People often use the word “dizzy” to describe a wide range of uncomfortable sensations—feeling off-balance, unsteady, like the room is moving, or like they might faint. In this video, Dr. Patrick Nemechek explains that “dizzy” is common language, but medically it’s not very precise.
To help patients communicate symptoms more clearly, he outlines a practical way to separate “dizziness” into more specific categories: vertigo, lightheadedness, and a broader “in-between” term clinicians may use, disequilibrium. In his clinical discussion, these distinctions matter because the sensations can come from very different underlying problems.
Why “dizzy” can be confusing
Dr. Nemechek describes “dizzy” as a vague umbrella term—something people say when they know their balance or perception feels “off,” but they can’t easily describe it. Clinically, he notes that when patients report altered sensations in the balance “zone” (for example, the floor feels like it’s moving or their balance feels wrong), it’s helpful to sort symptoms toward one of two main ends of a spectrum:
- Vertigo: a spinning sensation (like being on a carousel).
- Lightheadedness: a sensation that the “lights are going out” and you may pass out, typically when upright.
Between these ends is a gray area where people may still say “dizzy.” Dr. Nemechek explains that clinicians often use the term disequilibrium for that broader, nonspecific sense that the balance/equilibrium system isn’t working properly.
Vertigo: “spinning” and balance-mechanism dysfunction
In Dr. Nemechek’s description, vertigo is related to the balance mechanism not working correctly. At its most intense, it feels like the world is spinning—“like you’re on a carousel.” He also points out that vertigo doesn’t always reach that extreme; sometimes it presents as a milder sensation, such as feeling like you’re on a boat.
Importantly, he notes that this doesn’t necessarily mean the balance mechanism is permanently damaged. In his example, it may simply not be working right in the moment, such as with sinus congestion.
A key clue Dr. Nemechek uses: not dependent on being upright
One practical way he distinguishes vertigo from lightheadedness is by posture dependence. With vertigo-type sensations, he explains you may still feel the “swimming” or “whoa” sensation while lying in bed—or when rolling over in bed. In other words, in his clinical framing, it’s not specifically triggered by standing upright.
Lightheadedness: “about to pass out” and difficulty maintaining blood pressure to the brain
Dr. Nemechek contrasts vertigo with lightheadedness, which he describes as the sensation that you might faint—especially when sitting or standing still, or when standing up. In his explanation, the core issue is often difficulty “driving blood pressure up to the top of your head,” leading to not enough oxygen reaching the brain and the brain “not working right.”
He says this problem is typically due to autonomic damage in the patients he sees, while also noting other possible contributors he mentions in the video, such as severe anemia or being truly dehydrated.
How lightheadedness can look “mild” at first
Dr. Nemechek also explains why lightheadedness may be reported as vague imbalance rather than obvious near-fainting. In a mild degree, he says, people may just feel “off,” uneasy walking, or like their balance is slightly impaired. Someone might describe bumping into a door jamb while walking down a hallway. In his framework, that can still fit under disequilibrium—but the origin is different than vertigo.
Disequilibrium: the middle ground that can come from different causes
“Disequilibrium,” as Dr. Nemechek uses it, refers to a general sense that the equilibrium/balance system isn’t working right. He emphasizes that this middle ground can be confusing because it can arise from two very different causes:
- Vertigo-related disequilibrium: balance-mechanism dysfunction that may include spinning or a boat-like sensation.
- Lightheadedness-related disequilibrium: reduced ability to maintain adequate pressure/oxygen delivery to the brain when upright, creating unsteadiness or “off” feelings.
He also notes that people can have both vertigo and lightheadedness; it’s “not unheard of.” But he adds that, often in the setting of autonomic damage, the “dizziness” people report is due to lightheadedness when they stand up.
Practical symptom questions to discuss with your clinician
Based on Dr. Nemechek’s distinctions in the video, clearer descriptions can help a clinician understand what you mean by “dizzy.” Examples of symptom clarifiers include:
- Is it spinning? (suggesting vertigo at the more intense end)
- Is it a near-fainting feeling when upright? (suggesting lightheadedness)
- Does it still happen when lying down or rolling over in bed? (a clue Dr. Nemechek associates with vertigo-type symptoms)
- Is it a vague unsteady/boat-like sensation? (disequilibrium that could be linked to either end of the spectrum)
Medical disclaimer: This article summarizes a brief educational video and is not medical advice. Dizziness, vertigo, and lightheadedness can have many causes. If symptoms are severe, sudden, recurrent, or associated with fainting or other concerning signs, seek evaluation from a licensed healthcare professional.
