I’m so dizzy, my head is spinning. Like a whirlpool, it never ends!

Imagine a sudden feeling of spinning when you first get out of bed that makes you feel like you’re on a carnival merry-go-round that won’t stop. You feel clammy, nauseous and out of control.

But then it stops, and you go about your day. That is, until you have to reach overhead for a can of soup in the cupboard or reach down and wash your feet in the shower, and the spinning starts all over again.

This could be Benign Paroxysmal Positional Vertigo (BPPV), which is the most common cause of vertigo and dizziness. It’s more common in women, and there’s an increased risk as we age. The first step is to identify if this is the problem. And if that is the case, it’s important to know that this is something you can manage, even though the timing is not always something you can predict.

What Is BPPV?

• Benign: not life-threatening
• Paroxsymal: the spinning or dizziness only lasts a short time
• Positional: the spinning sensation happens during certain positions, most often when you’re getting up/down from bed, rolling over, leaning forward or tipping your head back
• Vertigo: a spinning sensation, not related to lightheadedness or sense of imbalance

Why Does Vertigo Happen?

Our inner ear consists of a system of semi-circular canals. These canals help detect change of speed and direction in movement. There is also fluid that moves through the canals and stimulates nerve cells to communicate with the brain. Another part of the inner ear has small crystals or otoconia that sense gravity in relationship to our head position. 

BPPV occurs when small crystals, or otoconia, break off from another part of the inner ear and get displaced. This causes the fluid in the canals to move more during certain types of motion, such as getting in and out of bed or reaching up or down. So, basically, you have rocks loose in your head!

How Is Vertigo Treated?

The first step of treatment is to identify which canal the crystal is stuck in. Then perform certain movements to dislodge the crystal back to an area that’s not part of the semi-circular canals.

Your family doctor, an ENT (i.e., ear, nose and throat) doctor, an audiologist (i.e., professional trained to evaluate hearing loss as well as balance/dizziness issues and ringing in the ears) or a physical therapist with advanced vestibular (i.e., balance) training can manage positional vertigo.

A series of positional tests help determine which canal is involved. The tests are relatively easy to perform but should be directed by a professional as it is possible to dislodge the crystal into another canal which would cause a different type of dizziness and a different type of spinning sensation. Advanced equipment may be used to videotape the tests. This helps detect very small and fast movements in the direction of the eye, which in turn helps identify where the crystal is stuck. Knowing this leads to identifying the right treatment maneuver. Eye movements are closely related to the inner ear. Observing how the eye responds—and more specifically if there is nystagmus (a specific type of eye jumping)—will guide the treatment.

Treatment is directly related to what canal the crystal is stuck in. By moving at certain speeds or directions, this can move that crystal out of the area and will free you from the spinning sensations! You can learn these movement techniques and do them in your home. Eventually, you will also be able to do your own self-assessment to determine if the technique can provide relief from your vertigo.

People who have had positional vertigo in the past are more likely to have it reoccur. Sometimes, there may be certain factors that can trigger an episode, such as lying on a certain side or even if you change the type of pillow you use. Unfortunately, you cannot predict if a movement or position will trigger a vertigo episode. However, you CAN learn to identify and treat this so that you can stop the spinning and return to your life.