Do you feel dizzy and nauseous when you
- Turn over in bed
- Make quick movements to the left or right
- Make quick movements up or down?
If you are experiencing any of these symptoms then you could have Benign Paroxymal Positional Vertigo, or BPPV.
This a type of Vertigo that can be frightening, but it is harmless and can be easily remedied with the Epley Manoeuvre.
What is BPPV?
BPPV is the most common inner ear problem and cause of vertigo (a false sense of spinning).
BPPV is a specific diagnosis and each word describes the condition:
Benign: this means it is not life-threatening, even though the symptoms can be very intense and upsetting
Paroxysmal: it comes in sudden, short spells
Positional: certain head positions or movements can trigger a spell
Vertigo: feeling like you’re spinning, or the world around you is spinning
What causes it?
There are crystals of calcium carbonate that are a normal part of our inner ear and help us with our balance and body motion. These tiny rock-like crystals are settled in the centre “pouch” of the inner ear. BPPV is caused by the crystals becoming “unglued” from their normal place. They begin to float around and get stuck on sensors in the wrong canal of the inner ear. The dizziness you feel will continue until the crystals settle after you move. As the crystals move and settle, your brain is getting powerful, false messages telling you that you are violently spinning, when all you may have done is moved slightly.
What are the common symptoms and how can BPPV affect me?
Everyone experiences BPPV differently, but there are common symptoms. The most common symptom is distinct spells of vertigo. You may experience nausea (vomiting) or a severe sense of feeling unstable or like you are losing your balance. These symptoms will be intense for seconds to minutes. You can have lasting feelings of dizziness and instability, but at a lesser level, once the episode has passed. In some people, especially older adults, BPPV can appear as an isolated sense of instability brought on by a position change like sitting up, looking up, bending over or reaching. It does not cause constant severe dizziness and is usually triggered by movement, and it does not affect your hearing or cause you to faint.
The natural course of BPPV is to become less severe over time. People often report that their first spinning episode was the worst and that the following episodes were not as bad.
How common is it?
BPPV is very common. It is more common in older people. Many of us will experience it at some time in our lives.
What caused my BPPV?
Most cases happen for no reason. It can sometimes be associated with trauma, migraine, other inner ear problems, diabetes, osteoporosis, and lying in bed for long periods of time (preferred sleep side, surgical procedures, and illness).
How is it diagnosed?
Normal scans and x-rays, and medical testing cannot confirm BPPV. However, a simple bedside test can be completed to confirm your diagnosis. This involves moving your head into a position that makes the crystals move and will make you dizzy. The testing may include hanging your head a little off the edge of the bed or rolling your head left and right while lying in bed. The examiner will be watching you for a certain eye movement to confirm your diagnosis. The most common tests are called the Dix-Hallpike test and the supine roll test.
Can it be treated? Yes, with the Epley Manoeuvre.
Although medicines are only used to relieve symptoms, such as nausea, most BPPV cases can be improved with bedside repositioning exercises, such as the Epley Manoeuvre, which usually takes only a few minutes to complete. This has high success rates (eight out of every 10 people will respond immediately) although sometimes the treatment needs to be repeated a few times. The Epley Manoeuvre is designed to guide the crystals back to their original location in your inner ear. It can be done at the same time that the diagnosis is carried out.
You can also be taught to perform these manoeuvres by yourself, which is called “self-repositioning.”
Is there any down side to the Epley Manoeuvre?
During the actual treatment there can be some brief distress from vertigo, nausea, and feelings of disorientation. Following the treatment, some people report their symptoms start to clear right away, and others report that they have continuing motion sickness-type symptoms and mild instability. These symptoms can take a few hours or a few days to go away.
Can BPPV go away on its own?
There is evidence that if left untreated, it can go away within a few weeks. However, remember that while the crystals are out of place, in addition to feeling sick and sensitive to motion, your unsteadiness can increase your risk of falling. You will need to take precautions to not fall. You are at a higher risk of injury if you are a senior or have balance issues. Older adults are encouraged to seek professional help quickly to resolve symptoms.
How do I know my BPPV has gone away?
The strong spinning sensations that have been triggered by position changes should be greatly reduced, or completely gone.
How long will it take before I feel better?
You can still feel a little bit sensitive to movement even after the Epley Manoeuvre is successful. You can also feel unsteady at times. These mild symptoms can take up to a few weeks to slowly go away, but you should follow up with your medical provider or physiotherapist if your symptoms of dizziness or instability do not get better within this time. Older adults with a history of falls or fear of falling may need further exercises or balance therapy to cure their BPPV completely.
Is there anything I should or shouldn’t do to help?
Yes. Your balance will be very poor, so you will need to take precautions so that you don’t fall. You will feel more sensitive to movement until the BPPV has healed. When your symptoms are fading, it is important to return to normal activities that you can do safely. Exposure to motion and movement will help to speed your healing.
Can BPPV come back and/or can I prevent it?
Unfortunately, it is a condition that can sometimes return. You may only ever have a few episodes, or they may become more frequent, often caused by factors such as physical injury, inner ear conditions, or aging. We cannot stop BPPV from coming back, but we can treat it with a high rate of success.
What happens if I still have symptoms following my initial Epley Manoeuvre?
There are a number of reasons Epley Manoeuvre could have failed:
It is quite normal to need more than one repositioning session to get the crystals back in their proper place. You may only need a few more treatments. There are a number of different types of BPPV. The self-treatment is designed for the most common form, but there are other treatments available for the other types. BPPV can sometimes be in more than one canal and/or side at the same time. This may require multiple treatments to resolve. If your initial tries at self-repositioning have failed, seek a BPPV specialist. It can be difficult to complete correct positioning by yourself. A professional may be able to complete better positioning and/or use helpful equipment.
There can be some significant leftover dizziness even after the BPPV crystals have been correctly repositioned. This dizziness may require more time (few days to couple of weeks) or it may be appropriate for a different exercise/movement. It is VERY important to follow-up with your healthcare provider if you continue to have symptoms. You may be sent for further tests to confirm your diagnosis or discuss further treatment options.
If you would like to know more about BPPV and Epley manoeuvre, this is a useful link
What if your Vertigo does not match the listed criteria?
If your Vertigo does not match the above criteria, do not despair as we are still able to help. Vertigo can be caused by a variety of things, for example neck problems, TMJ problems, side effects of medication and allergies are just a few possible reasons.