Dizziness lying down
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Dizziness When Lying Down: Causes and Diagnostic Insights
Prevalence and Symptoms of Dizziness in the Elderly
Dizziness when lying down or turning over in bed is a common complaint among the elderly. A study involving 498 individuals aged 70-85 years found that 29% reported dizziness, with 10% specifically experiencing dizziness when turning in bed. Among those examined, 6 out of 22 were diagnosed with benign paroxysmal positional vertigo (BPPV), indicating that positional dizziness is a significant issue in this age group .
Benign Paroxysmal Positional Vertigo (BPPV) and Diagnostic Indicators
BPPV is the most common cause of vestibular vertigo, characterized by brief episodes of rotational vertigo triggered by changes in head position, such as lying down or turning in bed. A study highlighted that asking patients about dizziness when turning in bed can significantly increase the likelihood of diagnosing BPPV, with an odds ratio of 60 . This suggests that specific questions during medical history taking can be crucial for early identification of BPPV.
Lying-Down Nystagmus in BPPV Diagnosis
In cases of horizontal canal BPPV, lying-down nystagmus can help lateralize the affected ear. A study of 54 patients showed that nystagmus induced by lying down tends to beat toward the involved ear in apogeotropic BPPV and toward the healthy ear in geotropic BPPV. This finding can assist clinicians in accurately diagnosing the affected side in horizontal canal BPPV .
Hemodynamic Orthostatic Dizziness/Vertigo
Hemodynamic orthostatic dizziness/vertigo is another condition that can cause dizziness when changing positions. It is characterized by dizziness triggered by standing up, which subsides upon sitting or lying down. Diagnosis requires documentation of orthostatic hypotension or postural tachycardia syndrome. This condition is distinct from BPPV and requires different diagnostic criteria and management .
Treatment Approaches for Motion-Evoked Dizziness
For patients with intractable motion-evoked dizziness, including possible BPPV, a combination of head-up sleep (HUS) and vertical recognition training (VRT) has shown promise. A study involving 162 patients found that those who underwent both HUS and VRT reported significantly lower vertiginous sensations compared to those who did not receive these interventions. This suggests that HUS and VRT can be effective initial treatments for undiagnosed motion-evoked dizziness .
Risk Factors and Multifactorial Assessment
Dizziness in middle-aged and older adults can be influenced by various factors, including vestibular disorders, cardiovascular conditions, anxiety, and postural sway. A multifactorial assessment that includes these factors can help identify individuals with significant dizziness handicap and tailor appropriate interventions. For instance, a positive Dix-Hallpike test for BPPV, cardiovascular medication use, high postural sway, and anxiety were significant predictors of moderate to severe dizziness handicap 67.
Conclusion
Dizziness when lying down is a multifaceted issue, particularly prevalent among the elderly. BPPV is a common cause, and specific diagnostic questions and maneuvers can aid in its identification. Hemodynamic orthostatic dizziness/vertigo and other risk factors also play a role in dizziness symptoms. Effective management may include targeted treatments like HUS and VRT, and a comprehensive assessment of contributing factors to provide tailored interventions.
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