Yesterday morning I sat up to get out of bed and was dizzy. Sitting in bed.
I thought, “That’s new”, and then “That’s not good”.
Right on both counts.
See epilogue on vitamin D.
To cut to the …
Vertigo. An inner-ear problem. Benign paroxysmal positional vertigo (BPPV). When in doubt, see what the Mayo Clinic says. And Cleveland Clinic.
You have rocks in your ear. Little tiny bits of calcium carbonate. They help form your innate accelerometers. But sometimes, they break off and bits of them travel. Particularly if you are old.
If they end up in your circular canals — where your sense of balance hangs out — then, in various ways, the stuff hits the fan, balance-wise. Anything from instability when standing, to full-out puking-as-the-room-spins.
But, per Mayo, above, one can use the Epley procedure to try to move the offending rock chips back to where they belong. Or, at least, to where they’ll do no harm. Or something.
The Epley procedure.
The Epley looks benign enough, per the writeup at the Cleveland Clinic. Turn your head to one side, lie down, turn head and torso in the other direction, sit back up. Three of that, and you’re done.
Weirdly, there appear to be at least two reputable versions of the Epley procedure. I would characterize one of them as emphasizing speed at some phases of the operation (the Cleveland Clinic version), versus a go-slow, wait for the symptoms to clear, then hold-each-pose-for-half-a-minute method (which is how I read the Mayo version). Citations above.
As the potential puke-er and puke-ee, I chose the Cleveland Clinic get-this-sucker-over-with version of the Epley. Even with that, I aborted one attempt. Couldn’t follow through on it. Had to sit up and hope it went away.
What they don’t tell you is that the first maneuver — tilting your head that way, and lying flat — that’s designed to set this whole vertigo thing off, about as hard as it can be set off. In my case, right on up to — but not passing, thanks to aborting one of the attempts — the puke level.
For me, at some point, doing the Epley maneuver was very much like stifling a gag reflex. At least, doing it the second and third times was. Doing it the first, time, you don’t know quite what’s coming. But you are intentionally causing something solid to strike the extremely sensitive nerve cells in your circular canals — a place where only fluids should abide. The nerve cells in your inner ear REALLY don’t like that, and they let you know accordingly.
I made it through the recommended three Epleys, start to finish, but I was nauseated and sweating heavily for the next half-hour.
I would not have voluntarily undertaken a fourth.
But first, which ear/side is the problem?
Oh, golly, you’ll know. Put some pillows on your bed, turn your head 45 degrees to one side, and lay back on your pillows. (Essentially, do a half-baked version of the first step of the Epley procedure). If this problem — an otolith — is in that downward-facing ear, this should trigger vertigo. Be prepared.
Retold: First figure out if you have this problem, and which side it’s on, by the “lay back on pillow” method just above. The vertigo was clear as a bell for me, and then some. And then, proceed to the full Epley, if needed, and if and as able.
A key risk factor
I saw a doctor about it today, and she mentioned that a visit to the dentist is a risk factor for this happening. Something about the lie-back-and-say-aah position opens up a path for these to little calcium carbonate chips to escape into the circular canals.
I further note that one of the Epley procedure writeups emphasized the importance of hyperextending the neck, for bringing the head at least to fully flat, and beyond flat (hanging off the edge of the bed),within reason, if possible.
Finally, I note that I’ve recently taken to lying down completely flat, in bed, for extended periods. Basically, I’ve been trying to sleep on my back, without a pillow. And the morning when this started, I sat up quickly, directly from that position.
And was dizzy. From an escaped otolith.
Coincidence? I think not.
I think the moral of the story for me is don’t do that. Don’t sleep flat on your back, with no pillow, and if you do, don’t go from that position to fully upright in one motion.
R-E-L-I-E-F
Some people get what is described as “immediate relief” from the problem, after doing a set of three Epleys. It goes away, just like that.
No such luck here.
But the gross symptoms finally disappeared that night. Sometime in the middle of the night, I stopped getting dizzy if I turned onto my right side.
Once you get comfortable with this, it’s pretty weird. For example, there’s about a three-second delay between turning over, and getting dizzy. And then the episode of dizziness stops. No idea why there’s that little delay, no idea why it stops, but plausibly both are related to the movement of my wandering otolith.
My balance still doesn’t feel A-1.
So what else is new.
(But seriously, there seem to be lingering effects. Not the room-spinning vertigo of the acute phase (apparently caused by/associated with involuntary eye movements (nystagmus). But seemingly more balance issues than usual. Or I’m noticing it more than usual.)
Conclusion
A reminder of frailty is never fun.
I’m trying to take renewed joy in (e.g.) being able to walk around.
But, whatever happens, I just have to live with it.
That’s a fact of life. Doubly so with age.
Epilogue: I’ll take some vitamin D with that.
It’s unsurprising that vitamin D might play a key role here, as the same bone-building mechanisms that occur throughout your body also apply to the bones, rocks, and minerals in your inner ear.
Anyway, that’s my vitamin D level, above. Barely sufficient, as of two days ago.
I realize that one of the risks of eating few calories for weight loss is a high risk of missing critical nutrients. I realize that vitamin D levels drop in winter. And this, being roughly the end of winter, should mean that they are about as low as they are going to get.
But how can I have low vitamin D levels, when I eat (a small portion of) salmon a couple of times a week? If you ask Google for foods that contain a lot of D, salmon is right at the top of the list.
Surprise. Wild salmon has a fair bit of vitamin D. Farmed salmon does not. The assertion that salmon is a good source of vitamin D is based on the USDA data, which in turn are probably so old they predate the widespread practice of salmon farming.
The upshot is that I’ve added few thousand units of vitamin D supplements to my daily routine.
I can’t blame the problem on low vitamin D. But it surely doesn’t help. And the lack of D in my diet is cheaply and easily correctable.
