It’s probably a pretty safe bet that most of us have, on occasion, felt a moment or two of dizziness after getting up from either a sitting or a reclining position; this becomes more common as we age. Dr. S. James Shafer, a Vero Beach neurologist, says “This is very often due to dehydration, which makes it difficult for the heart to pump blood and oxygen to the brain.” When dizziness happens for this reason, it does not mean you are sick; it’s just a reminder to get up more slowly and drink more water.
However, if this dizziness happens frequently and when well-hydrated, it might be an indication of a health condition called orthostatic hypotension (OH), a form of low blood pressure that happens after changing position; OH is linked to certain neurological conditions, according to a recent study from Harvard Medical School published in an online edition of Neurology.
OH generally occurs within 3 minutes of getting up or sitting down; along with dizziness, it can cause lightheadedness and even fainting. Delayed orthostatic hypotension (DOH) involves the same drop in blood pressure, but the symptoms occur more than 3 minutes after the change in position; it is considered less serious than OH.
The researchers reviewed the medical records and test results of 230 individuals who had reported dizziness and feeling faint while standing – for example, waiting in a long line at the grocery store. At the time of treatment, 50 (22 percent) were determined to have OH, and 58 (25 percent) were determined to have DOH. In the remaining 122, the dizziness was due to something other than blood pressure – such as dehydration, a reaction to medication or fatigue.
A follow-up review of medical records done 10 years later, in 2013, found that 26 of the 58 individuals with DOH had progressed to the more serious OH. Most significantly, 15 of those 26 patients developed a degenerative brain disease, such as Parkinson’s disease or dementia with Lewy bodies (a disease caused by abnormal protein accumulation in the brain).
Lead study author Christopher Gibbons, MD, an associate professor of neurology at Beth Israel Deaconess Medical Center in Boston says that OH itself, whether delayed or not, is not a benign condition. He says, “Delayed OH is a real entity and has real complications and is largely unrecognized. If patients are complaining of lightheadedness and dizziness, particularly after standing for long periods of time, clinicians should definitely consider this as a possible diagnosis.”
The study was done as a retrospective review of a small number of cases, so the team from Harvard can’t conclusively say their research draws a definite line between DOH, OH and dire neurological conditions. However, such a connection is generally thought to exist, and people of middle-age or beyond should be aware of OH and what it may lead to. Dr. Shafer says, “Hypotension is a real disorder, and can be a precursor to Parkinson’s. It is also seen in people with diabetes.”
In recent years, tests have been developed to help diagnose OH, and oral medications have been introduced to treat it. Many of them are, in Dr. Shafer’s words, “fluid expanders.” He says these drugs keep more salt in the body, which in turn expands the volume of water, a key factor in preventing the low blood pressure which causes the dizziness.
Dr. Shafer says that men who get up at night to urinate are at particular risk for dizziness and even losing consciousness; they don’t need to be diagnosed with OH for this to happen. He says, “When men empty their bladder, their heart rate goes down and their blood pressure goes down. So they should always sit, not stand, to urinate.” Dr. Shafer says he sees several patients a year who fell in those middle-of-the-night trips to the bathroom and hit their head, causing a serious injury.
Dr. Shafer also has more general advice for both men and women who wake up and get up in the middle of the night. “It’s a time when we are dehydrated and our nervous system is less responsive, so we are prone to dizziness,” he says. “Before standing up, sit at the edge of the bed and count slowly to 5. Then stand up and count to 5 again before you start moving.” While good advice for everyone, it is especially important for those in middle age and beyond.
Dr. Shafer’s practice is part of Vero Orthopaedics and Vero Neurology, 1155 35th Lane, #100; 772-569-7039.
