Tips For Breaking the Vicious Cycle of Dizziness

Hi everyone, I recently found some great information from a vestibular specialist by the name of Andy Beltz. There was quite a lot there so I have tried to extract ‘the gold’. This is the first good bit. It starts off in a catchy way with “The top nine reasons people remain in the cycle”. I found it very useful and my annoying daily dizziness symptoms immmediately improved once I looked at it from the point of view of this writer. The “red light” and “green light” dizziness stuff was very good especially.
Okay… now I find I can’t upload my extracted article but you can find it on this website Scroll down to p.41.
The other good part starts with a diagram on p.26. It is a set of instructions to therapists for how to help their dizzy clients. I liked it because it’s very practical and straight talking without any need for the careful, empathic (sometimes ‘fluffy’) language that might be necessary if this article was meant for patients. Its headed Explanation of Vicious Cycle of Dizziness - What the Therapist Should Do For Their Clients.


Great pack! Thanks for sharing.

The tips (last two pages) are really useful and confirm much that we’ve discussed on here.

I love the smiling faces diagram for levels of compensation and nystagmus.

The vicious cycle diagram is completely on point. Lose that stress and anxiety! (Easier said than done!!!)

I like the note on stiff necks being a reaction to “not trusting the ears.”

Is that big cyan image otoliths within the labyrinth? If so why are they not “in” the tissue matrix?

If I’m fussy I’d have the odd issue with the “History Algorithm”. If only things were that clear cut? Not sure about the workflow here. Initially I had “Persistent with gait/station” imbalance and this was definitely a peripheral cause. Also the terms “Labyrinthitis” and “Vestibular Neuronitis” are apparently not considered contemporary? Apparently because the aetiology is unconfirmed you shoukd refer to those things as “Acute Peripheral Vestibulopathy”?

I think without much more molecular and cellular level evidence we will continue to have to deal with some level of vagueness.

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Good find that one. As @turnitaround has already said the tips on the last two pages are really useful and certainly confirm much of what has been said on here. Perhaps they should be made compulsory reading for all participants. The author certainly seems to have a handle on the subject. Almost to the extent one wonders if he has ever suffered himself. If only such people were more common and accessible for all.

I’m probably the worse sinner here as I do tend to scan read everything at speed but I seem to have missed the “red light” markers and indeed only found references to the “green light” ones in passing. Is there no definitive list for both? Or did I just miss it?

Much of these notes reminds me of something I was reading very recently @ajw, one of this sites founders wrote, about VRT helping, once condition was stable, to sort out all the maladaptions of posture etc that was caused by suffering from a balance disorder chronically. I found the mention of sway interesting in relation to MAV. Is this the ‘rocking’ sensation felt by some MAVers. The normal body movement intensified? That has never crossed my mind before. Very thought provoking indeed. Could adherence to the principles contained bring relief to some from the ongoing dizziness/imbalance. I wonder.

Be very interesting to hear about your experience in more detail if you feel able to share of course.

I found the pdf very interesting. Thanks for sharing.
I didn’t like some of the final advice, it felt a bit like gaslighting when he wrote, are you actually dizzy or is it just because you’re focusing on it too much. If he were dizzy I bet you he would know the difference between imagination and feeling god awful with sickening imbalance.

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Yes, I agree with you Lucy. Fair point.

Yes! That made me stop and think hard too. I tend to go into a hypervigilant state for weeks (sometimes months) after a main attack, noticing even the tiniest symptoms acutely, even taking daily notes. But maybe many times it’s just normal movements of the body and I am making myself very conscious of what is meant to be an unconscious event (the body finding it’s balance). After reading this article I changed my attitude and decided to try powering on through ie ignoring what I felt and treating it as “green light dizziness” and amazingly the light headedness and brain fog lifted quite quickly.

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I think he’s pretty clear about green light dizziness but I agree he doesn’t really describe red light dizziness. I think red light means “not green” !! haha. But I guess we know what red light dizziness is. I think back to my worst time when I had to crawl on the floor to my bathroom because the vertigo was so bad or another occasion when I threw up on my bed and couldn’t even clean it up because I dared not move my head in any way. Horrible. As he says in the article “Spells of dizziness are so terrible that they are not quickly forgotten”. Years and years later my main attacks are infrequent and much, MUCH less severe but the lingering effects are what are so dreary now. If this theory about the trauma of red light dizziness resulting in unhelpful hypervigilance is true then maybe I can better help myself :slight_smile:

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Yes, I can understand why you might think this Lucy. And that’s certainly the last thing anyone on this site needs! I don’t believe that he is gaslighting though. His ideas worked for me. Perhaps it would be helpful if you listened to and saw the man talking. He says he has treated 1000’s of dizzy patients over 20 years. That’s quite a high level of specialisation. Here are a set of videos which feature him talking about different issues. They were made quite recently. Andy Beltz, P.T. - YouTube
The one titled What To Do If Your BPPV Returns In The Middle Of The Night is exactly the kind of practical help we need. I appreciated the way he acts through all the movements himself (on his own bed by the looks of it!). I was just going to write that BPPV is not my problem but I’m not actually sure about that. I have rolled over in bed in the night and immediately felt spinning. In one of the other videos there he talks about how there can be multiple causes of dizziness. I’ve been diagnosed by specialists as “somewhere on what we now believe might be a continuum from Meniere’s to MAV but you’re more up the vestibular migraine end” but there could be some BPPV in the mix as well I think especially as I’m now in my late 60’s.


Okay Helen, glad to. But I knew this would be long – sorry! Feel free to scan read to the bullet points at the end :wink:

This is what the Recovery Period after a vestibular attack looks like for me:

Most of the time I have a feeling in my head I describe as ‘spacy’, lightheaded and foggy. I don’t feel grounded. I feel tired, unmotivated to do much. Its hard to concentrate, hard to launch into projects. My eyes play up. Moving my head fast or flicking my eyes quickly from one spot to another will, I feel, exacerbate my dizziness. Sitting tilted back like on a lounge chair is unpleasant. Looking down at my phone or reading a book looking down will, I feel, make me dizzier when I look up. In the shower I feel very unstable. I’m reluctant to close my eyes to wash my hair for example. I place one hand on the tiles of the shower wall as a sort of brace and try and do it with just the other hand sometimes! Movements where I turn my head dramatically, for example to look under a couch, I feel will increase my dizziness. My neck is very sore and stiff usually on the right side and this lasts for days and comes and goes. I sometimes get a headache too. Uneven surfaces give me jolts of alarm. I don’t like spaces that are crowded with objects/people. Social occasions (unless its just with one person in an outside space) are a nightmare. The tinnitus in my right ear ramps up. Being animated is hard. Even talking to an animated person is difficult! The fast movements of their face and hands is unpleasant. I want to look away. Noisy restaurants, shouted conversations, turning my head sideways to talk to someone next to me, moving around in a crowded busy public place. These are all unpleasant and make me feel tense and vigilant. Being in a cinema or theatre especially in a seat high up when the lights go out is unpleasant.

After a period of about three months all this dies down and I get back to normal. Except maybe the noisy restaurants. I think I’m over them for good :slight_smile:

I very much want to shorten these Recovery Periods.

I reflected on what I do in my recovery periods:

Yes, I do focus A LOT on my dizziness

Yes, I do pay close attention to every sensation I feel

Yes, I certainly engage in avoidance behaviour

Yes, I may be sensing normal sway as abnormal

Yes, I certainly start depending too much on my vision

Yes, my neck stiffens (a LOT!)

Yes, I use my hands for balance

Yes, I feel anxious and fear dizziness

So, after reading the Andy Beltz notes I:

  • Tried to ignore the dizziness symptoms
  • Pushed through “green light” dizziness and told myself “It’s ok. This is good dizziness. You’re re-training your brain.”
  • Stopped reading about and documenting my symptoms
  • Tried to move normally (‘aggressively’ as Beltz says) and turn my head normally
  • Walked for long stretches on a grassed playing field with my eyes closed (!)
  • Went swimming (even with all that head turning) and walked up and down the beach with its sloping gradient and uneven sand. Sometimes with eyes closed.
  • Told myself “It’s all just an illusion. Come on brain, get over it!”
  • Went to a remedial massage therapist for my neck
  • Made a series of appointments to see a psychologist specialising in anxiety solutions

Hallelujah! My residual symptoms started to clear up. And faster than usual, I think. The brain fog, which is one of the symptoms I most dislike, lifted within days :+1:

PS: I probably should add that I don’t take any regular meds for my vestibular condition. I had been taking 16 mg Betahistine twice a day for the last 1.5 or so years till recently. I stopped it because a bad side effect developed - gastritis - which was also giving me persistent chest pain. That stopped shortly after going off the Betahistine. I do take an array of B vitamins and magnesium.


That would probably come under the category of “red light” dizziness I’d say and I don’t think Andy Beltz’s tips apply to that kind of very severe dizziness/vertigo. You just have to get through that however you can even if it means staying in bed the whole time and the use of meds. The reply I wrote to Onandon03 describing how I tried to use Beltz’s tips was for “green light” dizziness only.

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I don’t think many health professionals even appreciate that such can happen. They never witness it because by its very nature patients are housebound if not bedbound. Despite over twenty years experience the VRT Body I had was completely blown away by my loss of balance type attacks. She’d never heard it could happen. Dizziness comes in wide variety of disguises. The very acute type we get is not widely known.

I would like proper clarity on his concept of ‘green’ and ‘red’ light dizziness. I could speculate that he, as one professional health provider writing for others, maybe there exists known definitions similar to the U.K. NHS ‘red’ flag system whereby certain symptoms of every condition are thus classified where they can have repercussions beyond their initial apparent reach. I suspect that could be the case. In which case, as example, being dizzy to the point of losing consciousness would be an obvious indicator of something more sinister.

Brilliant. I do love actual concrete examples. Makes up for my lack of imagination I suspect.

In general terms then according to your description I have been in one of these ‘Recovery Periods’ permanently for a little over six years. Yes I think my progress could be seen in that light. Sure it could. I’ll go along with that. Being as that’s the case I can see how the tips contained could have helped you. I think anybody who has had this chronically over a period of time develops various maladaption techniques to compensate ie by using hands in place of legs, and that gets them through daily activities but builds up Long term to create further problems of its own. That combined with the increased hyper vigilance keeps the complications running totally without us being aware of what’s happening. Reading those tips brought it directly to your attention and you have been able to take action yo implement changes. Well done and so pleased it’s working for you. Helen
Persistent Symptoms - Maladaption? - PPPD?

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Ohhh! I feel a bit naive now and definitely ignorant. I didn’t realise that there is a name for all this stuff I have been describing… PPPD. And that there is a whole thread on it here on this site! Ah well… that’s the trouble with clinical sounding acronyms - I suspect that many people (like me!) glaze over and pass them by not realising how directly and usefully they might apply. I have enough trouble remembering BPPV … or is it BBPV? haha. Thanks Onandon03 for bringing this to my attention. I’ll have a good look at that thread.
PS: In a way I like my term Recovery Period better than a label which has the word ‘Persistent’ in it :grin:


Don’t give it a thought. You aren’t to know. Take comfort from the fact PPPD has only been recognised and named a very few years so presumably before then even the ‘experts’ didn’t know either! All these abbreviations just exist to confuse laymen I suspect. There’s PPPD, BPPV, how’s about BRV, that’s Benign Recurrent Vertigo to you and me. If it’s any consolation PPPD was previously known as Chronic Subjective Dizziness (CSD) amongst other things but my favourite from even further back is ‘Floating Woman Syndrome’.

My favourite paper, I can recite chunks by heart. Yes I know I really should get a life. This link is in draft - Unfinished - form but you should get the drift. Try the beginning and then Page 19 if pressed for time/vision playing up etc.