I have been battling a severe anxiety disorder episode, partially from BPPV and partially from several external stressors.

Question: one doctor told me that anytime you move your head and provoke the accommodation after a successful Epley it sends stimulating anxiety signals directly to the brain. So more head movement means more agitation and anxiety.

If thats the case then wearing a neck collar would seem appropoiate.

The neurologist says "no" he says the anxiety comes from moving your head, getting an upsetting sensation and having a fear of that sensation...which causes anxiety.

It seems on my less anxiety days I can move my head much more and also in different positions and have no increased sensations or anxiety.

BUT...if my anxiety is high head movement seems to set it off.

Looking for opinions (please no scary ones)

James

Listen to the neurologist, the collar is not a good idea, for lots of reasons. Watch the sensation arising, feel it, know that you have it, don't ignore or deny it, then breathe deeply, let yourself relax, (ahh you say easy to say, hard to do, true, very true) but at least have the thought. Feel it, know it, relax, breathe deeply and let go the anxiety. Did I read before that you were on something for anxiety, not helping? Talked to your doctor about a beta-blocker as a possible aid? Ever thought about meditation? Remember anxiety feeds on anxiety.

Nina

So is it our response to the sensation that causes the anxiety or a direct neurological stimulation of the brain

James

I wore a collare for 48 hours after having the epley and slept upright, because in that time there is a very real danger that extreme or sudden head movements or lying horizontal can move the ear rocks back to where they shouldn't be, and then the symptoms start all over again.

That being said, once the collar is off, you should resume daily activities gradually, because this is when the brain starts the relearning and compensation process. But i guess we need to feed the brain in small doses and give it a chance to accommodate itself to each activity that has to be relearned. That's why doing too much too soon can also set you back.

Personally, I feel that anxiety comes from having an upsetting situation, setbacks, sudden imbalance, dizziness, whatever, which sends us into a panic as to whether we really are going to get better or are we going to have this stuff for ever. And bad days can really make you feel like you're losing your mind. So I would say that anxiety is caused by our instinctive response to the sensation. I'm no doctor but that's just my feeling from my own experience with BPPV.

Hope this soon passes for you James

Madeleine

James, anxiety states like panic attacks can be provoked by many things, physical and mental states. I would assume that a large percentage of us on this board are all too familiar with anxiety states, myself included. It's always easy to say "it's nothing I'm doing, it's this vestibular/inner ear disorder that's what's doing it. It's when I lie down or turn round or move my head" or whatever. Mine always occured when I would wake from sleep during the night and I would insist "how can it be anxiety on my part, I'm sound asleep, it's this thing that's causing it, not me, it's nothing I'm doing". Wrong!!! It was me, the head sensations were waking me from sleep and frankly they were scary and I would get anxious, and get rapid heartbeat, blood pressure up, etc., etc., etc. Now the same sensations wake me from sleep and also overwhelm me at other times, the difference is they no longer scare me, I accept them for what they are, no more rapid heartbeat, no more blood pressure rising, etc., no more anxiety, well not much anyway. Our state of mind can make a difference to our physiologicol state even when things are otherwise out of whack. It's a small thing that's worth trying that's all, it wouldn't cure you, you'll still have the same problem, but it might make living with it easier, until it does get better.

James,

I couldn't agree more with Madeleine's last paragraph. Yesterday, out of nowhere, I woke up and sat up and felt a bit lightheaded/dizzy. For the first time in many months, I had to sit there on the edge of the bed to let it pass. I don't really know what was going on, and today I'm a bit better, but the damn anxiety immediately kicked in. I wasn't freaking out, but the old skittish feeling came back and I spent most of the day monitoring how I was feeling (I hate that!!). It seemed to be positional again, a la BPV, though no room spins. Just that off-kilter, uneasy sort of feeling I remember getting just before the room started spinning. It's so disheartening, and the anxiety only adds fuel to the fire.

Also, I think you should check out my last post under your "Compensation Questions" thread you started a week ago or so. It explains what is going on with you (Subs agrees) as far as your brain's switching off certain functions to compensate for your vestibular damage. It doesn't make the anxiety go away, but at least you know WHY it's happening.

Wishing you a zen day . . .

Terri

I've read plenty of articles, and felt the evidence that vestibular stuff can cause anxiety and panic on a physological level, yes once anxiety gets a small hold then your mental anxeity takes you from there, but I think the vestibular stuff puts you in a state that even a small bit of stress can build into a major panic attack. I had panic attacks years before I got dizzy, but they were more controllable and much more a mental process, since being dizzy the anxiety comes on as a general feeling and gets directed at whatevers on my mind. I've had Cognitive Behavioural Therapy which helps a great deal with not letting those small feelings of anxiety build into anything large. Of course it works bothways, anxiety makes the vertigo worse so they feed off of each other.

But as far as the neck collar goes, I think most PTs make you where them for 48 hours after the eply to stop the crystals falling back into place. If the Epley was a complete success (ie the crystals are back where they are supposed to be) then you shouldn't need to compensate afterwards, - but I guess theres often a few "bits" left...

Billy,

Oh yes, there can definitely be "bits" left that can be problematic. My ENT told me that because the crystals are more akin to tiny grains of sand, it sometimes happens that all of them are not removed, even though the patient no longer experiences positional vertigo. Also, in my case it wasn't true that there was no need to compensate after a successful Epley. I didn't have the Epley until my second major episode of BPPV, and I think by then the damage to my right inner ear had been done. That damage is what I've been compensating for ever since, with more good days than bad for sure, but a few crummy ones (like yesterday) still creep in nonetheless.

Terri

According to what I've read - correct me anyone if I'm wrong - a successful epley positions the crystals back where they belong and so cures the vertigo, but you can still be left with a sense of imbalance, unsteadiness, whatever, while the brain now learns to compensate.

Madeleine

Madeleine,

My ENT told me that the crystals weren't put back to where they belong, per se, which was somehow physically not possible because of the configuration of the area from which they fell, but they are just displaced out of the inner ear into the greater inner ear cavity, if you will (something the size of a dime!). But you are absolutely right in that you can still be left with a sense of imbalance, trampoline walk, or whatever that your brain needs to compensate for.

Terri

the physiotherapist who did my epleys and gave me the VRT exercises never explained anything about which canals the crystals could be in etc. Wish I'd found these boards while i was still having treatment - I didn't even know enough to ask the right questions. I don't get the dizziness any more but do get just a little heavy-headed when I first sit up or lie down - passes in a few seconds. I usually sit on the bed for a minute or two before carrying on. Other than that I seem to be more or less OK but since I know this can return any time I feel I can never really say "I am cured". Just thankful for feeling better.

Hope today is a good day for you
Madeleine

Madeleine,

Thanks. Every day has been better since the blip on Sunday. It's like you said, just a little woozy when getting up from bed, with a little of that heavy headed thing. The good thing that you can consider is what Dr. Hughes (the guy who performed my ENG and James9393's Epley, and who also worked with Dr. Epley to develop the maneuver) says about the chance of recurrence. He says that after a successful Epley, the BPV patient has the same odds then as the rest of the population of it happening again. I'll hang on to that!!

Terri