You got me feeling Faint
The COVID era has not been short of stressful moments.
Sure, we all got anxious from being cooped up in the house for far too long. Unable to see family, friends, co-workers. Some still have limited access to those connections.
And then there's the anxiety piece. The fear of catching COVID and what it might do to ones self. Or to one's family. Or friends.
But before COVID was around, we all had high stress moments already. Many of us already experienced high levels of anxiety.
For me, the thought of speaking in front of large crowds, big tests, important events (like my wedding), all brought about high levels of anxiety. And with it, came various symptoms including changes in respiratory rate, sweating, gastro-intestinal issues, and bouts of dizziness.
Ever stood on the edge of a cliff or on balcony of high rise and been queasy? Maybe even dizzy?
The simple thought of or actually witnessing painful incidents can be enough to also cause these same symptoms for some.
I bring this to your attention because it's all too familiar when patients come into the clinic for their dizziness, that the GP thinks is BPPV (Benign Paroxysmal Positional Vertigo) and can be treated with a simple maneuver. But that's not always the case.
There is a somewhat direct connection that occurs between the vestibular system and the vast network of nerves involved in expressing anxiety and emotions.
In particular, the connection between the vestibular nuclei to the parabrachial nucleus (PBN) in the pons.
The Parabrachial nucleus (PBN) has an important role in regulating respiratory, cardiovascular, and GI functions, meaning its a key player in the Autonomic Nervous System (ANS).
It is involved in generation of emotional, behavioural, affective, and physiologic manifestations of fear and anxiety.
The PBN network is a location where vestibular and visceral information processing merges. These are pathways involved in avoidance conditioning, anxiety, and conditioned fear.
The PBN output pathways explain the spectrum of fear and anxiety responses including changes in heart rate, blood pressure, pupil dilation, perspiration, hyperventilation, and somatic motor responses as avoidance.
To sum it up, the parabrachial nucleus contributes to an internal sense of well-being (or lack thereof).
Special thanks to Katherine Deines and Jaimy Wahab (Positive Spin on Dizziness) for their stellar model depicting the numerous connections created between the vestibular system and anxiety-related disorders.
To top things off, when some of us get anxious, we start notice every little thing ten-fold.
This is called Interoception. It's the perception of sensations from inside the body, along with nervous system related activities (such as heart rate and breathing), and emotional state. (Ceunen, et al. 2016).
This means when we get anxious, some of us are aware of what's going on with our bodies so much more, that it makes us feel these negative experiences in the form of dizziness for example.
So how to we stop this dizziness from happening?
It's easier said than done, but we need to find a way to help lower those anxiety levels.
Some of the more widely used options include Box Breathing (4 second breath in, 4 second hold, 4 second exhale, 4 second hold, repeat). Breathing helps to stimulate our parasympathetic nervous system (our rest and digest system).
Other ways to help reduce anxiety levels include grounding/ sensory weighting. This is where those nice weighted blankets or vests can come into play. Or even a simple pair of ankle weights.
Professional counselling is also an option when other resources have not been as effective as we would like.
So between you and I, if you experience some dizziness and your medical professional tells you it's anxiety-related, please DO NOT take it as a sign that they are telling you that you're crazy.
Although treating vestibular disorders or dysfunctions that aren't stress related can be a little easier, it doesn't mean that dizziness caused by stress and anxiety isn't real.
Don't be afraid to seek help when you need it.
As always, if you're in need of more information or have any questions, feel free to ask away.
Live active and prosper.
Aras Ruslys
Registered Physiotherapist
Vestibular therapist/ Concussion management
