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What causes dizziness when standing up?

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When i wake up in the morning, upon standing I feel off balance most of the time, but I feel it throughout the day as well. I am a homebound agoraphobic and have been so cine this past October, so I get panic attacks almost every day as well as high anxiety. But as for the off balance feelings, it feels like I'm tilting one way sometimes or floating like in an elevator. I've never fallen or vomitted from this, but these sensations really scare me. They've been on and off the past 4-5 months. Also, i've had blood work done that came back normal, blood pressure normal as well and also sugar levels normal. Also, these feelings seem to get worse when I'm more anxious or put in a situation that makes me anxious. Thank you for your help!
Posted Mon, 3 Mar 2014 in Ear, Nose and Throat Problems
 
 
Answered by Dr. Sumit Bhatti 1 hour later
Brief Answer: As below: Detailed Answer: Hi, Thank you for your query. 1. It is important for you to undergo an examination when you are dizzy. 2. Feeling dizzy when standing up when you wake up in the morning may be due to BPPV (Benign Paroxysmal Positional Vertigo). This is treatable without medication. In this condition, hearing is usually normal. Has your hearing been tested? 3. Feeling dizzy throughout the day is more likely due to a central cause for vertigo. There are many causes for this kind of vertigo. Medication can be used to decrease this vertigo. 4. Vertigo worsening with anxiety, in certain places or situations may be related to phobic positional vertigo. 5. You may follow up here with the results of your investigations, examination results and clinical findings for further advice. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
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Follow-up: What causes dizziness when standing up? 47 minutes later
Hearing is normal from testing, and no blurry vision. I do get panic attacks that worsen the symptoms. Also when i wake up in the morning, I'm often very agitated and shaky from anxiety, which makes getting out of bed hard as well.
 
 
Answered by Dr. Sumit Bhatti 30 minutes later
Brief Answer: As below: Detailed Answer: Hi, Thank you for writing back. 1. There are many physical attributes that I am unaware of on this forum. For example, what is your weight? 2. I would rule out any sleep disordered breathing and snoring, since you feel agitated and shaky on waking up. 3. A Cardiac evaluation and a 2D Echocardiography may help rule out a common condition such as a MVP (Mitral Valve Prolapse), which would cause similar symptoms. 4. A polysomnography would detect longer REM sleep associated with dreaming or interrupted sleep due to sleep apnea, which would cause agitation and shakiness on waking up. 5. Do you have any abdominal complaints? I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
Above answer was peer-reviewed by
 
Follow-up: What causes dizziness when standing up? 22 minutes later
i'm 1.79meters and weigh 185 pounds, but not fat more muscle. I've had my heart tested, everything normal. and no stomach aches or any pain whatsoever. I drink plenty of water throughout the day too. But I could be walking to the bathroom and be totally fine, then start to feel anxious and get that dizziness feeling again. And I don't lean to only one side, sometimes it feels like I'm leaning left, sometimes right and sometimes like I'm being pushed forward. If there's any more information you need, I'll be happy to provide it.
 
 
Answered by Dr. Sumit Bhatti 52 minutes later
Brief Answer: As below: Detailed Answer: Hi, Thank you for writing back. 1. Your current BMI (Body Mass Index) places you in the overweight (not obese) category. 2. Hence you may get a Level I Polysomnography (Sleep Study) done. 3. Is there any hyperventilation preceding the unsteadiness? Have you been given a trial of anti-anxiety medication and anti-vertigo medications? 4. Ear related dizziness usually does not appear when walking unless there is up or down head movement while in the bathroom. Have you noticed any head movement preceding the attack? Is there any latent period? What is the duration of the attack when it occurs? If you close your eyes, can you hold your upright position without support? 5. Gastritis or silent acid reflux may cause a similar issue. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
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Follow-up: What causes dizziness when standing up? 9 minutes later
If I'm in the bathroom, sometimes starring at something I might get an episode. I can close my eyes and maintain balance even though I feel like I'm swaying at times. Yes my therapist has told me I hyperventilate many times throughout the day because of my anxiety. I do notice my breathing change somewhat before I start to feel dizzy. My BMI is considered overweight, but I played sports before this homebound episode happened. Attacks usually last a few seconds to a couple minutes at the most, then anxiety kicks in and makes it worse. I take no meds for anything.Also, when I do start to get dizzy and very anxious, I feel my face start to get pressure like sinuses and my neck ad back muscles tense up a lot.
 
 
Answered by Dr. Sumit Bhatti 31 minutes later
Brief Answer: As below: Detailed Answer: Hi, Thank you for writing back. 1. Get a plain CT Scan of your nose and sinuses along with an MRI Brain done. If you have nasal congestion, get a post decongestion (with Xylometazoline nasal drops) CT done. 2. Get your Calcium, Vitamin D and B12 levels checked. Do you have any other blood investigations, blood pressure readings? Have you cleared a neuro examination? I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
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Follow-up: What causes dizziness when standing up? 1 hour later
I did have an upper resp. infection 3 weeks ago, lasted about a week with a low grade fever of 99-101F. I still have some phlegm and cough, but its getting better now.
 
 
Answered by Dr. Sumit Bhatti 7 hours later
Brief Answer: As below: Detailed Answer: Hi, Thank you for writing back. 1. Well, such a history would add a viral infection to the list of probable causes. 2. A mild vestibular neuritis will eventually settle down since the symptoms are decreasing. 3. To speed up the recovery, request a physician to treat the URTI (Upper Respiratory Tract Infection) since you had fever. I hope that I have answered your query. If you have any further questions, I will be available to answer them. Regards.
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