Tag Archive: BPPV

Hello, Nystagmus, my old friend

Out of the blue a few weeks ago, I experienced nystagmus when turning my head to the right in bed. It has been ages (years) since I had my eyes jerking around like that. I have no idea what precipitated it.

In other news, since then I have restarted the neck/back physical therapy that I had to stop in 2014 when my vertigo got bad. The first time the PT was working on my neck when I was supine, I felt dizzy. I asked if it was OK for me to place my feet on the treatment table, and they said yes. From that day on, I always bend my knees and keep my feet flat on the table when supine. I also keep my eyes open. My eyes and my feet provide reliable proprioceptive information that counteracts any confused messages sent by my vestibular system. I haven’t felt dizzy on the table since.

Last week I felt distinctly unsteady when I left my PT appointment. I had learned a new exercise that required me to be supine with my head flat on the ground (usually my supine treatments are on a pillow). Then immediately after that, my PT tried to manually adjust my back. I started supine, and as part of the adjustment she rolled me to my right. I felt fine as the appointment ended, but as I walked out of the room I felt unsteady and had to slow my pace. Instead of getting out my keys while walking, as I usually do, I deliberately stopped and took care of that before walking again. I got into the car to drive away and did not notice any more symptoms. Lying flat and turning to the right were big problems when my vertigo was at its worst.

I am doing back & neck exercises and stretches at home, which means I am challenging my vestibular system every day. I have become habituated to many movements over the past four years, but there are still some movements that are outliers–and I am finding them through physical therapy.  Today I nearly fell in the shower, which is alarming no matter how infrequently it happens. I was leaning over and tilted my head to the right in just the right way, apparently, and started to careen over. Thankfully I caught myself, heart pounding.


A family affair

One night a few weeks ago, my spouse awoke at 2:38 a.m. with vertigo. They tried to get up to go to the bathroom, felt the room spinning, and immediately lay back down flat on the bed, their hand scrabbling under the covers to grip my arm. Thus awakened, I asked questions to determine what was going on and then offered advice based on my many months with vertigo. What was frightening to my spouse was old-hat and not at all alarming to me, so I could offer some calming words.

  • I had them put their feet flat on the mattress as they lay there. This provides reliable data for the vestibular system and helps promote stability.
  • They told me that the spinning died down after a few minutes, and I reminded them that the same thing would happen with the spinning they experienced when they sat up. I encouraged them to sit up and then hang in there while the spinning subsided. (First I got a big bowl in case it was needed for nausea!)
  • After they sat up, I held their hand and helped them scoot back so their back was against the wall and then had them bend their knees so that their feet were once again flat on the mattress. This position has been very helpful for me when I am trying to help my body know where it is in space and the data from my eyes is unreliable.
  • I coached them as they got out of bed and moved carefully to the bathroom, suggesting that they put their hands on the door jambs and walls and that they not bend over.
  • I held their hand as they eased back into bed and waited for the spinning to stop.

In the morning, they felt better but not completely well, so I urged caution while exercising and while driving. I have found that if I modify my usual 30-minute exercise routine to accommodate any unsteadiness I feel, I usually feel close to normal by the end of it. Going through the motions and moving my body in a variety of ways seems to help recalibrate my vestibular system.

My spouse said they gained a new appreciation for what I went through during my many months with vertigo. They couldn’t imagine feeling “that way” for so long. Thankfully, their vertigo cleared up by the end of the day without treatment. Whew.

Neglected muscles

I recently experienced excruciating back pain every day for two weeks. It’s a long story, but suffice to say that this was unusual for me. I had a physical therapy evaluation last week and am now working on stretching some specific muscles that had become over tight. I already feel better!

During the evaluation, the PT asked me to flex and extend my back while standing. Although I regularly bend over (my hamstrings are in good shape!), I have not extended my back while standing upright for at least three years because tipping my head back was my most reliable trigger for vertigo. (In fact, a month ago in a different context, a nurse asked me to extend my neck while sitting upright, and I outright refused to do so.) But last week at PT, I leaned back without hesitation because my gut told me that I would be fine. And I was! It felt like seeing a familiar friend again, and I marveled at the flexibility I still had. The PT put me through a series of measures that had me standing, sitting, lying prone, lying supine, and lying on my sides. I moved through them all with no problem. My gut told me to take extra care moving from a prone position, so I did; otherwise, my movements were basically normal.

So that’s the good news. The bad news is that I couldn’t do even one sit up. Not one! The swinging head motion in sit ups is something that I have avoided for years due to vertigo. I’ve been exercising regularly for the past 15 months, but apparently certain ones of my core muscles still need work. For the first time, I realized the impact vertigo had on my overall body strength. Because I could not move and exercise normally, some of my muscles became weak. I modified exercises as best I could and managed to restart a regular exercise program, but still, problems remain. I’d like to see vestibular physical therapy include creative solutions for these types of muscle problems in patients with ongoing balance problems.

Hearing test

I had my hearing tested a few months ago because my wife felt that I was saying “What?” more often, and I myself felt that I wasn’t hearing as well. I knew I had some hearing loss in my right ear — this was officially diagnosed as part of the vestibular testing I had three years ago when all this started. I am pretty sure the hearing loss extends back to my teen years. I remember a school-sponsored hearing test in high school where the technician seemed puzzled and asked me if I had allergies. When I said yes, she relaxed. I didn’t think anything of it at the time, but in retrospect, I believed she was explaining away the hearing loss shown on the test.

In college I was aware of having a “better” ear. This is the one I used for the phone. But instead of viewing my right ear as damaged and my left ear as normal, I thought of my right ear as normal and my left ear as superior! I told myself that I used the phone on my left ear because I wanted my right hand available to write. I was a musician at the time, and I think I was in denial about having hearing loss. Additionally I’ve had phonophobia for most of my life, and I assumed that being sensitive to sound meant my hearing was perfect.

Anyway, back to my recent hearing test. According to the test, my hearing improved slightly. I’m awfully close to the normal range. While I’m happy that my hearing is not worse (I’m guessing that my perception that it is is simply due to my increased awareness–and acceptance–that there is a minor problem), I realize now that I interfered with the test to some extent. During the test, I focused with all my might on the sounds. I closed my eyes to “help.” Sometimes I wasn’t sure if I heard the sound or if my musical training was allowing me to imagine the next pitch, which are played in octaves. Basically, I created an unnatural situation that didn’t mimic real life. I don’t typically close my eyes and focus on sound to the exclusion of all other input. I’m sure we all would hear better if we did! So if I ever have my hearing tested again, I’ll try to strike a balance between “doing my best” and interacting realistically with the sounds.

Getting into bed

Before my 2013 vertigo episode started, I got in and out of bed in a very active way. I was in constant motion as I approached the bed, tucked my hands under the pillow, placed a leg on the mattress, and slid into bed nearly horizontally, ending on my right side. Getting out of bed was similarly fluid: a sudden movement to flip onto my left hip, raise the blanket, and lever upward, then an immediate step forward into walking away. (I should mention how startling this was to my cat if she happened to be sleeping on the comforter!)

All that changed with vertigo. Lying flat was my worst trigger, and going to bed became a nightly torture of nausea and holding on for dear life as the room spun. I got into and out of bed very carefully. Verrrry deliberately. I wake every night to use the bathroom, and I would walk with my arms out, ricocheting off the walls and doors jams as I made my way down the hall.

I believe it was summer 2015–around the time my tinnitus died down–that I found my self climbing into bed with my old habits. Not quite as vigorous, a little caution to be sure, but definitely a flowing move toward horizontal. I realized my nightly walk to the bathroom was more upright, more sure-footed. This was a clear sign of how far I’d come on my path to returning to health and normalcy. A small, but meaningful, sign.

Monday, Monday…

So this morning I got out of bed and noticed right away that I had some vertigo going on. The best way to describe it is to say my eyes felt wobbly. To be honest, things have been a little worse lately, if I can even say that with my symptoms being so mild. Not long ago I was rejoicing in my ability to pull a sweatshirt over my head while walking down stairs (!!) and to duck laterally under a barrier at the airport in order to retrieve my dropped boarding pass. But recently I fell out of balance twice in one day, hit the wall in my stairwell a few times (always when I am turning the corner), and even took off my sunglasses before going down steps. Clearly my vestibular system was struggling.

I decided to try my exercise video this morning and to stop if I couldn’t do it. The routine starts with jogging in place, and I took one step and almost burst out laughing. There was no way I could jog! So I followed the “modifier” on the video and marched in place. I modified many of the moves and found that by the end of the video, I was nearly back to normal. It seems that 30 minutes of familiar, controlled, and constant movement was enough input for my vestibular system to get its groove back.

Update: I noticed a pattern of having vertigo on three of the past four Mondays. At first I thought: gee, am I that stressed out about going to work on Mondays?! But then I realized that I do a yoga exercise routine on Sundays, and in that routine I bend over and put my head straight down for at least 30 seconds. I think that is the problem. I have had this happen before where the trigger and the symptoms are separated by a day. (Lying down in bed seems to exacerbate things.) So  next Sunday I’ll not put my head in such extreme positions, and we’ll see how I feel on Monday.

Later update: it worked! I haven’t had any “Monday trouble” since modifying my Sunday yoga workout.

Boating in the dark

Recently I went out in a kayak for an evening paddle. It was delightful and unremarkable from a vertigo perspective – except for one thing. As the sun set, I noticed that I felt unsteady when I turned my head. I guessed that, in the dim light, my eyes were not getting enough visual information to compensate for the rocking motion of the boat. I stopped turning my head – or at least not as quickly – and after awhile everything seemed back in calibration.

Exercise videos

I’ve been struggling with grief and depression this spring, and I realized at one point that I hadn’t exercised for five months! I hoped to do a triathlon with my Training Buddy in August, but even that was not motivating me. Figuring out my training schedule and dealing with gear and weather was more than I could manage.
I was looking for ways to take care of myself when a triathlon friend of mine announced an exercise accountability group. Perfect! I’ve been doing the 30-minute exercise videos every day and gradually building up my strength. Even dropped a few pounds! I love that the workouts are short, straightforward, indoors, and require minimal equipment. (A far cry from triathlon!)
When I started the video program, I still experienced vertigo every day, but it was mild and momentary. Thankfully, the pace of the videos was such that I could take a few extra seconds to transition between exercises, and sometimes (rarely) I held onto the wall for balance. Almost every workout includes lying on my back, which you might remember is my worst trigger for BPPV. Sure enough, I felt a little dizzy and nauseous when I lay back. Certain exercises with my arms and legs moving simultaneously were disorienting for a few seconds. But after six weeks or so, I felt the dizziness less often when on my back. It seems the short exposure to this trigger several days a week has helped me to improve!

My vestibular physical therapist told me in no uncertain terms that I was to never do backstroke again. She recommended against handstands and back bends. These are the movements that most reliably triggered nystagmus for me.

A year has passed. A few days ago I did a short yoga practice at home. (A co-worker recommended the Runner’s World Yoga Center, and I’ve found the online workouts are short, simple, and easy to modify.) I felt steady. I had the luxury of several days at home, so it wouldn’t matter if I triggered BPPV. I eased up into Urdhva Dhanurasana or upward bow pose. It looks like this:

Nina Mel doing the upward facing bow yoga pose

I don’t think I need to say that this is not me!

I didn’t stay upside down but for a moment, and then I eased back down. Success! Hard to believe it has been two years since I’ve done one of those.

Since I have a few days off of work, I was able to return to my favorite yoga teacher’s class. (I used to attend her evening classes, but now she teaches only in the morning.) I told her I had done a little back bend earlier in the week, so she worked it into the class. Again, I felt steady, and I had plenty of time. The first time I pushed up with too much vigor and felt disoriented. I came down quickly. I did the pose three more times, each time with no symptoms. I moved into the pose more gently, stayed for no more than about 4 seconds, and gently returned to the mat. I had no vertigo the rest of the class or the rest of the day. More success!

Notable progress

I recently installed an eight-foot vertical cellular shade over my siding glass door. First I removed the old shade, and I definitely felt nauseous as I unscrewed the brackets. That made the job a bit unpleasant. I had to wait for my cordless drill to charge, so I finished up the next day. I did not feel nauseous when I installed the new brackets.

Then I spent the better part of an hour down on the floor loading the monstrous shade into the rail. The strings were tight, and it required some fancy handy work with a pliers to complete the final step. I was able to avoid turning my right ear down for the entire job until I reached that last part. I tried to figure out if I could use my belay glasses, but there really was no other way. So I laid my ear right down on the floor so I could see up inside the rail. A few more twists and turns, and I was ready to hang the shade.

Which I did.

So let’s recap. I triggered the vertigo when I looked up to remove the brackets. The next day I looked up to install new brackets, then put my right ear down, then looked up to hang the shade. And I had no vertigo or related problems that day or the next! This is notable progress indeed.