Orthostatic Hypotension's Got Me Down

March 4, 2016 8:46 PM

My ability to get out of bed and get ready for work is inhibited by frequent dizzy spells. Almost every time I stand I have to sit again or lean against a wall until it passes, and sitting on my bed often turns into lying down/sleeping again. Dizzy spells happen at all times of day but less frequently and usually less severe. Looking for suggestions to reduce the frequency or severity of my morning episodes.

The dizzy spells from standing have happened my whole life and my doctors have always known and don't think it's cause for concern. Aside from the morning episodes I get them once or twice a day, usually mild but sometimes severe. My blood pressure is on the lower side (almost always below 120/80) and I have no other health issues that we're aware of and so I think they chalk it up to that. Today is the first time I realized how seriously this has interfered with my ability to morning. I can think of at least three instances since fifth grade where I've outright fainted, but that only happens when I decide to "work through it" instead of sitting or stopping for a moment. (Last year I landed on my bedside table and from there onto my humidifier - do not recommend.).

Problem 1: Sitting after standing turns into crawling back into bed
My alarm clock is currently on my dresser and moving that to my bedside table is the easiest fix. I am currently scrambling out of bed to get it and then need to sit on my bed and usually wind up back under the covers. I moved my alarm to my dresser because I was snoozing it without waking up, but at this point I'm seeing the same results with the added risk of head injury.

Problem 2: I actually need to sit to do some things!
After I can finally stand up and leave my bedroom the situation repeats itself every time I sit/put my head below my waist.
bedroom -> toilet -> stand -> lean against the wall;
coffee -> chair -> stand -> lean on wall and slide down
chair -> put on shoes -> stand again -> sit -> stand -> lean against wall
I don't know how I can get ready in the morning without sitting at least 5 times.

Potential influencing factors:
I take Adderall (2x 20mg) and Lamotrigine (2x 200mg), get about 5-7 hours of sleep on a weeknight. Eating enough used to be an issue because of the Adderall but not anymore. Safe to assume I'm sometimes but not always dehydrated. Caffeine intake is 6ish cups (8oz) of coffee a day. I donate blood and platelets every 8 weeks and so I know my iron isn't low. If you're like me and read people's previous questions, the last incident I had with double-vision was thankfully a one-off. No one else in my immediate family has this problem.

I would love to be able to turn off my alarm, sit on the edge of the bed for a second, then walk 15 feet to my coffee pot and 8 more feet to a chair in fewer than 25 minutes. Has this happened to anyone else? Have you been able to find solutions or workarounds?

posted by good lorneing to Health & Fitness (21 answers total)

Best answer: I have something called a Chiari malformation and one of the symptoms is dizziness like this. I've never fainted (I've had tilt table tests and all evidence points to me being immune to fainting) but oh god the dizziness.

The thing that helps me most, especially in the mornings, is gradual verticality. I have my phone snooze set to 5 minutes; first time the alarm goes off, I stay lying down but pick up my phone to read things to start waking up. Second time the alarm goes off, I cheat myself up the pillow a bit and drink a bottle of water (I keep one by my bed). Third time, stick another pillow behind my head so it's more like I'm reclining. Next one, maybe I'll actually sit up in bed, start talking to my dog, etc. Eventually I get up and go shower and stuff, but it's a gradual process. Getting right up right when the alarm goes off means I fall into the wall and hurt myself and fuck my whole day up. You have to take it slow.

I also find that things are much, much worse if I don't get 9 hours of sleep a night. I know 9 hours seems gratuitous, but rest needs are a spectrum and some of us (meeee) are on the long side. 5-7 means I have to sit in my shower or I'll break my neck--on days I don't get enough sleep it can take as much as an hour to find my balance. Go to bed earlier if you can.
posted by phunniemee at 9:02 PM on March 4, 2016 [2 favorites]

So I have POTS, which often causes orthostatic hypotension and dizzy spells. In fact, my eyes going completely black and my heart racing when I stood up (and that it kept getting worse) was one of the ways I realized I had it. So, be sure that you don't have other symptoms of POTS (legs turning purple, etc.) as it can happen in people starting when they're young.

That said:
1) Of course, make sure there's nothing else going on or that it's the meds.

2) You can just buy compression socks - mostly marketed towards athletics - without a RX. They can be expensive ($20-$50 a pair) however I don't know if an RX would only cover medical ones which are ugly and uncomfortable. I love the Acel brand which are 20-30mmgh but I think you'd want to start at the 15-20mmgh level (just a lower level of compression). I use the higher level because I get really bad blood pooling. It helps A TON! Especially upon standing.
Woot has the Acel brand on mega sale right now (I just bought 4 pairs. I wear them all day, every day.) Consult a physician before wearing them of course, though many people wear them regularly when they have standing jobs or during exercise.

3) I have read and experienced that making a tight fist and pumping your fist with both hands (like they make you do when they draw blood) helps with the dizziness upon standing. As well as getting up slowly! More slowly than you think you need to.
posted by Crystalinne at 9:43 PM on March 4, 2016 [2 favorites]

I keep a glass of water next to the bed. Sometimes it helps when I experience this. I've always had orthostatic hypotension, but it's definitely worse since I started taking vyvanse.
posted by LaunchBox at 9:56 PM on March 4, 2016

I had no idea this had a name, but I eventually figured out that my blackouts were caused by exposure to marijuana, which was something I wasn't aware was happening at first. (I was living with a pot smoker and didn't know it). I also solved much of my morning misery by throwing out a problem mattress.

So, maybe consider those two possibilities.
posted by Michele in California at 10:14 PM on March 4, 2016

I get dizzy spells somewhat randomly, and mornings are frequent.

Also, I just you know, sit. And crawl if needed. At the peak of illness, I had a plastic chair in the shower so I could sit while showering, and sometimes just sat on the floor of the shower stall while showering, brushing my teeth etc. Humidity and hot water are the worst for increasing dizziness for me, so showering the night before helped, and having a cool washcloth face rinse in the morning instead helps.

You can get dressed and do quite a lot while sitting/reclining in your bedroom if you move things to your height or put them in a box that is easy to transfer to the floor or back up to the dresser and have a full-length or adjustable mirror.

My bed is on the floor directly, and everything is arranged so that if I need to, I can almost literally crawl around and manage 80% of my morning routine without having to stand up. I pack my kid's schoolbag and my bag the night before, and we eat a non-cooked breakfast so I don't have to think about stoves. I've started doing coffee at the office when I'm fine, rather than trying to do it first thing in the morning.

Sleep makes a big difference, both early to bed, and having a snooze alarm before the real alarm setting that wakes me up so I can know I have twenty minutes before I must get up, and I can slowly rouse myself.

Seriously, crawl/lean with abandon. Re-arrange your bedroom furniture and accept that you are someone who in the morning will sometimes need to do your morning routine like a drunk sailor. Put chairs or small stepstools ins strategic spots and make your routine around a 40% functional day, not a 100% day. That way, on a non-dizzy day, you'll get extra time in the morning to read metafilter and get to work early but on a dizzy day, you'll be right on schedule.
posted by dorothyisunderwood at 10:23 PM on March 4, 2016 [3 favorites]

Best answer: You say your doctors know that you have dizzy spells from standing, but I just want to make sure that they know exactly how severe it is in the morning. You say you kind of just figured this out yourself, so I would definitely recommend letting your doctor know how much it impacts your quality of life.
posted by sockermom at 10:47 PM on March 4, 2016 [5 favorites]

You need to be getting 7-9 hours of sleep instead of 5-7, first. The best way to get out of bed is to not be tired at the time. Then you won't need to jump out quickly, which is the fastest way of setting off a spell. (I have low blood pressure too, although I get vision blackouts rather than serious dizziness.)
posted by serelliya at 1:40 AM on March 5, 2016 [1 favorite]

Remember to drink lots of fluids, it can affect blood pressure.

Talk to your doctor again just to rule out any serious issues as this had been getting worse for you.
posted by AlexiaSky at 1:45 AM on March 5, 2016

And stop donating blood for awhile to rule out it isn't effecting your blood pressure.
posted by AlexiaSky at 1:49 AM on March 5, 2016 [2 favorites]

Increase your hydration in the morning (drink a glass of water before bed, or if that will make you have to pee at night, drink one half an hour before getting up). Also experiment with increasing your salt intake and going a few months without donating blood, to see if that makes a difference.

My symptoms have dramatically decreased since I gained weight, going from a "normal" to slightly "overweight" BMI. It could be coincidence, and I wouldn't recommend actively trying to gain weight, but if you put significant effort into staying thinner now it might be worth experimenting with that too.
posted by metasarah at 4:28 AM on March 5, 2016

Best answer: I agree you should try going to bed earlier. It sounds like your alarm is jarring you out of a deep sleep which is super unpleasant. Also make sure your doctor knows how severe your morning episodes are, as someone above suggested.
posted by JenMarie at 4:28 AM on March 5, 2016

While I do not suffer this with anything like the intensity you experience, I do get vertigo/dizziness if I get less than 7 or so hours of sleep. I would question why you regularly sleep so little, and address that first. A side benefit is that your quality of life will be so much better when you are not sleep-deprived.
posted by Atrahasis at 6:20 AM on March 5, 2016

6 cups of coffee per day? Cut back to one or zero cups and get a full nights sleep. It's likely to help significantly.
posted by txmon at 7:27 AM on March 5, 2016 [3 favorites]

Buy a rolling walker with a seat. Always have it directly within reach. Permits seating everywhere. Use it for every move you make in the morning. Seated, you can kick your feet to go backward in kitchen, etc.

The day I slacked off I fainted and broke three bones in my ankle.

Vibrating alarms that you put under your pillow wake you up without the across-the-room alarm clock. Marketed to Deaf & hard of hearing.

Re: fist pumping, I also tighten up pelvic muscles to slow blood rushing downwards.

My doc had me on a variety of drugs after I failed my tilt-table test, all aimed at increasing blood volume, but none worked. Drinking a gallon/day plus copious pickles and other salty food has helped some, as have compression stockings (always on when I'm vertical.)

Compression stockings are now available in patterns! Sockwell.us.com to admire.
posted by Jesse the K at 7:43 AM on March 5, 2016 [1 favorite]

I googled around and saw that it's typical to have more problems in the morning, and the Parkinson’s Disease Foundation (NOT that you have Parkinson. Parkinson patients also deal with this) compiled the following advice -

"If you experience dizziness in the morning:

- Raise the head of the bed by four inches (10 cm).
- Drink two eight-ounce cups of cold water 30 minutes before getting up.
- Do isometric exercises before getting up that contract the leg or feet muscles. For example, raise the toes, contract the thigh muscles and hold for 30 seconds, or march the legs slowly in place.
- Shift slowly from lying to sitting and then standing.
- Try putting on an abdominal binder before you get out of bed (and remove it before lying down again).
- Compression garments such as antigravity stockings can be effective in preventing OH."

I'd start with the ones easier to implement, like having a bottle of water by the bed to drink and the isometric exercises before getting up.
posted by mirileh at 7:53 AM on March 5, 2016 [1 favorite]

Seconding cut the coffee and the blood donating. Are your doctors sure that your medications aren't aggravating your dizziness? Someone above mentioned Vyvanse making their symptoms worse, and Vyvanse is, I think, similar to Adderall.
posted by mareli at 8:25 AM on March 5, 2016 [2 favorites]

For the toilet, consider getting a riser seat. The four inches could make a difference.
posted by 922257033c4a0f3cecdbd819a46d626999d1af4a at 10:47 AM on March 5, 2016

I have OH and POTS and a little trick my cardiologist taught me is to put on compression stockings before getting out of bed. They seriously improve my quality of life and even though they are a bummer to wear all the time, it's worth it. I got a rx from my cardio pretty easily and my insurance company paid for 2 pairs at $45 each. (If you end up going this route, theyre usually covered under 'durable medical equipment') It's definitely worth looking in to.

Staying hydrated, as annoying as it is, will help a ton as well. My doctor really drilled into my head that dehydration is the number one reason for dizziness.

Also, look into getting your blood pressure checked while STANDING. My blood pressure is just great when sitting, but upon standing my heart rate sky rockets, my blood pressure drops significantly and I get short of breath, all leading to dizziness and fainting.
posted by eggs at 2:56 PM on March 5, 2016

For what it's worth, Lamotrigine, according to the Mayo Clinic's website, can cause dizziness.
posted by a sock of sheep at 8:46 PM on March 5, 2016

Seconding the point about coffee. Caffeine is a diuretic - it makes you pee. The usual recommendation is that you need to drink 6 to 8 glasses daily of non-caffeinated, nonalcoholic beverages. The other tips here are good but the coffee really jumped out at me as something you're shooting yourself in the foot with.
posted by treehorn+bunny at 10:32 PM on March 5, 2016 [1 favorite]

Response by poster: Hey everybody, thanks for the replies! As some context, my self-care has sucked for almost two years. >5 hours of sleep regularly, anywhere from 0-3 meals a day, not taking either medication regularly, no exercise. I'm also down from 3 pots (pots!) of coffee a day to 6 cups. I'm on track with meds, eating, and exercise now, but I couldn't figure out why I still didn't have it together until thinking about the OHT. Your suggestions helped me hone my focus, which I really needed. Sunday and Monday nights I got almost 8 hours of sleep, had water by the bed for when I woke up, and got out of bed slowly. I drank water regularly during the day and consequently took breaks, which I don't do enough of either. Very little light-headedness both mornings, more productive workdays, and more productive evenings at home. I have two other phone calls I'm putting off currently, but putting off a call to my doctor is third on the list. I know you all suggested pretty simple stuff but obviously I was having trouble putting the remaining pieces together. Thank you so much.
posted by good lorneing at 8:28 PM on March 8, 2016 [3 favorites]