Hi Customer (name blocked for privacy)

Dizziness in the morning could be from low blood pressure.

If it happens as you stand from a lying position, it is called orthostatic hypotension.

Read more about it here:
http://www.dizziness-and-balance.com/disorders/medical/orthostatic.html

Non-Drug Treatment for Orthostatic Hypotension

Generally it is best to start with non-pharmacological treatment, and proceed to drug treatment only when this fails. Note that measures such as voloume expansion with increased salt and fluid, moderate exercise and tilt training are relatively safe but their effectiveness has not been demonstrated by controlled trials (Kapoor, 2003). Nevertheless, we think it is reasonable to give these things a try.

1. Use an automatic blood pressure cuff (about $30 at Walgreens or Radio Shack). Check blood pressure daily, preferably standing and lying flat, and record it. Also check blood pressure when you have symptoms.
2. If possible, eliminate medications that lower blood pressure (usually blood-pressure or heart medications). Check with your doctor first, however, to be sure that this is safe.
3. Take in extra amounts of salt - about 10 gm/day total. Another way to get extra salt is to use salt containing beverages (e.g. "gatorade"). If you start to have trouble breathing or get excessive swelling at the ankles, you may have to use less than 10 gm. Similarly, be careful not to overdo it and end up with hypertension.
4. Wear Jobst stockings (tight custom made leotard like garment -- worn by both men and women).
5. Sleep with head of bed elevated about 15-20 degrees (4-6 inches). This maneuver increases blood volume and, after a few days, is helpful. It is also helpful in that it may reduce supine hypertension( sometimes blood pressure is too high lying flat, and too low standing up). Try to be up during the day, not lying in bed. Reconditioning may be helpful for persons who have been on bed rest for long periods of time.
6. Eat frequent small meals (because eating lowers blood pressure). Avoid sudden standing after eating.
7. Avoid straining at stool (because this may lower the blood pressure)
8. Avoid hot showers or excessive heat. Use air conditioners.
9. Get up gradually in the morning. Take 5 minutes to get up and use support. Perform isometric exercises before moving about.

Tilt-training, a series of prescribed upright posture exercises may be helpful in vasovagal faints as well as orthostatic faints.

Recently a group in Tokyo has reported that vestibular "noise" (via galvanic stimulation) may improve baroreceptor function. (Soma, Nozaki et al. 2003; Yamamoto, Struzik et al. 2005). While the author has some skepticism, this is an interesting idea that needs clinical validation.

Certain medications may be helpful, usually as a combination. Most useful drugs are Florinef (fludrocortisone), erythropoetin and Midodrine.

• Two strong cups of coffee in the morning
• Fludrocortisone (Florinef) forces more salt into the bloodstream, 0.1 mg daily starting dose. Blood pressure raises gradually over several days with maximum effect at 1-2 weeks. Alter doses at weekly or biweekly intervals. Hypokalemia (low potassium) occurs in 50%, and hypomagnesemia in 5%. These may need to be corrected with supplements. Florinef should not be used in persons with CHF (congestive heart failure). Florinef does not work in the orthostatic intolerance syndrome of chronic fatigue syndrome (Rowe et al, 2001). Headache is a common side effect.
• Effexor (an antidepressant which raises blood pressure as a side effect).
• Inderal and other beta-blockers (small doses are used for positional-orthostatic-tachycardia syndrome (POTS), start inderal at 10 mg/d, increase to 30-60 mg/d over 2-3 weeks. Other useful agents are Nadolol (10 mg qd), Pindolol (2.5-5 mg 2-3 times/day) and atenolol (25). Several controlled trials did not show these agents to be effective in preventing syncope (Kapoor, 2003)
• Motrin or Indocin (blocks blood-pressure lowering effects of prostaglandins).
• Midodrine. An alpha-1 agonist. Causes increased blood pressure, vasoconstriction, pupil dilation, and "hair standing on end". Other common side effects are paresthesia of the scalp or itching. Usual doses are 2.5 mg at breakfast and lunch or three times daily. Doses are increased quickly until a response occurs or a dose of 30 mg/day is attained (Wright et al, 1998). Midodrine does not cross the blood-brain barrier and it is thus not associated with CNS effects. In theory, Mitodrine might work for the orthostatic hypotension of MSA (or Shy-Drager), but not that of Parkinsonism. Most patients on Midodrine also take Florinef (see above). Mitodrine has been shown to be helpful in controlled trials (Kapoor, 2003).
• Erythropoietin. This agent is used if there is also anemia and other measures have failed. Doses of 25 to 75 U/kg TIW are used, by injection.
• Methylphenidate 5-10 mg orally 3 times/day given with meals. An amphetamine -- side effects may include agitation, tremor, insomnia, supine hypertension.
• Ephedrine 12.5-25 mg orally three times/day. Side effects may include tachycardia, tremor and supine hypertension.
• Fluoxetine 10-20 mg daily. Side effects may include nausea and anorexia. Paroxetine (Paxil) has also been shown to reduce syncope at 2 years.
• Phenobarbital may improve POTS.
• Desmopressin. This analog of vasopressin is used as a nasal spray. Low blood sodium is a possible side effect.

I hope this helps, please let me know if you have more questions.

Kerry