Published:
March 17, 2023
Benign Paroxysmal Positional Vertigo (BPPV) is one of the most common causes of vertigo—a false sensation that you are moving or that the environment around you is moving. Most people describe the sensation as “spinning.”
BPPV often comes on suddenly and can be very frightening. You may feel very unsteady on your feet and experience nausea after moving from one position to another. Knowing what to expect can help you cope with the symptoms of vertigo and find the treatment that is right for you.
What is Benign Paroxysmal Positional Vertigo?
BPPV is a condition of the inner ear. The inner ear has a portion that is important for hearing, and a portion that is important for balance. Small calcium carbonate crystals called otoconia normally rest in the balance portion of the inner ear called the otoliths. The crystals serve an important function in helping the brain detect movement.
The balance portion of the inner ear also has three semicircular canals that detect movement. These canals have fluid in them. When your head moves, the fluid stimulates sensors, which then communicate to the brain. Sometimes the “crystals” float into the canals and cause the fluid to flow abnormally and overly stimulate the sensory structures. This causes the brain to conclude incorrectly that you are moving or spinning.
What Are the Symptoms of BPPV?
Symptoms of BPPV usually start during the night and you notice them when getting out of bed. You feel as if you are spinning for about one minute while you sit on the edge of the bed. The vertigo returns when changing positions. The most common positions that cause vertigo symptoms are looking up, bending down, rolling in bed, or getting in and out of bed.
Who is at Risk for Getting BPPV and Can it Be Prevented?
The most common cause of BPPV is related to aging. As the inner ear ages, the otoconia (or crystals) start to degenerate and are prone to floating out of their correct positions.
Most of the time there is no particular event that causes BPPV. In some instances, events like head trauma, falls, or lying in the same position for a very long time can bring about vertigo. While you can’t prevent BPPV, having low Vitamin D levels seems to increase the incidence. So try to maintain adequate levels of Vitamin D. Good sources include sunlight, fatty fish and seafood, and foods fortified with Vitamin D like orange juice and milk.
How is BPPV Diagnosed?
The diagnosis starts with your health-care provider interviewing and examining you to help rule out other causes of vertigo and to rule in BPPV. The physical exam includes placing you in certain positions in an attempt to provoke the vertigo. Your eyes will be looked at closely for movement patterns that indicate what is happening in your inner ear. Your provider will look for an abnormal, jerky movement pattern called nystagmus. Sometimes patients wear special goggles, called infrared goggles, to help the provider view their eyes to carefully assess the eye movements and discover exactly where the “crystals” are located.
How is BPPV Treated?
BPPV often resolves spontaneously in a few days. This occurs while the person continues to move normally and the crystals have a chance to move back to where they belong.
When the symptoms continue past a few days, a health-care professional who is specially trained to treat this condition will first assess you and then help you through evidence based maneuvers to reposition the crystals. These maneuvers known as “canalith repositioning maneuvers” are chosen based on your symptoms and exam. The most common maneuver used is the “Epley,” named after the doctor who created the maneuver in 1980. If you feel very ill or are unsteady on your feet, professional treatment is recommended ASAP.
Many physical therapists (PTs) treat BPPV, but some have additional, specialized training. These “vestibular competent PTs,” along with the availability of infrared goggles, help ensure the exam and treatment will be as efficient as possible. It usually takes one to three visits to treat BPPV. Additional visits may be required if you have more than one canal involved, have had BPPV for an extended period, have an unusual form of BPPV, or if your balance is affected.
Do You Need to go the Emergency Room for Vertigo?
Vertigo can be a symptom of a stroke, so if in doubt, it is better to be sure that the cause is not a stroke.
If your vertigo lasts more than a few minutes, even when holding still, or is associated with other stroke symptoms—difficulty speaking, difficulty standing, weakness in your face or limbs—call 911 right away. Also call 911 if you are experiencing a sudden loss of hearing or severe headache.
The emergency room staff will examine you and conduct tests to rule out a stroke or heart attack. If BPPV is suspected, you will be treated with medication to decrease your symptoms and sent home with a recommendation to perform home maneuvers or to see a physical therapist who specializes in the treatment of BPPV.
Having Benign Paroxysmal Positional Vertigo (BPPV) can be a frightening experience. Knowing what to expect can help you cope with the symptoms. Knowing that there is treatment, and where to find a qualified physical therapist to provide treatment, can help you get back to your normal self as quickly as possible.