What is BPPV? (Benign Paroxysmal Positional Vertigo)

Do you ever have “a dizzy spell” when rolling over in bed, getting up too quickly from your chair at work, looking down at your feet or looking up where it just feels as though the room is spinning, when you are actually standing or laying still?

You may be experiencing Benign Paroxysmal Position Vertigo, or BPPV.

BPPV is a condition where dizziness, vertigo or spinning sensations are felt where it seems like the entire environment around you moves as you change body and head positions.

The good news is, that for most people this is a temporary condition but it can be persistent with symptoms ranging from minutes to hours and in worst cases even days or weeks.

It’s important to note also, that there are many conditions that can cause similar symptoms to BPPV, so careful diagnosis is of high importance.

Common symptoms of BPPV

If you have BPPV, you may experience dizziness or vertigo symptoms whenever you perform movements that involve rotating your head and you may experience:

• Difficulties getting out of bed after rest;
• Difficulties rolling over in bed;
• Difficulties tying your shoe laces or bending over to feed the dog;
• Difficulties look up at the ceiling or cupboard;
• Difficulties checking your “blind spot” while driving or other quick turning head movements.

A common symptom of BPPV is Nystagmus – or rapid movements of the eye, where your eyes flicker back and forth like a typewriter making you feel dizzy, and this is used as a key indicator in diagnosis.

Effects of BPPV on your body

You may find that your body reacts to certain movements more than others, but the common feeling is of a spinning sensation (where the whole room spins fast - lasting only for seconds) while others experience a violent onset of vertigo or a longer lasting nausea.

Causes of Benign Paroxysmal Position Vertigo

In some cases of BPPV, a primary cause is never found but there are many common causes such as the following:

• Ear infections;
• Head injuries;
• Nerve inflammation;
• Degeneration of the inner ear structures;
• Viral Infections.

Ears are a common culprit when it comes to BPPV, as you have three fluid filled semi circular canals in your inner ear all tilted at different angles. These canals provide feedback to the brain on how fast and at which angle your head is moving.

When out of alignment, or obstructed these ear canals can really mess with your balance and vision.

Diagnosis of Benign Paroxysmal Position Vertigo

Your physiotherapist can diagnose BPPV by doing Hall pike test.

This test is performed with you sitting upright with your legs extended. Your head is then rotated to one side (around 45 degrees). Your physio will get you to lie down backwards quickly with your head a slight extension, which may be achieved by supporting your head as it hangs off the table.

Your physio will then observe your eyes for the onset of nystagmus. If nystagmus occurs then the test shows a positive result for BPPV.

The direction of nystagmus in your eyes is used to differentiate whether the primary problem lies in the periphery (ear canals) or a more central location. If problems are central, then you need to consult your medical practitioner.

How to treat Benign Paroxysmal Position Vertigo

BPPV can often be cured in one session and you may never have issues again.

Your physio will perform different manoeuvres to reset the semi circular canals that control your balance by preforming tilt, roll and yaw movements of your head.

This treatment is known technically as the Epley Manoeuvre (or Vestibular Rehab) and is aimed at re-setting the balance in the inner ears.

Your physio will get you to start sitting up, and then lay you down, putting their hands on your head to move your head to different positions, using gravity to relocate tiny, free floating particles in your ear canals.

Treatment may take a couple of sessions and you may get some additional exercises to do at home.

Tips for getting better results after Epley Manoeuvre / Vestibular treatment

There are a few things to keep in mind after your treatment to prevent symptoms from reoccurring. Such as:

• Do not lie flat
• Do not look down
• Do not bend

You may even be advised to not sleep laying down – sounds weird, but sleeping in a chair sitting up may help you recover quicker.

Conclusion

If you are having dizziness, spinning sensations or nausea when performing rotating movements, you may be suffering from Benign Paroxysmal Position Vertigo or BPPV please book yourself in for a Free Initial Assessment at your nearest Back In Motion practice and we can help you.

References

Image courtesy of Alamy; Northwestern University 2001