Dizziness in the Morning

Waking up feeling dizzy can be a disorienting and scary experience, but if it happens infrequently, there is probably no cause for concern. Occasional dizziness is very common, and there are several reasons why you may feel dizzy, woozy, or off-balance in the morning. However, if you frequently wake up with dizziness, it may be time to make an appointment with a doctor to rule out serious health concerns.

There are several forms of dizziness, including imbalance, lightheadedness or wooziness, vertigo, and dizziness related to anxiety or fear. Vertigo is a unique type of dizziness in that it includes a spinning or rotating component. You may experience any of these forms of dizziness when you wake up.

Physical therapy is an effective way to manage dizziness symptoms, regardless of the cause. The providers at FYZICAL are highly trained and have experience in helping people overcome dizziness and get their mornings back on track. Using evidence-based methods, our holistic therapies provide an effective strategy to minimize dizziness without the need for medications or surgical approaches.

What is the cause of dizziness?

Dizziness is not a disorder, but rather a symptom that can be caused by many things. For people who are experiencing dizziness when they wake up, dysfunction in the circulatory system or peripheral vestibular system may be the cause. Some medications can also cause morning dizziness, as can alcohol and recreational drugs. Even dehydration or low blood sugar can make you feel dizzy.

To understand dizziness that occurs when you wake up, it may be helpful to understand how our bodies keep us balanced under normal circumstances and where things can go wrong.

The circulatory system

Without adequate blood flow, brain cells don’t receive the fuel they need, and you will feel dizzy or lightheaded. The circulatory system plays a crucial role in maintaining normal brain function. The brain is an energy-intensive organ, using about 25% of the oxygen you breathe and about 60% of the glucose (sugar) that you eat.  

In some cases, there may be adequate blood flow but there is not enough oxygen or glucose to sustain brain function. Disorders like sleep apnea can prevent your brain from getting enough oxygen while you sleep, and going to bed on an empty stomach can cause low blood sugar-induced dizziness when you wake up. People with diabetes are at particular risk for low blood sugar that can lead to dizziness and pre-syncope (feeling like you’re going to faint) or syncope (fainting).

The vestibular system

Most of us rarely think about the ear as anything other than our hearing organ, but the ear contains one of our most important balance organs, the peripheral vestibular system. There are three sections of the ear: the outer ear, which is made up of the ear lobe and the canal; the middle ear, which includes the bones of hearing and the Eustachian tube, which regulates pressure; and the inner ear, which is composed of the cochlea and the peripheral vestibular system.

The peripheral vestibular system also plays a role in maintaining proper blood flow. Because it senses your spatial orientation, it influences blood flow. When the brain receives signals that you have gone from lying down to standing up, for example, the cardiovascular system changes how it directs blood flow in order to accommodate your change in position.

The peripheral vestibular system plays a major role in helping us maintain consistent balance. The peripheral vestibular system is housed in the inner ear, and has two important components:

• Otolithic organs

  The otolithic organs, or otoliths, are tiny inner ear structures that sense linear motion (up/down, left/right, forward/backward) and transmit information about our spatial orientation to the brain. The otoliths are found under a sticky gelatinous membrane that contains embedded calcium carbonate crystals. Every time you move, the membrane also moves, and the embedded crystals activate inner ear hair cells that go on to send information about the speed and direction of your motion to the brain. If these hair cells are activated erroneously, the brain receives incorrect information regarding whether and how you are moving, which leads to a feeling of imbalance or dizziness.

• Semicircular canals

  The inner ear has three semicircular canals that are filled with fluid. When you turn your head to the left or right, tilt your head toward your shoulder, or nod up and down, the fluid moves through the canals, sending information about your rotational movements to the brain. When inner ear fluid is displaced inappropriately, you will experience the characteristic spinning sensation known as vertigo.

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The peripheral vestibular system of the inner ear sends information to the central vestibular system, which is located in the brain. Under normal circumstances, the brain integrates information from your peripheral vestibular system with information from other systems (visual, motor, sensory) about your movement, and you maintain balance and equilibrium. If the peripheral vestibular system is active when you aren’t moving, the brain receives mismatched information from the different systems, causing you to lose equilibrium.

Although dizziness can be caused by central vestibular system dysfunction, the majority of cases of dizziness are caused by abnormalities in the peripheral vestibular system. Physical therapy is an evidence-based treatment strategy that can treat inner ear disorders and provide long-term improvements to balance and equilibrium.

Waking up dizzy in the morning

Waking up to a spinning room or without normal equilibrium is never a good way to start your day. There are a number of potential causes for waking up feeling dizzy, and many of them can be prevented with some simple lifestyle changes.

Dehydration

Dehydration is one of the most common reasons why people are dizzy when they wake up. When you’re dehydrated, you actually lose blood volume. This makes your blood pressure drop, resulting in insufficient delivery of oxygenated blood to the brain. This can make you feel dizzy when you are lying down, and the dizziness will worsen when you go from lying down to standing up. 

A common factor in dehydration-related dizziness in the morning is alcohol. If you woke up dizzy and nauseous or in a room that was spinning after a night of imbibing, alcohol is a likely culprit.

Low blood sugar

In order to maintain normal function, the brain depends on a sugar called glucose for energy. When you eat, glucose is transported from your digestive system to your bloodstream and delivered to the brain. If you skip dinner, you may experience dizziness the next morning because your blood doesn’t have sufficient amounts of glucose to keep your brain working properly. Low blood glucose is also called low blood sugar or hypoglycemia.

Diabetes

Diabetes is a condition that affects blood glucose (sugar) levels. People with diabetes are missing an enzyme that allows glucose to get into the bloodstream, so diabetics have an increased risk for low blood sugar in the morning, which can lead to dizziness and fainting.  

Sleep apnea and other obstructive breathing conditions

Anything that interferes with your breathing will reduce the amount of oxygen that gets to your brain, leaving you feeling dizzy or woozy. A common complaint among people with obstructive breathing conditions is, “I woke up in the middle of the night feeling dizzy.” While sleep apnea is the most common type of obstructive breathing condition, others include chronic obstructive pulmonary disease (COPD), emphysema, chronic bronchitis, and asthma. Even having a common cold could interfere with normal breathing while you sleep.

Orthostatic hypotension

If your morning dizziness sets in when you first sit up or get out of bed, you may be experiencing orthostatic (or postural) hypotension. This is a condition that is caused by inadequate blood flow to the brain and occurs when people get up too quickly after they have been sitting or lying down. Dizziness or lightheadedness related to orthostatic hypotension lasts for just a second or two, so if your dizziness is persistent, there is probably something else contributing to it.

Medications

Some medications are known to cause dizziness, and you may wake up in the middle of the night or in the morning feeling lightheaded or faint. Blood pressure medications like ACE inhibitors, beta-blockers, and calcium-channel blockers can all cause dizziness. In addition, drug interactions may leave you feeling dizzy.

Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo, or BPPV, is a disorder of the inner ear’s peripheral vestibular system. When we move, crystals in the inner ear activate tiny hair cells that send information about our movements to the brain. These are normally attached to a membrane so they can’t accidentally activate hair cells. Age-related degeneration or head trauma can cause these crystals to become detached, and they activate hair cells at inappropriate times. This signals to the brain that we are moving even when we’re not.

If you regularly experience vertigo when waking up, you may have BPPV. People with BPPV often get vertigo when they roll over in bed or turn their head. BPPV can also affect just one ear, which would cause dizziness only when you turn or roll to one side. BPPV-related vertigo lasts for 15-20 seconds, and BPPV can also cause lightheadedness, nausea and vomiting, nystagmus (rapid, involuntary eye movements), and fainting.

Other causes of dizziness in the morning

• Labyrinthitis: This is inflammation in the inner ear that affects nerve signaling between the peripheral vestibular system and the brain. It may be caused by an ear infection or head trauma, and usually resolves within 3-6 weeks. Some people with labyrinthitis may be especially prone to dizziness after a period of lying down, especially if they sleep in a position that allows fluid to accumulate in the affected inner ear.
• Ménière's disease: Ménière's disease is a rare disease that is still poorly understood. It is associated with severe vertigo that can last for several hours. Other symptoms of Ménière's disease include tinnitus (ringing in one or both ears), intermittent hearing loss in one or both ears, and a sensation of fullness in the ear.
• Anxiety: If your dizziness always occurs on the morning of a big day, anxiety could be the cause. There are several helpful exercises that can help you control anxiety and minimize dizziness without resorting to anti-anxiety medications.

When to see a doctor

In most cases, occasionally waking up feeling dizzy is not a serious cause for concern. However, if you are regularly experiencing dizziness or vertigo when you wake up, it is recommended that you make an appointment with your doctor.

If your dizziness is accompanied by any of the following, seek immediate medical treatment:

• Chest pain
• Trouble breathing
• Rapid heart rate
• Confusion
• Slurred speech
• Severe headache
• Numbness in the face, arms, or legs
• Double vision
• Ongoing vomiting

How to stop feeling dizzy

For many people, drinking plenty of water, eating a healthy diet, and making sure to get some exercise to promote blood flow are sufficient to prevent dizziness. If you are taking prescription medications, ask your doctor whether they could be causing your dizziness.

One of the most effective ways to manage dizziness is physical therapy. Nearly all of the root causes of dizziness respond well to physical therapy, and providers who are experienced in treating dizziness can tailor an exercise plan to meet your needs.

The experts at FYZICAL are highly trained and skilled in treating different forms of dizziness. Our holistic, whole-body approach doesn’t depend on medications or surgery, and many people find that the benefits of physical therapy go beyond helping them overcome dizziness.

FYZICAL offers free assessments that can help you understand your dizziness and anxiety and create a tailored exercise program that will help you manage your symptoms. Find a FYZICAL location near you and make an appointment today.

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book,or click on the button below to find your local clinic.