Vertigo and BPPV: why the room spins

In shortBrief spinning triggered by head movement is usually BPPV, caused by loose inner-ear crystals. It is treated with guided repositioning movements by a doctor.

You roll over in bed and, suddenly, the whole room is spinning like a fairground ride. It lasts less than a minute, but it leaves you shaken and wondering what on earth just happened. Patients describe it to me in exactly these words, and most are relieved to hear what I say next: the most common cause is not serious, and it is very treatable.

Dizzy or vertigo?

"Dizzy" is a catch-all word. Doctors separate it into different feelings. Vertigo is a false sense of spinning or tilting. Feeling faint or light-headed when you stand up quickly is something else. Telling your doctor exactly which one you feel is the first step in finding the cause.

The usual suspect: BPPV

BPPV stands for benign paroxysmal positional vertigo, a mouthful for a simple problem. Deep inside your inner ear are tiny calcium crystals. They are meant to sit in one small chamber, but sometimes a few break loose and drift into the fluid-filled canals that sense head movement. Now, every time you move your head in a certain way, those crystals move, and your brain gets a confusing signal: "We are spinning!"

How do you know it might be BPPV?

• Brief spinning, usually under a minute, triggered by a change in head position
• Common triggers: rolling over in bed, looking up, bending down
• Nausea during the spell, and sometimes a wobbly feeling afterwards
• No new hearing loss, ringing or weakness

What does treatment involve?

The treatment is delightfully practical. Instead of medicines, we use a series of gentle, guided head and body movements that coax the crystals back to where they belong. The best known is called the Epley manoeuvre. It takes a few minutes, and many people feel much better after one or two sessions.

Helpful habits meanwhile

• Get up slowly from lying down, and pause on the edge of the bed
• Take care on stairs and avoid climbing ladders during an active spell
• Keep a note of what triggers an attack
• Stay hydrated and sleep well

When it is not BPPV

Vertigo can also come from other conditions of the inner ear and balance system, which need a proper assessment. And please seek urgent care straight away if the dizziness comes with a sudden severe headache, weakness or numbness, difficulty speaking, double vision, chest pain or fainting.

At CARE Speciality Clinic, Dr. Rekha AR assesses vertigo and dizziness, including BPPV, inner-ear imbalance and vestibular dysfunction. You can read more on our vertigo page.

Dr. Rekha AR
Consultant ENT Specialist, MBBS, DLO. Sees patients Mon–Sat at CARE Speciality Clinic, HSR Layout.

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This article is for general information and does not replace a medical consultation.