One of the most frequent sources of vertigo, or the unexpected feeling that you or the room around you is spinning, is benign paroxysmal positional vertigo (BPPV).
This type of vertigo occurs when you:
- sit up when you’ve been lying down
- nod, shake, or turn your head
- roll over in bed
- move from a standing position to lying down on your back or side
While it’s usually not serious, this condition is both uncomfortable and unsettling. Fortunately, it can be easily treated in your doctor’s office.
There are many times when a cause for BPPV can’t be pinpointed. When a doctor is able to diagnose the origin of your vertigo, it’s commonly related to:
- migraine headaches
- head injuries, like concussions
- time spent in a reclined position
- inner ear damage
- surgical procedures inside the ear
- fluid on the ear
- movement of calcium crystals into your ear canals
- Meniere’s disease
Deep in your inner ear are three canals shaped like semicircles, otherwise known as the vestibular system. Inside the canals are fluid and cilia, or tiny hairs, that help you keep your balance as your head moves.
Two other organs in your inner ear, the saccule and utricle, hold crystals made of calcium. These crystals help you maintain a sense of balance and your body’s position in relation to the rest of your surroundings. But sometimes, these crystals can move outside of their respective organs and into the vestibular system. When this happens, it can cause you to feel like the room around you is spinning, or like your head is spinning, when you move your head or change positions.
When the crystals have become dislodged and move where they shouldn’t be, this causes your ear to tell your brain that your body is moving, which creates that unpleasant feeling of spinning.
Symptoms of BPPV often come and go sporadically, and can include:
- feeling off-balance
- experiencing a spinning sensation
- mild to severe dizziness
- balance loss
- Motion sickness, or nausea
Most episodes last less than a minute, and you might feel mildly off-balanced in between each occurrence. Some people don’t experience any symptoms at all between episodes of vertigo.
In severe cases, vertigo can put you at risk for falls and injuries. Most of the time, however, it’s not a serious or dangerous condition.
This type of vertigo comes and goes and doesn’t make you feel dizzy at all times. It also shouldn’t:
- cause headaches
- impact your hearing
- create neurological symptoms, such as tingling, numbness, problems with coordination, or speech difficulties
Because there are other conditions that can cause these symptoms alongside vertigo, it’s important to contact your doctor right away if you any of those symptoms.
Your doctor can use a method of diagnosis known as HINTS (Head, Impulse, Nystagmus and Test of Skew) to help diagnose either BPPV or another condition. This will help give your doctor a starting point if your diagnosis turns out not to be BPPV.
The most common treatment for BPPV is a method called the Epley maneuver. It was developed to help move the calcium crystals back to the area of your ear where they belong. This maneuver can be performed either by your doctor, your vestibular specialist, or at home, depending on what your doctor recommends or what you prefer.
If you have vascular problems, a detached retina, or conditions involving your neck and back, don’t perform the Epley maneuver at home. You’ll need to let your doctor help you with this technique.
If your doctor performs the Epley maneuver in-office, they will:
- Ask you to turn your head 45 degrees in the direction of the affected ear
- Help you move into a lying position, keeping your head turned and keeping it right over the side of the exam table (you will remain here for 30 seconds)
- Turn your body to the opposite side 90 degrees (remain for another 30 seconds)
- Turn your head and body in the same direction, positioning your body to point to the side and your head at the ground at 45 degrees (remain for 30 seconds)
- Help you carefully sit up again
- Repeat this position up to six times until your symptoms of vertigo have subsided
To perform the Epley maneuver on yourself at home, you will want to familiarize yourself with what the movements and positions should look like before you get started. Study an online video or set of photos first to learn each step for yourself. For peace of mind and safety, have someone present while you perform the maneuver in case your symptoms worsen during self-treatment.
Before you get started, position a pillow so it will be under your shoulders when you lie down during the maneuver. Then:
- Sit down on your bed
- Turn your head 45 degrees in the direction of the affected ear
- Keeping you head turned, lie down with your shoulders on your pillow and your head slightly reclined over its edge (remain in this position for 30 seconds)
- Carefully rotate your head to the other side by 90 degrees, it should now be facing the other direction at 45 degrees (remain in this position for 30 seconds)
- Move both your head and body together in the opposite direction, 90 degrees (remain in this position for 30 seconds)
- Sit up (you should be on the opposite side from your affected ear)
- Repeat up to three times per day until symptoms subside
If the Epley maneuver doesn’t work for you at home, let your doctor know. It’s possible your doctor may be able to help you successfully execute it in-office.
In the event this treatment isn’t effective for you, your vestibular specialist will try other methods. These could include other movement techniques like Canalith Repositioning Maneuvers or a Liberatory Maneuver.
BPPV is treatable, but it may take time for your symptoms to go away. For some people, the Epley maneuver works after one or two executions. For others, it could take a few weeks to months before your symptoms of vertigo subside or disappear completely. BPPV is sporadic, unpredictable, and can come and go, sometimes disappearing for months at a time. Because of this, it can take time, patience, and observation before you know whether your vertigo is gone for good.
If your BBPV is caused by a condition other than dislodged calcium crystals, like a chronic illness or an injury, it may recur. Each time it does, it’s important to seek appropriate treatment from your doctor or specialist to alleviate your symptoms.