If your vision spins or you feel lightheaded when you stand up from sitting or lying down, it may be orthostatic hypotension. It happens when your blood pressure isn’t adjusted quickly enough as your position changes suddenly, so for a moment less blood reaches the brain. Medically it is defined as a drop of 20 mmHg or more in systolic pressure, or 10 mmHg or more in diastolic pressure, within three minutes of standing. In Parkinson’s, the autonomic nervous system that regulates blood pressure is also affected, which makes this more likely to happen.
There are other signs besides dizziness
Dizziness is the most common symptom, but fatigue, confusion and blurred vision can come with it. A less well-known symptom is “coat-hanger pain” — an aching tightness in the neck and shoulder muscles. It gets worse when you stand and eases when you sit or lie down, which makes it a recognizable signal of orthostatic hypotension.
Medications can make it worse
Parkinson’s medications themselves, such as levodopa and dopamine agonists, act in a direction that lowers blood pressure, and can make orthostatic hypotension worse. This is especially noticeable when you start one of these drugs while you already have orthostatic hypotension — so if your dizziness got worse after starting a new medication or after a dose change, tell your care team.
You may have the opposite problem at the same time
About half of people with orthostatic hypotension are known to also have the paradoxical combination of blood pressure that falls when they stand and blood pressure that runs too high when they lie down (supine hypertension). The two problems pull treatment in opposite directions, so applying measures like increasing fluid and salt intake without thinking can push your lying-down blood pressure too high. That is why raising the head of the bed slightly for sleep can help manage both at once. Measuring your own blood pressure and recording it both standing and lying down also gives your care team a great deal to work with in striking the balance.
What you can try right away
- Move slowly when you change position. Instead of going straight from lying down to standing, break it into steps — sit for a moment first, then stand — which buys your body time to adapt.
- Before you stand, cross your legs or firmly tense your thigh, buttock and abdominal muscles. These movements help push blood back up toward your heart and brain.
- If you have to stand for a while, try drinking two glasses of cold water quickly beforehand. This can briefly increase your blood volume and help raise your blood pressure.
- Try compression stockings. Thigh-length or waist-high stockings are known to work better than the ones that only reach the calf.
- After talking with your care team, you may be able to increase your salt intake a little. Broth-based dishes or salty snacks such as chips can help, but if you have heart disease you need to discuss it first.
This symptom leads directly to falls
If orthostatic hypotension briefly clouds your awareness or throws off your balance, that can turn straight into a fall. The moment you feel dizzy, stopping where you are to sit down or find something to lean on is far safer than trying to keep moving and going over.
What you can do now
Recording how often you feel dizzy and in what situations gives you something concrete to bring to your appointments. You can also review with your care team whether your blood pressure medication or your Parkinson’s medication is contributing to the symptom.
This article is not a substitute for medical diagnosis or treatment. If you feel dizzy often, please talk with your care team.
