So far in our series about Ménière's Treatments, we’ve looked at hydration (water) and nutrition (diet). Let’s move next to movement and rest.
Movement (Exercise)
If you already have an exercise program that’s working well for you, keep at it. If you are not exercising regularly at this time, you may want to join an age-appropriate exercise group at a local gym, Y, or community center. You can also work with a personal trainer, though that’s more expensive. You might want to check with your medical insurance carrier to see they’ll cover any of the costs of a gym or trainer because of your Ménière's diagnosis. If you are covered by Medicare, you can join Silver Sneakers. Most gyms I’ve checked with work with Silver Sneakers, which is free to Medicare recipients.
I’ve taught martial arts fitness for 60 years and T’ai Chi for 25 years. Both are excellent ways to strengthen the body. Depending on how motion and exertion affect your Ménière's, you may want to begin with T’ai Chi. It’s a gentle exercise that is done slowly and fluidly. It’s very good for strengthening the body while de-stressing through the deep breathing that is part of the exercise. You can do it standing, sitting, or even in a supine position.
You can learn some ‘vestibular specific’ exercises from specially trained physical therapy doctors. Both my ENT and Neurologist highly recommend PT for Ménière's sufferers —
Improve and help maintain adequate balance e.g. Vestibular rehabilitation (an exercise-based program, designed by a specialty-trained vestibular physical therapist, to improve balance and reduce problems related to dizziness) includes: Balance and/or leg strength/flexibility exercises; Gait training; Visual stability and training; Neck mobility and neck and arm strength techniques. The goal of treatment plan is to improve any deficits, in turn, will improve ability to function in activities of everyday living, reduce risk for falling and ultimately, improve quality of life .. Educate patients on how to avoid injury due to imbalance or vertigo, techniques on how to fall to minimize injury .. Rehabilitate patients after destructive treatments that result in static unilateral or bilateral vestibular loss .. Treat the “spin-offs” of Meniere’s disease. Physiopedia
Most of the exercises that are related to Meniere’s disease focus on improvement of balance. There are different levels of these exercises and they usually begin with an exercise known as Romberg exercise, and gradually progress to other levels and forms of exercise.
It is advisable to start these exercises for Meniere’s disease very slowly and gradually increase them in duration and repetition. While starting with these exercises it is advisable to have someone with you just in case you feel like losing balance. ePain Assist
You may find that you prefer certain exercises over others. That’s fine. The idea is to keep moving. I remember that was one of the first things my ENT told me after I received my Ménière's diagnosis. He told me to keep moving and even ‘push’ myself a little when I didn’t feel like it. The primary idea, I believe, was don’t give up.
Rest (Relaxation and Sleep)
Ménière's Disease can take a toll on your body. Fatigue is a big problem for many sufferers. Here’s how one person explained the experience —
Fatigue comes up frequently with people who have Meniere’s Disease.
One of the suspected reasons for the fatigue is the continuous conflicting information the brain gets from the damaged balance organ in the inner ear/ears and the other parts of the balance system, the eyes and the muscles.
In a sense both the brain and the muscles are constantly adjusting for the constantly conflicting information, which is what wears you out.There are some days, when I need more sleep than others and after an attack of vertigo, it may take several days, or longer to recover. You shouldn’t feel bad about the extra sleep needed. Acceptance of the changes taking place in your life is sometimes the hardest part of dealing with your disease. Menieres.org
Here’s some good advice about ‘rest’ from Menieres.org.uk —
Plan your day. Start with a short, realistic list which includes time for breaks. Breaks are important, especially if you begin to feel tired. Rest when you feel tired; sit quietly for 5-10 minutes. Rest before and after any major activity during the day. At night, listen to a relaxation tape or soothing music.
More sleep advice from Menieres-Help.com —
Lack of Sleep, is agreed to be a problem. Meniere's sufferers need their sleep. You know how much sleep your body needs, so make sure you are getting it. Regular sleep patterns are recommended.
Exertion
Exertion is a ‘trigger’ for some people with Meniere’s. It can bring on anything from fatigue, to internal spinning, to external spinning and vertigo. Those of us who deal with the ‘exertion’ trigger need to be aware when we’ve pushed too hard. I often find that sitting and closing my eyes for 15-20 minutes is enough to restore my ability to move around again. However, I sometimes need to lie down for a few hours to allow my mind and body to recover.
“Living with Ménière's Disease: Understanding Patient Experiences of Mental Health and Well-Being in Everyday Life” is a chapter from the 2017 book Up to Date on Meniere's Disease. Here is a small portion of the chapter that addresses the importance of rest and relaxation for people with Ménière's —
With the assistance of the Ménière's Society UK, a purposive sample of 20 Ménière's patients was recruited from across south west England, focusing on individuals diagnosed by an Ear Nose and Throat consultant, reporting symptoms within the previous 12 months … Participants described lifestyle shifts made in an effort to regain some semblance of control over Ménière's, be they diet‐related, or focused more on physical activity, rest and relaxation. Some of these were in response to recommendations from their Ear Nose and Throat consultants (e.g. reducing salt, caffeine and alcohol), whereas others were strategies they had identified through trial and error in the process of learning to ‘read’ their body as the condition progressed. These included, for example, the use of specific vitamin supplements, postural adjustments, finding activities that would build their core strength without aggravating symptoms (e.g. modified versions of yoga, pilates, tai chi) and maximising sleep and rest where possible.
The Challenge of Sleep
A good night’s sleep can be a challenge for people with Ménière's —
Our finding of decreased deep sleep and an elevated arousal index is a striking new finding in Ménière's disease. This poor quality of sleep in Ménière's disease patients has received little attention in the past, but may cause additional stress and lead to a negative spiral of symptoms. Impaired Quality of Sleep in Ménière's Disease Patients, Journal of Clinical Sleep Medicine (2010)
This Sleep Advisor article had some interesting takes on how to sleep better with Ménière's —
Not getting enough sleep can make your episodes more frequent and pronounced. By sleeping restfully and through the night, you may find relief. Further, not sleeping in the right position can trigger an episode.
Avoid eating spicy food: Hot and spicy food can disrupt your digestive processes and make it harder to sleep through the night. In the several hours before you go to bed, stick to milder options.
Avoid looking at bright screens: The light from your television or phone delays the production of melatonin, a crucial hormone to help you fall and stay asleep. Instead of looking at electronics, try reading a book instead.
Avoid caffeine: In addition to keeping you awake, the acid in caffeine could wake you up with heartburn. Its diuretic nature could also make you feel like you have to go to the bathroom in the middle of the night. If you’re making a concerted effort to sleep through the night, abstain from caffeine after morning hours. How To Sleep With Vertigo – Causes, Symptoms, and Treatments (2023)
Though not specifically addressed to people with Ménière's, you might also want to read 9 Simple Nighttime Rituals To Help You Relax and Unwind. (2023)
I also came across an interesting study about Obstructive Sleep Apnoea (OAS) in some Ménière's patients struggling with sleep —
The otologist/neurotologist must be mindful that some patients with MD may have concomitant OSA. Unless this comorbidity is treated, it may not be possible to control the symptoms of MD with standard medical therapies. Identification and successful treatment of OSA could potentially avoid the need for functionally destructive MD surgeries which are normally reserved for patients with uncontrolled disease. Symptoms suggestive of OSA must be proactively sought as these patients may not exhibit obvious phenotypic features of OSAS, especially in Asians. Concomitant Obstructive Sleep Apnoea in Patients with Meniere’s Disease: A Case Report and Literature Review (2021)
As for the best sleep position, many doctors recommend sleeping on your back. If you are a side sleeper, consider sleeping with your “bad” ear up. If you have Bi-lateral Ménière's and are a side sleeper, you can experiment to see which side is better for you. You may also find that sleeping (or resting) with a wedge pillow helpful, especially during or after a vertigo attack. I find that moving my head in any direction is most uncomfortable during and immediately following a vertigo attack. I lie on my back on a wedge pillow for a few hours until I can finally move to my side and go to sleep. Everyone is different, so learn what’s best for you.
Getting up from a ‘lying down’ position (whether sleeping or resting) is another challenge for people with Ménière's. Many experts recommend moving from a lying to sitting position slowly, then sitting for a minute or two to get your balance. Moving too quickly for some people can set off a vertigo attack.
I find that lying on my back and doing some simple leg and arm stretches in the morning helps me prepare to get up to face the challenges and opportunities of the day. I move slowly to a sitting position, do a couple of sitting stretches, then slowly move off the bed. I’m in my mid-70s and have had Ménière's for many years. You may not find this routine necessary, but thought I’d mention it if it helps someone.
Here are some articles about sleep that you might find helpful in your ‘quest for rest’ —
10 Ways to Get Better Sleep Tonight For Better Health — Mind Over Ménière's
Sleeping Positions that can Combat Vertigo — Neuroworks
Sleeping and Vertigo: How They Relate and Tips For Better Sleep — The Sleep Judge
Don’t Let Meniere’s Disease Keep You Up At Night – Treatments To Help Improve Sleep — Sleepation
A Healthy Lifestyle for Managing Ménière's Disease — Menieres.org
What you need to know about Ménière's disease — Medical News Today
Meniere’s Disease — American Hearing Research Foundation
How to Understand and Cope With Meniere's Disease — WikiHow Health
Choosing the Best Sleep Position — John Hopkins Medicine
We’ll look at dealing with Stress, Anxiety, and Environmental Hazards in the next Managing Ménière's Disease newsletter.
“… rejoicing in hope, patient in tribulation, continuing steadfastly in prayer.” Romans 12:12
Here’s to hope!
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