Do you feel like the room suddenly spins when you roll over in bed, sit up, bend down or look upwards?
One possible cause is BPPV (Benign Paroxysmal Positional Vertigo) — one of the most common causes of vertigo.
The good news is that BPPV is often very treatable. However, not all dizziness is caused by BPPV, which is why getting the right assessment is an important first step.
In this guide, we’ll explain what BPPV is, what it feels like, how it’s diagnosed, and how vestibular physiotherapy can help.
What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo.
It is a condition affecting the inner ear that causes brief episodes of vertigo when your head moves into certain positions.
To understand BPPV, it helps to know a little about how your inner ear works.
Your inner ear contains a system called the vestibular system, which helps your brain understand how your head is moving and where your body is positioned in space.
Within this system are tiny calcium carbonate crystals called otoconia. Normally, these crystals sit in an area of the inner ear where they help detect changes in gravity and head position.
Sometimes, these crystals become displaced and move into one of the semicircular canals.
When you move your head, the displaced crystals can move within the canal and send incorrect information to your brain about how your head is moving.
This mismatch of information can create the sudden spinning sensation associated with BPPV.
What does BPPV feel like?
BPPV typically causes brief episodes of spinning or vertigo triggered by specific head movements.
You may notice symptoms when:
- Rolling over in bed
- Getting into or out of bed
- Sitting up or lying down
- Looking upwards
- Bending down
- Turning your head
- Reaching for something above you
The spinning sensation is usually brief, often lasting less than a minute.
However, you may continue to feel unsettled, unsteady or “off” for longer after the spinning stops.
Some people also experience:
- Nausea
- Feeling unsteady
- Difficulty walking immediately after an episode
- A general sense of dizziness or imbalance
A common example
You go to bed feeling completely normal.
You roll onto your right side and suddenly the room starts spinning.
After several seconds, the spinning settles.
You stay still and feel okay again.
The next morning, you sit up and the room spins again.
That pattern is commonly associated with BPPV.
However, symptoms alone cannot confirm that you have BPPV. Other vestibular, neurological, cardiovascular and medical conditions can also cause dizziness or vertigo.
Why does rolling over in bed cause vertigo?
This is one of the most common questions people ask.
When BPPV is present, the displaced crystals can move when you change the position of your head.
Rolling over in bed changes the orientation of your head relative to gravity. If the crystals are sitting within a semicircular canal, this movement can stimulate the balance system in an abnormal way.
Your brain receives information suggesting that your head is moving when your eyes and other sensory systems may be telling it something different.
The result can be a sudden spinning sensation.
This is why someone with BPPV may feel perfectly fine while sitting still but experience intense vertigo when they roll over, lie down or look upwards.
What causes BPPV?
Sometimes, there is no obvious reason why BPPV develops.
It can occur spontaneously, but some factors may increase the likelihood of developing BPPV, including:
- Age-related changes within the vestibular system
- Head injury
- Previous vestibular conditions
- Certain periods of prolonged inactivity or changes in head position
Importantly, having BPPV does not necessarily mean that something is seriously wrong with your brain or inner ear.
Despite its unpleasant symptoms, BPPV itself is considered a benign condition.
How is BPPV diagnosed?
A vestibular physiotherapist will begin with a detailed discussion about your symptoms.
We may ask:
- What does your dizziness feel like?
- Is it spinning, light-headedness or imbalance?
- How long does each episode last?
- What movements bring it on?
- Does rolling in a particular direction trigger your symptoms?
- Do you have nausea?
- Have you experienced hearing changes?
- Have you recently had a head injury?
- Are there any other symptoms occurring alongside the dizziness?
We then perform an appropriate physical assessment.
This may include looking at:
- Eye movements
- Head and neck movements
- Balance
- Walking
- Coordination
- Positional changes
Specific positional tests can also be used to assess whether BPPV is likely to be present.
During these tests, your physiotherapist may move your head and body into particular positions while observing your symptoms and eye movements.
The findings help determine whether BPPV is likely and, importantly, which part of the vestibular system may be involved.
Can physiotherapy treat BPPV?
Yes. Specific vestibular physiotherapy techniques can be used to treat BPPV.
The treatment depends on the type and location of the BPPV identified during your assessment.
A physiotherapist may use a canalith repositioning manoeuvre to help move the displaced crystals out of the semicircular canal and back towards their normal location.
You may have heard of the Epley manoeuvre, which is one type of repositioning manoeuvre commonly used for certain types of BPPV.
However, the Epley manoeuvre isn’t appropriate for every presentation of BPPV.
Other manoeuvres may be used depending on which semicircular canal is involved and the specific findings of your assessment.
This is why simply performing a manoeuvre you found online isn’t necessarily the best approach.
The right manoeuvre depends on the right diagnosis.
How quickly does BPPV improve?
Many people experience significant improvement after appropriate treatment, sometimes very quickly.
However, recovery can vary between individuals.
Some people may:
- Improve after one treatment
- Require more than one repositioning manoeuvre
- Experience some residual dizziness or imbalance afterwards
- Need additional vestibular rehabilitation
If symptoms persist, your physiotherapist can reassess you and determine whether further treatment is appropriate or whether another cause of your symptoms needs to be considered.
Can BPPV come back?
Unfortunately, BPPV can recur.
Having successful treatment doesn’t necessarily mean you will never experience it again.
If you have previously had BPPV, you may become familiar with the characteristic spinning sensation when changing position.
However, it’s still important not to automatically assume that every future episode of dizziness is BPPV.
New or different symptoms should be assessed appropriately.
Is all vertigo BPPV?
No.
This is an important distinction.
Vertigo is a symptom, not a diagnosis.
BPPV is one possible cause, but dizziness and vertigo can occur for many different reasons.
Other causes may include:
- Vestibular neuritis
- Labyrinthitis
- Vestibular migraine
- Ménière’s disease
- Persistent postural-perceptual dizziness (PPPD)
- Concussion-related vestibular dysfunction
- Medication-related dizziness
- Cardiovascular causes
- Neurological conditions
- Other medical conditions
The treatment for each condition can be very different.
That’s why a good vestibular assessment isn’t simply about finding out whether you have BPPV. It’s about understanding what is causing your symptoms and what the most appropriate next step is.
When should I see a doctor about dizziness?
Most dizziness isn’t an emergency, but there are situations where you should seek medical attention.
If your dizziness is new, severe, unusual, persistent or accompanied by other concerning symptoms, medical assessment may be appropriate.
Seek urgent medical attention if dizziness or vertigo occurs alongside symptoms such as:
- New weakness or numbness
- Difficulty speaking or understanding speech
- New significant problems with coordination or walking
- Double vision or significant visual changes
- Fainting or loss of consciousness
- Severe or unusual headache
- Chest pain
- Significant new hearing loss
- Other sudden or concerning neurological symptoms
If you’re unsure whether your symptoms are appropriate for physiotherapy, speak with your doctor or another appropriate healthcare professional.
A vestibular physiotherapist will also screen for symptoms that may require medical referral rather than physiotherapy treatment.
Can I treat BPPV myself?
You may find videos online demonstrating the Epley manoeuvre and other repositioning techniques.
However, it’s important to remember that not every case of dizziness is BPPV, and not every case of BPPV is treated with the same manoeuvre.
Performing the wrong manoeuvre may be ineffective and could potentially make you feel worse.
A proper assessment can determine:
- Whether your symptoms are consistent with BPPV
- Which side may be involved
- Which semicircular canal may be affected
- Which treatment is appropriate
- Whether another cause of your symptoms needs to be considered
If your symptoms don’t fit the typical BPPV pattern, further investigation or referral may be recommended.
Dizziness doesn’t have to be something you simply live with
Feeling dizzy or experiencing vertigo can be frightening, particularly when you don’t understand why it’s happening.
While BPPV is a common and often treatable cause of positional vertigo, the first step is identifying what’s actually causing your symptoms.
Our vestibular physiotherapists, Aditi & Rheine, have undertaken comprehensive training in the assessment and management of dizziness, vertigo and vestibular conditions.
If you’re experiencing dizziness, vertigo or balance problems, Rheine & Aditi can assess your symptoms and help determine the most appropriate next step.
Think your dizziness might be BPPV?
Or contact our clinic to discuss whether a vestibular assessment may be appropriate for you.
Frequently Asked Questions
What is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. It occurs when small calcium carbonate crystals within the inner ear become displaced into one of the semicircular canals, causing brief episodes of vertigo with certain head movements.
How do I know if I have BPPV?
BPPV commonly causes brief spinning sensations triggered by movements such as rolling over in bed, lying down, sitting up, bending down or looking upwards. However, an assessment is required to determine whether BPPV is actually causing your symptoms.
Can a physio treat BPPV?
Yes. Vestibular physiotherapists can assess and treat appropriate cases of BPPV using specific repositioning manoeuvres. The manoeuvre used depends on the type and location of the BPPV.
Is the Epley maneuvre safe?
The Epley manoeuvre is commonly used for certain types of BPPV, but it isn’t appropriate for every person or every type of BPPV. A suitable assessment should be performed first, particularly if you have other medical conditions affecting your neck, blood vessels or neurological system.
How long does BPPV last?
Untreated BPPV can persist for weeks or longer, although symptoms vary considerably. Appropriate repositioning treatment can result in rapid improvement for many people.
Can BPPV come back?
Yes. BPPV can recur even after successful treatment. If you develop new or different dizziness, it’s important to have your symptoms reassessed rather than automatically assuming it is BPPV.
Should I get an MRI for vertigo?
Not everyone with dizziness or vertigo requires imaging. Some vestibular conditions can be identified through a detailed history and physical examination. However, certain symptoms require medical investigation, so appropriate screening is important.
Can dizziness be treated with physiotherapy?
Some causes of dizziness and vertigo respond well to vestibular physiotherapy. Treatment depends on the underlying cause and may include repositioning manoeuvres, gaze-stabilisation exercises, balance rehabilitation, education and graded exposure to movement.
Dizziness Decoded
This article is intended for general educational purposes and does not replace individual medical assessment. If you are experiencing new, severe or concerning symptoms, seek appropriate medical attention.
