Acronyms can drive you crazy. However, if you aren’t already familiar with BPPV, it stands for Benign Paroxysmal Positional Vertigo. Now you know why it’s shortened to BPPV. You should also know that when it comes to treating vertigo, your best option is treating BPPV through physical therapy.

So What Exactly is BPPV?

It starts with good news. Benign means that it isn’t a life-threatening condition. More good news: paroxysmal indicates that your dizziness comes on suddenly but only lasts briefly. Positional further indicates that your dizziness is connected to specific head positions. Vertigo, of course, refers to the spinning sensation you experience.

BPPV is a fairly common condition, affecting 9 out of every 100 older adults. It is rare among children, and the incidence increases with age in adults, especially impacting those who are over 60. Typical symptoms of BPPV include:

  • Dizziness
  • A spinning sensation (vertigo)
  • A loss of balance
  • Nausea

BPPV sufferers also describe the dizziness as happening when turning over or sitting up in bed. Others report problems with dizziness when tilting the head up or bending over to pick something up. Dizziness generally lasts only a minute or two, but if left untreated, the condition will not go away on its own.

Treating vertigo rather than ignoring it is important. Vertigo can lead to a loss of balance, which can lead to a fall. A fall might only result in bruises, but it can also result in more serious injury, especially in older adults. Occasionally, dizziness is an indicator of a more serious medical problem.

Your body’s GPS system

The ear is not only your organ of hearing but also your organ for balance. When functioning properly, structures in your ear respond to gravity, allowing your brain to process your position relative to the ground. These vestibular structures, along with your eyes and your muscular-skeletal system, also help you maintain your balance as you move, even as you change speed or direction.

A complex structure consisting of three loop-shaped canals inside your ear is called the vestibular labyrinth. These canals contain fluid and fine, hair-like sensors that detect rotation of your head. The utricle and saccule, which are part of the otolith structure of the ear, detect gravity.

The utricle contains crystals made of calcium carbonate. When these crystals, called otoconia, migrate from the utricle into one of the semicircular canals where they do not belong, they create a false sensation of movement. You experience dizziness when your brain receives conflicting information from your ears, eyes, and muscles. In this case, the otoconia send a false signal to the brain, which triggers your eyes to move.

Diagnosing Benign Paroxysmal Positional Vertigo

Not all dizziness is vertigo, and not all vertigo is caused by BPPV. It’s important for you to see your healthcare provider to get a proper diagnosis. Several inner ear problems, including Meniere’s disease, also present with dizziness. Those conditions all require different treatments. Treating vertigo effectively means treating the correct root cause.

Because BPPV is linked to eye movements referred to as nystagmus, your healthcare provider can conduct a simple test to confirm BPPV. The Dix-Hallpike test moves you from a seated position to lying on your back with your head tilted at a 45° angle, which is held for 30 seconds. If you have BPPV, this should trigger an episode of vertigo, and the healthcare practitioner can watch for the eye movements to confirm the diagnosis.

A well-trained practitioner will even be able to determine which ear is affected, and equally important, which type of BPPV you have. There are two types and they require different treatments. The most common form is canalithiasis. The crystals, which can move easily in the canal, take less than a minute to stop moving after the dizziness is triggered.

In rare cases, the crystals become lodged on a nerve bundle. This type of BPPV is called cupulolithiasis. The sensation of vertigo lasts longer because the crystals tend to stick to the nerve bundle, taking a longer time for the signals to the brain to stop.

Is it BPPV or something else?

When you see your healthcare provider, be sure to disclose all of your symptoms. Constant dizziness indicates something other than BPPV, for example. BPPV episodes of dizziness are always brief. If your vertigo also includes any of these other symptoms, you need to tell your healthcare provider:

  • Headaches
  • Double vision
  • Hearing loss
  • Difficulty speaking
  • Weakness or numbness
  • Loss of consciousness

In this case, what you have might not be BPPV, or it could be another health issue along with BPPV. Don’t try to diagnose yourself, and don’t make assumptions about which symptoms are important. Give your healthcare provider all the information you can about your symptoms, and let them make the diagnosis.

Treating Vertigo

The standard procedure for treating vertigo caused by BPPV is called the Epley maneuver, named for Dr. John Epley. It is also referred to as the “canalith repositioning procedure” or the “particle repositioning procedure.” There are variations of this maneuver, but the main goal is to move the crystals from the semicircular canals where they don’t belong.

Recommended instructions following the procedure

Once the procedure is finished, you will need to wait for a few minutes to allow the repositioned crystals to settle down. This will help you avoid triggering an episode of vertigo. It’s also wise to have someone else drive you home.

Other helpful hints after treating vertigo include:

  • Sleeping in a recliner the night after your treatment, or sleeping with a couple of pillows.
  • Avoid sleeping on your “bad ear” side.
  • Avoid going to the dentist or beauty shop, where you might need to tilt your head.
  • Avoid doing exercises that require head movements.
  • As much as possible, don’t turn your head to an extreme for the next week.

We’ll make your world stop spinning

Don’t let anyone tell you that vertigo is something you just have to live with. Treating vertigo caused by BPPV is highly effective. Although BPPV tends to recur, you will be able to find relief with additional canalith repositioning treatments.

Midland Physical Therapy has the expertise you need for treating vertigo. When the world stops spinning, you won’t need to worry about losing your balance. You’ll avoid falling and suffering from the injuries that result.

For your peace of mind, ask your doctor for a referral or contact Midland Physical Therapy to set up an appointment. It will be the best 15-minute investment of your time you can make.


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