Q.  Almost every time I stand up, I feel dizzy. It seems to be worse if I am lying down before standing up.  Should I be concerned?  –Jill

A.  Great question, Jill! We have all likely experienced the sensation of dizziness upon standing at one time or another.  You are likely experiencing a sensation known as orthostatic hypotension (also known as postural hypotension).  Orthostatic hypotension (OH) is defined by a drop in blood pressure that is greater than 20 mm of mercury during contraction of the heart muscles (systole, the top blood pressure number) and more than 10 mm of mercury during the expansion of the heart muscles (diastole, the bottom blood pressure number).

Suddenly standing up can cause blood to pool in the blood vessels of the body and legs.  For a short period of time, a decreased supply of blood is carried back to the heart to be pumped to the brain.  This results in a sudden drop in blood pressure which causes a feeling of dizziness.

Unless you’re experiencing severe symptoms or losing consciousness (blacking out), OH is typically not a concern and can happen to anyone.  In my clinical experience, I have treated highly active adults and athletes as well as the elderly for OH.  The concern is greater for the elderly as it may be a sign of additional cardiac related illness such as congestive heart failure (CHF).  OH can increase the risk of falling which is already an issue for many elder adults.

The following conditions may increase the likelihood of developing OH:

• A low blood volume from dehydration can cause OH, fatigue, and weakness. Be sure to adequately re-hydrate after activity. Soda and other processed drinks do not optimally hydrate your body. Water is best. Other options include coconut water, caffeine-free tea, and consuming fruits and vegetables.
• Postprandial hypotension is a sudden drop in blood pressure after eating. The body shunts blood to the stomach and digestive system to aid in the digestion and transport of nutrients out of the gut. This can lead to low blood volume in other parts of the body and could cause OH. Eating small, low-carbohydrate meals may help to reduce symptoms.
• When I am in a high volume cardiovascular training cycle, I tend to experience low blood pressure. Average blood pressure (BP) should be around 110/70 mm mercury. My blood pressure will be close to 100/60 mm mercury when I struggle with OH. To eliminate this problem, I increase my salt intake. Sherpa Pink Gourmet Himalayan Salt is my preferred type of salt to use. The extra sodium retains more fluid in my system which keeps my blood pressure up while providing important trace vitamins and minerals.
• Bradycardia (slow heart rate) can increase your risk of OH. A slow heart rate is generally considered a healthy side effect of being cardiovascularly fit. A heart rate less than 60 beats per minute (bpm) is considered low. This is a common finding in well trained athletes as they range between 40-60 bpm. Other more serious heart conditions, such as heart valve related issues and CHF, can be associated with bradycardia. OH is also common post cardiac surgery or heart attack. If your heart rate is low or you’re experiencing cardiac issues, please consult with your physician.
• Diabetes, thyroid dysfunction, and adrenal insufficiency as well as other hormone (endocrine) related issues can cause OH.
• Many illnesses affecting the nervous system (spinal paralysis, Parkinson’s disease, and some forms of dementia) can cause OH related symptoms.
• Many medications have side effects that can result in OH symptoms. If you develop symptoms of OH, address your medications with your medical physician or pharmacist.

Treatment options for OH include:

• Compression. Lower extremity compression serves to help prevent blood from pooling in the lower extremities and can aid the venous return system. With compression, the heart doesn’t work as hard to pump blood to and from your toes. You can utilize a common ACE wrap, but I highly recommend that you purchase a mild over the counter compression sock (at least thigh high) such as Jobst Relief Therapeutic Thigh High Stockings. Do not apply any compression too tightly that it causes numbness or tingling in the legs, feet, or toes. In cases of spinal paralysis, an abdominal corset (binder) may be necessary to maintain a normal blood pressure.
• Stand up slowly. If you’re suffering from OH, take your time when you first sit up after lying down or after you first stand up. Moving slowly will decrease your risk of injury (should you fall) while feeling dizzy.
• Perform a cardiac warm up to get the blood in your legs moving prior to standing and performing an activity or exercise. Begin with tapping your toe 15 times on each foot. Then perform a seated knee extension by moving your leg straight out 15 times on each leg. Next, remain sitting, but march in place 15 times on each leg. Once you have completed this routine, stand up slowly (if you don’t feel dizzy) and proceed with your activity. Be sure to pause briefly to insure that you’re not experiencing dizziness as a delayed response of a few seconds is typical.

In most cases, OH is a common and benign condition.  It can affect anyone for many different reasons.  In most cases, dizziness can be easily treated with hydration and possibly a small increase in salt intake.  Elder adults should take care if they are experiencing dizziness.  Seek medical advice to determine if dizziness is a symptom of a more serious condition.  If the condition worsens or you lose consciousness, please consult with your medical physician as OH is just one of many forms of dizziness.

Thank you, Jill, for your question.  I hope these treatment options for OH will not only help you to determine the cause of your dizziness, but that they also decrease the frequency of your symptoms.  For additional information on dizziness, please refer to Q & A: Vertigo – Causes & Treatment and Q & A: How Do I Improve Balance? (Part I).

Have you ever experienced OH symptoms?  Which treatments for dizziness are the most effective for you?  Please share any recommendations that you may have by leaving your comments below.

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