Anxiety/Hyperventilation-Induced Dizziness

Alan Desmond
September 3, 2013

Anxiety seems to be part of everyone’s daily life. Some days we manage it well, other days we succumb to road rage, yell at the dog, do some meditation, or hang in there until cocktail hour. Many people resort to some type of pharmaceutical panacea, the most common being Xanax, Valium and Ativan. If one were to do nothing more than review the medication lists of patients referred for vestibular evaluation, you would see that there seems to be some connection between anxiety and dizziness. But, what is that connection?

Most patients coming to our clinic have been “dizzy” for a while, and have been to a few physicians without receiving answers or symptom resolution. This in itself could be an anxiety-producing situation. What about a direct physiological connection? Are they anxious because they are dizzy, or are they dizzy because they are anxious? Let’s explore…

Anxiety and dizziness are commonly associated complaints. Whether dizziness leads to anxiety, or anxiety leads to dizziness is open to speculation. The truth is both can occur.


Anxiety leading to Dizziness:
Anxiety, stress or panic creates chemical changes in the body. We all have a “fight or flight” response to stress. This surge of adrenaline gives our body what it needs to either “fight” the source of danger (anxiety) or run away from the danger- “flight.” When adrenaline is released into our bodies, our heart rate increases and our blood pressure rises. A secondary effect is that our respirations increase. Picture yourself running around a track: Your heart rate and respirations are up, but at the same time, through exercise, you are burning off the extra oxygen that is being pumped into the blood. This exchange of bringing in more oxygen and burning off more oxygen keeps things in balance.

If you have elevated respirations and heart rate as a result of anxiety, you are bringing in more oxygen without burning it off sufficiently. The oxygen level gets too high in the blood stream, and the relative carbon dioxide level becomes too low. This causes a constriction of the cerebral blood vessels leading to a sensation of dizziness or lightheadedness. Other symptoms often associated with condition include tingling around the lips and fingertips, shortness of breath, tightness in the chest. These symptoms can add further anxiety, exacerbating the condition.


Dizziness leading to Anxiety:
Patients with chronic, undiagnosed vestibular (inner ear) disorders are subject to a variety of anxiety reactions. The effects of vestibular disorders on Quality of Life are often underestimated, both by family and by physicians. First, there is frustration at not having a firm diagnosis for such bothersome symptoms. Second, vestibular disorders are more bothersome when one is exposed to unfamiliar, unreliable or moving visual settings.

An example of an unreliable visual setting would be a busy grocery store or market. Patients with vestibular disorders often become overly reliant on visual information for balance. In the busy market setting, all the movement, lights and colors make the visual information unreliable. This can make these types of environments very unsettling. Since it is not always easy to make the connection between the visual surroundings and the discomfort, many vestibular patients find themselves uncomfortable whenever they leave their own house. This describes an anxiety condition known as Agoraphobia, and can severely limit one’s enjoyment of life.

  1. Alan,
    As always you have done a great job of discussing conditions those of us who have been involved with balance disorders see all the time. It is interesting to also note that many of these patients with these symptoms would be diagnosed as having Migraine related dizziness if they went to one clinic, but Meniers’ if they went to another clinic. When, in fact they have neither. Keep up the good work.

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