Dementia, stress or low blood pressure? What your dizziness means and how to fix it

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It’s eight o’clock on a Tuesday morning and I’m wobbling across my bedroom like a tentative toddler. The floor dips beneath me and I lurch to grab the door frame for support. An onlooker might guess I’ve been partying hard, but hungover I am not.

In recent years I have developed Benign Paroxysmal Positional Vertigo (BPPV), which, in everyday language, is a condition which means the tiny calcium crystals which naturally sit in my inner ear become dislodged and mess up the balance messages sent to my brain. It usually occurs in the morning, triggered by me rolling over in bed.

Although it isn’t serious and it tends to ease off after a while, I really don’t like it, or the feeling of nausea that follows – and I wouldn’t want to be standing at the top of the stairs when it happens. On the occasions when it persists, I resort to what’s called the Epley manoeuvre to ease the symptoms – but more of that later.

Why do we feel dizzy?

Joseph Manjaly, consultant otologist and ENT surgeon admits, “Dizziness, especially in older patients, is complex. There are so many factors and various body systems involved. A person will feel well-balanced when their brain is successfully processing input from the eyes, inner ears, and feeling in the feet and joints. All of these organs are nourished by the cardiovascular system (heart and blood vessels) and influenced by the endocrine system (hormones and metabolism). If any of these systems malfunction, your balance can be thrown.

“As a general starting point, if your dizziness means you experience a light-headedness or you feel faint, it would be sensible to investigate cardiovascular problems first. But if it’s a rotatory vertigo sensation, like a spinning feeling, that would more likely be about the ears.

“The inner ears have fluid-filled canals with lots of tiny hairs that move with movement. When this happens, the brain understands you are in motion. If the system gets irritated, it can misfire or stop functioning altogether, causing your brain to be confused and resulting in vertigo.”

Other factors that can also cause giddiness include dehydration, certain medications, UTIs, hunger (low blood sugar), cataracts and even the wrong glasses prescription. And so, it’s important to understand why you suddenly get the “whirlies” to prevent ongoing illnesses and debilitating side effects like serious falls, isolation and depression.

The last time I had a bout of BPPV, I tripped over the cat and nearly hit my head on the corner of a heavy wooden table. Sitting on the floor afterwards, disorientated and shaken, I knew I’d only just avoided an emergency call out.

Dizziness affects one in three older adults in the UK. These are the conditions that might be tipping your world off kilter.

BPPV

Manjaly explains, “BPPV happens when crystal debris becomes dislodged within the inner ear chambers. It is not always clear what causes this, but there are associations with head injury, recent surgery or other inner ear disorders. It can happen alongside migraine, or with age as the inner ear deteriorates over time.

“With sudden movement, like bending down or turning over in bed, the tiny calcium crystals can shift and drift into the semicircular canals, affecting balance. The vertigo is brief, maybe seconds or minutes. Diagnosis can be achieved with the Dix-Hallpike manoeuvre to reposition the crystals.

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Treatment: “Doctors generally advise the Epley manoeuvre (guided head movements), carried out by an ENT specialist, audiologist or GP – often the patient is taught to perform this at home. Usually, a couple of sessions are enough to relieve the symptoms.”

There are also some studies which suggest Vitamin D deficiency can increase crystal formation in the ears. Sufferers may be recommended to have a blood test and advised to use supplements to help reduce reoccurrence rate.

Vestibular neuritis

This condition is no walk in the park. The severe spinning sensation can last for hours, days, even weeks and is often accompanied by nausea and vomiting. It is thought to be caused by a viral infection which inflames the vestibular system in the inner ear, and perhaps the vestibular nerve, affecting balance and walking. Initially, treatment involves rest, lots of fluids and anti-sickness medication.

Treatment: Steroids can be prescribed to reduce the inflammation. If vomiting is severe, the patient may need to be hospitalised. There is significant crossover with the symptoms of a stroke, so it’s important to rule this out in severe cases, or when hearing is affected. If the after effect of vestibular neuritis continues, physiotherapy can help.

Manjaly says, “It’s about retraining the brain to be rebalanced via other sources. For example, if the inner ear isn’t working as well, the brain can be encouraged to take more guidance from the organs that are still efficient, like the eyes or the feeling in the feet.”

Labyrinthitis

Symptoms are very similar to Vestibular Neuritis, and so treatment generally follows the same route, with the crucial addition of steroids to rescue permanent hearing loss. Labyrinthitis can be caused by a viral or bacterial infection of the labyrinth in the inner ear.

Treatment: If the cause is bacterial, antibiotics will be given. The main difference is hearing loss and tinnitus. If the hearing doesn’t improve, a hearing aid or implant may be recommended.

Meniere’s disease

Caused by a build-up of fluid in the inner ear, a person’s balance and hearing can be severely impaired. Vertigo attacks are chronic and often accompanied by fluctuating hearing loss, tinnitus and a feeling of pressure in the ear. There is not always an easy cure, and the focus is on treating the individual symptoms. Manjaly adds,

Treatment: “Lifestyle changes have traditionally been recommended: less alcohol, salt and caffeine to help reduce fluid, although the evidence base for this is limited. Steroid injections can be used for the hearing loss and dizziness. For those really struggling, a hearing aid or cochlear implants can help, and in a small number of cases, surgery for dizziness is undertaken.”

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The more serious conditions that might be causing dizziness

Heart problems

Ruth Goss, senior cardiac nurse at the British Heart Foundation says, “Dizziness is sometimes linked to cardiovascular disease. If you experience dizziness – especially if it occurs alongside other symptoms such as chest pain, palpitations, or shortness of breath – it’s important to seek medical advice.

Many heart conditions, including abnormal heart rhythms and low blood pressure, can cause dizziness (the blood flow and oxygen levels to the brain are compromised). However, with the right diagnosis and support, most people can manage their symptoms and continue to live well. If you’re concerned about dizziness, make an appointment with your doctor for further investigation.”

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Parkinson’s disease

While medication, fatigue and dehydration can cause light-headedness in those with Parkinson’s disease, it’s the damage to the brain cells which produce dopamine – crucial for controlling movement – that increases loss of balance. Also, it can be common for sufferers to experience orthostatic hypotension – a significant drop in blood pressure when standing up.

Normally, when a person stands, blood pools in their legs and the body compensates by telling the blood vessels in the legs to constrict and the heart rate to increase. Because Parkinson’s sufferers experience loss of feeling in their nerve endings, their body is often unable to make this adjustment and so blood flow to the brain is compromised.

It can be helpful to practice slower, more controlled body movements with fewer long periods of standing and to elevate the head when sleeping.

Dementia

Emma Taylor, information services manager at Alzheimer’s Research UK, says, “Dementia is caused by physical diseases in the brain. These diseases affect our memory and thinking but can also cause a variety of other symptoms. These include difficulties with vision, movement and finding your way around.

“Dizziness or light-headedness can be a symptom of small vessel disease (SVD). This is when small blood vessels deep inside the brain become damaged slowly over time. When these become damaged, less blood can get to areas of the brain involved in balance, and so our brain cells find it harder to work properly.

“SVD is linked to vascular dementia, the second most common cause of dementia. Some research suggests SVD may also be linked to an increase in disorders that affect someone’s inner ear, which could lead to dizziness and difficulty with balance.

Being active every day, eating healthily, staying socially connected, and managing underlying conditions like high blood pressure and high cholesterol can all help to protect our brains. If you are concerned about symptoms such as dizziness and how it is impacting your daily life, speak to your GP.”

Stress

While stress can sit alongside poor sleep, increased alcohol intake and erratic eating habits (all triggers of light-headedness) when someone is overloaded with adrenaline (stress hormone), their heart rate increases, they hyperventilate, and blood pressure fluctuates. As a result, dizziness can occur, even fainting.

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Charli Hilton, a pilates instructor and chronic pain and symptom recovery coach, says, “The link between stress and vertigo is widely cited. I often see patients in my clinic for stress-related dizziness. Once other possible causes are ruled out, we can use simple tools such as the breath to address the body’s stress response. Our breath is the gateway into our nervous system.

“Taking slow, deep breaths, with a longer exhale than inhale, activates the parasympathetic side of our nervous system (our relaxation response). But it’s not just about breathing slowly, it’s about breathing fully. You want to feel expansion all around your ribcage – front, back, and sides – not just your chest or belly. Think of your torso as a 360-degree container filling with air. This full diaphragmatic breath is crucial for using breath as a relaxation tool.”

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