Matthew Crowson, MD, a member of the Vestibular Division at Mass Eye and Ear, explained how too much alcohol can lead to an acute case of vertigo.
Drinking too much alcohol too quickly is a serious public health issue in the United States. Often referred to as “binge drinking,” this behavior has been labeled the country’s most common, deadly and excessive pattern of alcohol use by the Centers for Disease Control and Prevention.
“The spins” are an unpleasant, yet fairly common, side effect of binge drinking. Described as an intense case of vertigo, the spins can occur when someone lays down and shuts their eyes following a long night of drinking. The room might suddenly feel like it’s spinning, and, after a few minutes, a person might find themselves running to a nearby toilet with a serious bout of nausea.
Dr. Matthew Crowson, an ENT who specializes in balance disorders, explained to Focus how alcohol can cause this illusion of movement and how to best manage this type of vertigo.
What causes the spins?
Believe it or not, vertigo begins deep inside the ears. Each inner ear contains three tube-like structures known as the semicircular canals, which measure the body’s balance using a sensor called the cupula.
The cupula sticks upward from the bottom of salty fluid that fills the canals. It senses balance the same way a weathervane measures wind atop a barn. While weathervanes move in the direction of the wind, the cupula measures balance by moving in response to changes in the body’s gravitational position. Once the cupula moves, it relays a message to the brain and the brain attempts to stabilize the body’s position. The more intense the change in the body’s position, the stronger the signal relayed to the brain.
But what happens when the hypothetical weathervane inside the ears moves when the body doesn’t? According to Dr. Crowson, the brain becomes confused by the mismatch in signals and a false sense of movement commonly referred to as vertigo, or “the spins,” ensues.
“Picture the brain being pummeled by messages saying, ‘we’re moving, we’re moving,’ when the body isn’t moving at all,” Dr. Crowson said. “That’s how our brains become overwhelmed and confused. Then, our balance slips, and we imagine ourselves spinning.”
How does alcohol cause the spins?
People experience the spins when their blood alcohol concentration (BAC) approaches, or exceeds, 0.08 g/dl. Depending on a person’s size, this can occur after ingesting as many as three-to-four drinks in as little as one hour.
The buoyancy hypothesis is one explanation as to why alcohol disrupts the body’s balance. According to the hypothesis, ingesting too much alcohol raises a person’s BAC levels, which in turn can lower the density of certain bodily fluids. Among these bodily fluids are those inside the cupula. Under normal conditions, the density of the cupula should be nearly identical to that of the surrounding fluid in the semicircular canals. However, once the density of the cupula drops below that of its surrounding fluids, it becomes ultrasensitive to gravity and less resistant to subtle changes in motion.
Using the weathervane as an example: If the weathervane suddenly became lighter and less resistant to wind, it might begin to move on its own, or a slight breeze could knock it off the roof.
“In a nutshell: More alcohol makes the balance sensors in your head sensitive,” Dr. Crowson said. “Motions like turning your head in bed or moving a pillow become strong enough to stimulate the cupula, which causes it to fire signals even without wild movements occurring.”
Alcohol isn’t the only substance that can make the cupula floppier, Dr. Crowson added. “Heavy” water, or water with heavier hydrogen atoms, ingested from wells, along with high levels of glycerol, can disrupt this delicate balance in densities, too, leading to this same spinning sensation.
Is there a way to cope with alcohol-induced spins?
Positional alcohol nystagmus is the technical term for alcohol-induced spins. According to Dr. Crowson, the condition exhibits many of the usual symptoms of vertigo, such as nausea, but only lasts for as long as it takes the body to filter alcohol out of the blood. This can take up to three-to-seven hours. Once the density of the liquid inside the cupula comes close to matching that of the surrounding salty liquid, the vertigo symptoms should dissipate.
Dr. Crowson also suggests that fixation techniques can help lessen the effects of these spins. Keeping one’s eyes open and staring at a nearby object is one technique; sitting upright and firmly planting one’s feet on the floor is another. Both methods attempt to reassure the brain that the body isn’t actually moving.
“Basically, we’re encouraging people to use other senses to override false messages relayed to their brains,” Dr. Crowson said. “These are common techniques taught to patients who experience vertigo from other balance disorders and who might need help managing their symptoms in the moment.”
If symptoms persist well after alcohol has left their system, Dr. Crowson encourages people to seek immediate medical attention from a doctor who specializes in balance conditions. In extreme cases, sudden vertigo could be the sign of a stroke, or the sign of a vestibular disorder, such as Meniere’s disease, which could lead to progressively worse bouts of vertigo over time.
“Chronic balance issues can have a severe, adverse effect on a person’s quality of life if they go untreated for too long,” said Dr. Crowson. “We would never want to mistake these vertigo symptoms for drinking too much when the root of the issue is far more insidious.”
About our expert
Matthew G. Crowson, MD, is a fellowship-trained ENT who specializes in adult and pediatric balance disorders, in addition to treating patients with hearing loss. He sees patients at 243 Charles Street in Boston, and the Quincy and Braintree locations.