoring, constantly waking up during the night).

I believe strongly that most patients should not rely solely on their doctor to help them recover. My experience has been that many doctors are set in their ways, and if they didn’t learn it in medical school, it doesn’t exist and “it” won’t help. I can’t tell you how many doctors I’ve seen where when sharing various research articles I’ve discovered, they simply shrug their shoulders and say “We just don’t know,” or look at me with contempt for suggesting a treatment or cause of which they were not familiar. (Naturally, there are some doctors who are “cutting-edge” and are willing to expand their knowledge beyond what their initial training involved, so I don’t want to lump all physicians in the same category… However, after being married to a physician for many, many years, I’ve gotten to know a bunch of his colleagues on a personal level and now understand they are not omnipotent and all-knowing. Their word is not final.)

I really hope everyone on this board continues to share their experiences and thoughts regarding the cause/causes of their health issues. It may be just the spark someone else needs to help put together pieces of their own puzzle.


#13

Just another follow-up… I’ve been using a CPAP machine at night for a week now. It’s set at a pretty low setting (6), but it really seems to be what I need to keep my airway open during sleep. It has not been difficult at all to get used to the machine, except the nasal mask is a little weird and looks EXTREMELY sexy! :slight_smile:

The main thing I’ve noticed since starting the CPAP is that my tinnitus is MUCH improved. I went almost three weeks without a break in the ear ringing just prior to starting the treatment. During this past week, I’ve had no tinnitus for five days and tinnitus for two days although it was MUCH quieter than before. I did use Ambien to get to sleep the first two nights of using the CPAP. (In the past, I’ve noticed a strong correlation with using a med with sleep as a side-effect and a relief from the tinnitus.)

It’s hard to say whether the dizziness has improved due to the CPAP. I had some terrific weeks (maybe 90-95% back to normal) in January after getting more neck injections, and then the dizziness came back along with burning and pressure sensations in my occipital nerve pathways. Since using the CPAP, the dizziness has improved every day, but it’s hard to say if I would have been feeling better even without CPAP therapy.

Anyway, I’m so glad I persisted in getting a diagnosis of obstructive sleep apnea. It (OSA) certainly explains my horrible snoring, constant fatigue and elevated red blood cells.


#14

Congrats on getting the diagnosis and treatment for your sleep apnea! It’s bound to make some things better. How the treatment affects your various problems should become clearer over time. It can only be a good thing to be getting better sleep!

One way I know I’m really underslept is that my tinnitus is louder.

Good luck and keep us posted!

Nancy


#15

I’ve now been using cpap on and off for the last 5 weeks - consistently for the last two.

I started off with a two week trial from 01 April. The first week I hardly used it and struggled to adapt psychologically. The second week I managed to use it quite a bit more. Over the two weeks I averaged 2 hours a night. Technically I failed the trial, but in terms of alertness I was feeling much better so the sleep technician agreed to extend the trial for another 2 weeks.

Over the last two weeks I think I’ve been averaging between four and five hours a night. My tiredness is much reduced (although I still yawn a lot) but cognitively I feel amazing. My alertness is increased and my ‘incredible’ performance at work has been commented on. My depression/anxiety is also much less. My restless legs seem much better - perhaps reduced by 50% if not more.

The dizziness? I’d say it’s reduced by about 10-20%, which is encouraging. My trial finishes on Sunday when I have to give it back - I’ll probably then have to wait a few weeks to get my own machine.

The problem is I have very mild apnoea. My apnoea hypopnea index reading is 5.4 - 0-5 is normal and 5-15 is mild apnoea. Unfortunately, it does seem to be playing a role and CPAP is helping. The problem is I’m 28 and don’t want to have to use the machine for life. I’d be fine with it if I were older or married, but I’m single and don’t see that changing with CPAP.

I should be glad I’ve found something that helps - and I am - but it brings with it a whole set of problems.


#16

Hmmm… This is an interesting line of thought. Back when my VM started, I was having some sleep issues (couldn’t sleep at all during the night), so I was referred for a sleep study. (How many doctors did I see about the many issues I was having including sleeplessness, and not one even suggested it could be related to the 2 corticosteroids I was on at the time for my asthma and allergies - sheesh). Anyhow, before I figured out the cause of my sleeplessness on my own, I had a sleep study done. They did find that I have a mild case of sleep apnea. Or at least I did at that point. (It was 3 years ago…) Not sure I do now. (Back then, I occasionally woke up gasping for a breath - freaky. I don’t do that any more, though. Haven’t in a long while.) Anyhow, the doc said it was such a slight case that he doubted my insurance would cover a CPAP machine, which, let’s be honest, I had no interest in being hooked up to every night anyhow. But, wow, if it’d help with the VM, that sure would make it worth the annoyance.


#17

Your story is similar to mine Erika - I was diagnosed with mild apnoea 3 years ago. I was given a jaw advancement device but unfortunately it caused awful jaw pain so I stopped using it. I didn’t think my very mild case of apnoea could possibly be causing or contributing to MAV until a very experienced ENT doctor made the link.


#18

I dont think sleeping less improves diziness. I would rather say , sleeping well improves your attention,makes you sharp to survive the day. research shows that, people who sleeps less are more irritable,dizzy and unable to concentrate compare to the people who get enough sleep.Now there’s no magic numbers for that. But usually we need 6-8 hours of sleep a day.

Apu


#19

Wow. Last month my routine CBC came back with high RBC count. My doc had me hydrate and come back 4 weeks later and it was ok.

But now I wonder if dehydration (other meds make me prone) plus sleep apnea (which I probably have) are causing MAV?

Has anyone had relief of symptoms after cpap?

Also, does it seem strange I would have this RBC issue on blood thinners (for life)? I never thought to ask.

It never fails I have an ah ha moment on this board. Ty Kennedy for this!


#20

Any help with vertigo?