Over the last few years we have had a number of patients who have reached out to ask us how they can deal with vertigo while they sleep. One would be hard pressed to find someone who has not experienced the feeling of a dizzy spell, spinning, dizziness, nausea or imbalance / unsteadiness at some time in their lives and sleeping with vertigo can be a real challenge as it often feels worse when you lie down. Most of the time these bouts of vertigo are short lived.
This picture is but a snippet of what it feels like….
For those of you who are suffering with this as a chronic affliction we as two nurses are beyond empathetic! Vertigo as a constant companion must be a horrible experience and can be very serious especially when one has to be careful during many activities including driving a car.
How Do I Sleep With Vertigo?
We received a call from “Evelyn” who was instructed by her doctor to elevate her head while to help deal with vertigo while sleeping. Evelyn already had an enVy™ pillow and was wondering if she could continue to use her favourite pillow with her head elevated. We had some advice for her which we will get to later BUT first let us explain what Vertigo is and what can cause it.
There are 4 common conditions that can cause Vertigo (beyond a little too much wine) that can cause the “dizziness” aka Vertigo.
Causes of Vertigo
Vertigo is often caused by an inner ear condition such as these:
Benign Paroxysmal Positional Vertigo
(BPPV) can occur out of the blue and for no particular reason. Generally caused by debris (calcium particles) which have collected in the inner ear. About 20% of all dizziness seen in medical offices is due to BPPV. BPPV is most common in older persons with the peak age at 60.
Activities which bring on symptoms vary with the individual and may include dizziness, lightheadedness, imbalance, and nausea. Symptoms are almost always precipitated by a change of position of the head with respect to gravity. Getting out of bed, rolling over in bed, tilting ones head to look up (also called top shelf vertigo), having you head in the shampoo bowl when at a beauty salon or performing yoga or pilates positions are common "problem" motions.
In older people, the most common cause is degeneration of the vestibular system of the inner ear or simply "wear and tear". In these cases, BPPV is called "idiopathic" and is usually due to degeneration (getting older sucks).
The most common cause of BPPV in people under age 50 is a direct or indirect head trauma. -- commonly seen with whiplash or a concussion. Additionally, head trauma can happen post surgery or dental work. It is believed that the causes of vertigo in this trauma group can be a combination of long periods of supine positioning plus vibrations such as can come from a drilling.
This is an inner ear disorder believed to be caused by fluid buildup in the compartments of the inner ear (Labyrinth). The Labyrinth contains the organs of balance and hearing. The receptors send confusing signals to the brain which causes the episodes of vertigo and tinnitus (ringing in the ears) and hearing loss.
Labyrinthitis can happen after a viral infection or, more rarely, after an infection caused by bacteria. It can triggered by a middle ear infections, upper respiratory infection, the flu or even the common cold and most recently there are studies on the connection with COVID-19 and Vertigo.
These infection inflames the vestibular nerve and results in the nerve sending incorrect signals to the brain that the body is moving. But your other visual signals (eyes) don’t detect the same movement. The confusion in signals can make you feel “the spins” or that you have lost your balance.
Other Causes of Vertigo
There are causes of vertigo such as head or neck injuries, stokes, tumours, medication and migraine headaches. And many people experience it at least once in their lifetime.
There is also a strong connection of BPPV with migraines, neck and head injuries, strokes, tumours and medications such as ototoxic medications like the commonly used antibiotic Gentamicin .
Our Advice to Evelyn
Treatment is as varied as what is causing your vertigo. For Evelyn, the advice from her doctor to elevate her head on a wedge while sleeping may give some relief. We strongly discourage elevating your head on two or more stacked pillows as this is a very bad sleep posture and creates too much forward head lean which aggravates the vertebrae of the C-Spine. In addition, she should have a great neck support pillow that will stabilize her neck and head and discourage any side to side or up and down movement which many chronic Vertigo sufferers report will aggravate the condition. We told Evelyn that the enVy Pillow is ideal for stabilizing her head and neck and can certainly be used in addition to a wedge that starts at her mid to low back - elevating her upper body by hinging at the hips rather than stacked pillows that kink your neck forward. Alternatively we strongly suggest Incline Bed Therapy with the enVy™ Pillow.
Incline Bed Therapy with a Stabilizing Neck Pillow
Instead of sleeping on a flat surface, the bed is at a slight incline of 3.5 to 5 degrees. Not only does Inclined Bed Therapy help you sleep better, it also improves circulation of blood, lymph and cerebral spinal fluid simply by using gravity. During sleep, your brain is busy spring cleaning and detoxifying itself through the glymphatic system. Adding a lift to the top feet of your bed of 4-6 inches (ideally 5 degrees) can help the glymphatic system drain “downhill” to the gut so toxins such as heavy metals, pathogens (germs) and other harmful substances, can be removed from the brain and excreted.
In addition to helping improve brain health, IBT has been shown to help relieve migraines, straighten your spine, strengthen muscles, fascia and ligaments, improve digestion, reduce acid reflux (GERD), reduce water retention (ie puffy eyes), lower blood pressure, improve varicose veins AND we can’t help but wonder if this would also help with Vertigo as it helps reduce pressure in the inner ear.
*NOTE: Lifting just the head of the bed with an adjustable bed frame will not work; the entire bed has to be on a slope. This could be done by adding about 4-6 inches of height to the head of the bed. I purchased by 6 inch risers online for approximately $18 or you can use books or wooden blocks. To make sure you are on the correct angle there is a phone app called TiltMeter that can be used to measure the incline of your bed.
How to use the enVy™ Pillow with a Wedge Pillow
If Inclined Bed Therapy is not for you, we would suggest the second best idea. Placing the foam wedge either directly on top of your mattress or insert a wedge pillow between your mattress and box spring to elevate your body from the waist up so (hinging your body at the hips) as to prevent any strain on your neck. We would recommend a 32” wedge in length, 24″ width with a 7” height at the top. Then simply place the enVy pillow on top. The advantage of the enVy Pillow when supporting one’s sleep is the design helps keep your head and neck “cradled” which as we stated above, discourages any side to side rotation or up and down movement of the head that can exacerbate vertigo.
Some additional advice for Evelyn: Make sure you get up slowly from your bed in the morning, drink plenty of water throughout your day and get 8 to 9 hours of quality beauty sleep... that's where the enVy™ Pillow comes in.
We wish Evelyn the best and hope the vertigo goes away soon!