What are the next steps to manage my persistent dizziness and lightheadedness, given that my bloodwork and sleep study results are borderline and my upcoming heart monitor and stress test are scheduled for September and November?

Management of Persistent Dizziness/Lightheadedness

The most effective approach for your persistent dizziness is a multifactorial assessment followed by a tailored intervention targeting the specific cause(s) of your symptoms, as this has been shown to significantly reduce dizziness handicap in middle-aged and older adults. 1

Diagnostic Considerations

Your symptoms of constant dizziness/lightheadedness that worsens with movement but improves with focus on activities like watching TV or using the computer suggests a possible vestibular disorder. Since your symptoms have persisted for 6-7 months with borderline test results so far, further evaluation is needed.

Key Diagnostic Tests to Consider:

1. Vestibular Testing:

   • Dix-Hallpike maneuver to assess for Benign Paroxysmal Positional Vertigo (BPPV) 2
   • Supine roll test if Dix-Hallpike is negative, to check for horizontal canal BPPV 2
   • Video- or electronystagmogram to evaluate vestibular function 3

2. Audiological Testing:

   • Audiogram to assess hearing function 3
   • Electrocochleography if Ménière's disease is suspected 3

3. Neurological Assessment:

   • HINTS examination (Head Impulse, Nystagmus, Test of Skew) to differentiate between peripheral and central causes 2
   • MRI of the brain if central causes are suspected or if symptoms persist despite treatment 3

Treatment Approach

While awaiting your heart monitor and stress test results, you can pursue these evidence-based interventions:

1. Vestibular Rehabilitation Therapy (VRT)

• Specialized exercises to improve balance and reduce dizziness symptoms
• Particularly effective for chronic vestibular disorders 2
• Can help reduce visual dependency and improve central compensation 2

2. Canalith Repositioning Procedures (if BPPV is diagnosed)

• Epley maneuver for posterior canal BPPV (90-96% success rate) 2
• Gufoni maneuver for lateral canal BPPV (93% success rate) 2
• Barbecue Roll maneuver for horizontal canal BPPV (75-90% effectiveness) 2

3. Medication Management

• Vestibular suppressants (e.g., meclizine) should be limited to short-term use (<1 week) to avoid interfering with vestibular compensation 2
• Review of current medications that may contribute to dizziness

4. Lifestyle Modifications

• Fall prevention strategies given the increased risk with persistent dizziness 2
• Daily symptom journal to track triggers and patterns of dizziness 3
• Regular physical activity to improve overall balance and coordination

Follow-Up Plan

1. Reassessment within 1 month after initiating treatment to document progress 2

2. Referral to specialists if symptoms persist:

   • Neurotology or otolaryngology for persistent vestibular symptoms
   • Neurology if central causes are suspected

3. Monitor for treatment failure signs:

   • If symptoms persist after initial treatment, reevaluation is necessary as this may indicate:
     • Persistent vestibular disorder requiring additional maneuvers
     • Coexisting vestibular conditions that need identification and treatment
     • Possible central nervous system disorders that require different management 3

Important Considerations

• Multifactorial nature: Dizziness often has multiple contributing factors, which is why a comprehensive approach is most effective 1
• Persistence: About 20% of dizziness cases don't receive a definitive diagnosis, but symptoms can still be managed effectively 4
• Quality of life impact: Untreated dizziness can lead to reduced quality of life, depression, and increased fall risk 1

While waiting for your cardiac tests, pursuing vestibular evaluation and rehabilitation offers the best chance of addressing your persistent symptoms based on current evidence.