Do you sometimes feel dizzy for no reason, lose your balance when standing or sitting, and feel like you're floating on a boat? It's very difficult to live with this dizziness for days on end, isn't it? You may even feel very sad and scared about this. Today we're going to talk about this kind of long-term dizziness, which means it lasts for three months or even longer. Doctors call this PPPD (Persistent Postural-Perceptual Dizziness) . Although the name may seem a bit long, let's keep it simple.
What is PPPD (Persistent Postural-Perceptual Dizziness)? Simply put...
We can figure out the meaning of PPPD from the words themselves.
- Persistent: This means that it is constant, long-lasting . You have been experiencing this dizziness for at least three months, most days.
- Postural: This is related to body position . This dizziness is worse when you are standing, sitting, or in an upright position.
- Perceptual: This is related to our perception, that is, the way we perceive things . You feel as if you or your surroundings are out of balance. It feels like the ground is shaking, or you yourself are shaking.
- Dizziness: This is dizziness . But it is not like ``Vertigo'' where things are spinning around you. In PPPD, it feels like you are rocking, like you are on a boat, or unsteady .
Simply put, PPPD is a type of dizziness that begins after an event, lasts for a long time, increases when standing, and makes you or your surroundings feel off-balance, like you're swaying.
Our bodies have a complex system that controls our balance. It involves our eyes, muscles, the vestibular system in our inner ear, and the brain . All of these things work together, working as a team, to keep us from falling. This happens naturally, without us even realizing it.
But in a person with PPPD, there is a breakdown or inconsistency in the communication between the parts of this system. That is, there is a problem with the way the signals from the eyes, the body, and the inner ear all go to the brain and are coordinated together. The important thing is that there is no disease or damage to the individual parts of this system (such as the eyes, ears, and brain) . But they are not "synced" together. That's why you feel unsteady and dizzy.
How common is this PPPD condition?
PPPD may actually be the most common condition that has been identified as a cause of chronic vertigo. However, it is a relatively new diagnosis . It was only in 2017 that medical experts came together to develop the criteria for recognizing it as a separate condition. So there is still a lot of research going on, and there is a lot to learn. In the past, it may have been difficult to accurately identify people with these symptoms.
What are the symptoms of PPPD?
A person with PPPD feels dizzy most of the time . This means they may feel dizzy more than seven days a week. Sometimes this dizziness can last for hours at a time, and it can get worse as the day goes on . Or it can come and go without any pattern.
The dizziness caused by PPPD can feel like a boat is being tossed by the waves, or like you are swaying, feeling unsteady, as if you can't keep your feet on the ground . While this can happen for no particular reason, it can be more severe in some cases. For example:
- When you are standing, sitting up straight, or suddenly changing positions (e.g. getting out of bed).
- When you are walking or riding in a vehicle (car, bus, train) .
- When you see too many things at once . Think of staring at the shelves of groceries in a supermarket, or scrolling through social media on your phone. Dizziness can increase in places with a lot of visual stimuli.
In addition to these main symptoms, other symptoms may accompany PPPD:
- Brain fog: This means it's hard to think clearly and concentrate.
- Short-term memory loss: Forgetting small things quickly.
- Difficulty concentrating: It is difficult to focus on one thing or to continue doing one task.
PPPD can make you feel disconnected from your body, your surroundings, and other people, as if you are in a dream . You may also avoid social activities and daily tasks for fear of worsening your dizziness. This can have a significant impact on your quality of life.
What are the causes of PPPD?
PPPD usually starts after a "trigger" event that affects your balance . This means that you may have had a previous episode of dizziness, such as a head injury, and the PPPD may continue even after it has healed.
Here are some of the triggers that can cause PPPD:
- Sudden, severe dizziness (Acute vertigo).
- Benign Paroxysmal Positional Vertigo (BPPV) is a condition that causes dizziness when you move your head.
- Head injuries (e.g., a concussion).
- Inner ear diseases such as Ménière's disease.
- Panic attack.
- A `Stroke` (paralysis) condition.
- `Vestibular migraine` is dizziness that occurs with migraines.
- Vestibular neuritis is an inflammation of a nerve in the inner ear.
What happens in PPPD is that even after the initial dizziness or illness has passed, your brain remembers the "loss of balance" experience . Without realizing it, you start to be hyperaware of things that affect your balance, such as your body position and surroundings. This hyperawareness can also cause you to feel anxious all the time.
Imagine that you slipped and fell on the road. After that, you would be very careful every time you walked on that road, looking down, and thinking about every step, right? Similarly, in PPPD, your brain starts to think too much about balance and be vigilant.
Instead of being helpful, this hypersensitivity causes your brain to not be able to properly process sensory information from your eyes, muscles, and inner ear, keeping you stable. Experts say that your brain relies too much on the senses you feel most (e.g., what you see, how you hold your body), and under-uses the senses you feel least (e.g., information about subtle movements from your inner ear). That mismatch is what causes your symptoms.
This is very disturbing, because just as maintaining balance comes naturally to someone without PPPD, this hypersensitivity also comes naturally to someone with PPPD.
Who is at higher risk of developing PPPD?
Some studies have shown that women are about four times more likely to develop PPPD than men . Also, people who have a pre-existing condition that affects balance (a vestibular disorder) or a mental health condition such as anxiety or depression are more likely to develop PPPD after experiencing one of the aforementioned triggering events.
Your personality can also play a role. Studies have shown that PPPD is more common in introverts, who are more introverted .
How is PPPD diagnosed?
Diagnosing PPPD can sometimes be challenging because there is no disease in the individual parts of your balance system. Therefore, routine balance tests, such as vestibular tests, may come back normal .
Therefore, your doctor will diagnose you with PPPD based on five criteria related to your symptoms . You are diagnosed with PPPD if you meet these criteria:
1. You have felt dizzy or unsteady most days for at least three months (without a spinning sensation).
2. Symptoms may increase for no particular reason, but dizziness may be worse when standing, walking, or looking at a lot of things .
3. You have had a triggering event (either a temporary event or a long-term illness) that started the dizziness.
4. Your symptoms have had a negative impact on your daily life and quality of life .
5. You need to make sure that your symptoms are not caused by any other medical condition (you may need to have tests to rule out other conditions).
What are the treatments for PPPD?
There is currently no cure for PPPD. However, there are several treatments that can help you manage your dizziness. Your doctor may recommend one or more of these.
The main treatment methods are:
- Vestibular Rehabilitation Therapy (VRT): This is a specialized physical therapy treatment. It helps you understand how your body's hyper-sensitivity (hyperfocus) is causing your dizziness. Once you understand what's happening, you can learn strategies to manage your symptoms. It involves doing special balance exercises.
- Talk therapy: Treatments such as Cognitive Behavioral Therapy (CBT) can be very helpful in managing the anxiety that can exacerbate PPPD symptoms. It can also help you develop strategies to become more social and confident again if you have become socially withdrawn due to your vertigo.
- Medications: Your doctor may prescribe a class of medications called SSRIs (Selective Serotonin Reuptake Inhibitors) or, if those don't work, SNRIs (Serotonin-Norepinephrine Reuptake Inhibitors). These are medications that are specifically prescribed for depression and anxiety. Although research is still ongoing on exactly how these work for PPPD, they are thought to help reduce the anxiety and hypersensitivity associated with PPPD.
What kind of doctor treats PPPD?
If you have symptoms of PPPD, first see your family doctor (PCP) . He or she can refer you to a specialist if needed. Specialists who diagnose and treat PPPD include:
- Otolaryngologists (ENTs)
- Otologists - ENTs who specialize in inner ear conditions
- Neurologists
- Psychologists or Psychiatrists
- Vestibular physical therapists
Is PPPD completely curable?
PPPD does not go away completely , and it may take some time to find the right treatment to control your vertigo.
However, the good news is that many people with PPPD can successfully manage the condition with therapy and medication . Experts are still researching how individual treatments and combinations of treatments can help people with PPPD.
How do I take care of myself as someone with PPPD?
If you have PPPD, taking care of yourself means being patient with yourself as you try to find treatments that help you . Because this condition is new, research on the most effective treatments is still in its early stages. You may need to try different treatments and medications before you find the one that works best for you.
Also, be kind to yourself as you learn to live with this diagnosis. Many people with PPPD say that it's hard to explain what they're going through to others. Others may say things like, "They don't understand," or "It's all in your head."
But that's not the case. PPPD is a real condition that disrupts your sense of stability within your body. It's a condition that you'll struggle to control. But there are doctors who are ready to help you.
Can you drive if you have PPPD?
Ask your doctor if it is safe to drive if you have PPPD. Some people with this condition experience extreme dizziness while driving. They may feel as if the car is going to tip over. This loss of balance can make it difficult to drive safely. Some people can drive, but only at speeds well above the posted speed limit.
Your situation depends on how severe your vertigo is and whether you have found a treatment that works for you to control it. Never take chances.
Is PPPD just anxiety?
PPPD and anxiety are two different conditions . However, if you already have an anxiety disorder and then experience a triggering event, you may be at higher risk of developing PPPD. Also, living with PPPD without treatment can create a negative feedback loop that makes anxiety worse.
That's why anxiety treatments (e.g., CBT, medication) are often part of the PPPD treatment plan.
What questions should I ask my doctor?
When you see your doctor, you can ask questions like these:
- What is the most likely cause of my PPPD?
- What triggers should I avoid to prevent worsening dizziness?
- What are some things that are unsafe for me to do with my diagnosis (e.g., driving, working at heights)?
- What treatments do you recommend for me?
- By what criteria do we know that treatment is successful?
- Are there any side effects to these treatments?
Finally, things to remember (Take-Home Message)
If you experience frequent, unexplained dizziness, see a doctor right away . It may take some time to diagnose PPPD as the cause of your balance problems. However, the sooner you seek help, the sooner you can find a treatment plan that will help you stay stable again .
PPPD can be a lifelong condition, but it doesn't have to limit your quality of life. With the right medical advice and treatment, you can learn to manage it and live well. You are not alone, and there are doctors and therapists to help you on this journey.
` PPPD, Dizziness, Balance, Vestibular System, Anxiety, Treatment, Vertigo
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