After his examination and treatment, one of my patients asked me very inquisitively, “Is BPPV always on the side you sleep on?” He felt vertigo when lying down.
I thought the question was excellent so I want to share with you my reply. Here is what I said:
‘Acute BPPV is frequently on the same side you sleep on, especially if it came on spontaneously without head trauma, ear infections or sinus issues, which can dictate the involved side.
In contrast, Chronic BPPV is usually on the side people AVOID sleeping on for years.’
I recall one patient I saw who had been experiencing falls and imbalance for over ten years. She never complained of dizziness or vertigo but she did have repeated unexplained falls and complained of feeling “off balance” or “unsteady.”
When she slept, she propped herself up on pillows to avoid lying down flat. Sometimes she slept in her recliner chair. She only slept propped up on her back or on her LEFT side when she slept on her bed.
When I tested her vestibular system, she had a positive BPPV sign on the RIGHT side. We were able to clear it for her completely in two sessions of repeated particle repositioning maneuvers.
She was puzzled when my BPPV test was positive because she did not realize that she even had vertigo which was affecting her balance and causing falls.
I explained to her that is why BPPV is defined as POSITIONAL vertigo. She didn’t feel vertigo when lying down because she avoided lying on the involved side.
The Vertigo symptoms of BPPV are only triggered in certain head positions and with specific head motions, unless it is a very acute case of BPPV.
In chronic cases of BPPV, if you avoid the specific provoking positions and motions, you might never experience true feelings of vertigo.
The majority of patients I have met who have been falling for years – without a known cause of the chronic falls – and test positive for BPPV during my exam have learned to live in ways that do not provoke any vertigo symptoms.
To be clear, this means that they have altered their movement patterns unconsciously to avoid any feelings of discomfort from BPPV.
Most commonly, people with BPPV learn to sleep propped up on pillows and avoid sleeping on the involved side to prevent feelings of vertigo when lying down.
One clinician told me she had a patient who developed a pressure sore on the skin of his ear due to sleeping on the “uninvolved” side for years while he had BPPV in the opposite (or involved) ear.
I now teach my physical therapy colleagues and highly recommend for all older adults with repeated unexplained falls, complaints of imbalance or excessive fear of falling to be screened for BPPV.
Very often, older adults with BPPV have learned to live in ways that do not provoke symptoms of vertigo, but the underlying BPPV still affects their balance, steadiness, confidence level and walking stability – and it causes unexplained repeated falls or chronic falls.
Disclaimer
This blog is provided for informational purposes only. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that I might see and do not describe the circumstances of a specific individual.
My wife is diagnosed with Chronic BPPV and has been unsteady on her feet for 12 months, My question is about the crystals that cause this…. don’t they regenerate after 3 months? In my wife’s case, NHS ENT consultant is telling her the crystals have moved to the most difficult place in the inner ear and she has to undergo a special procedure to relocate them. She has undergone Dicks Hall (I think!) in the past with no success … what other procedure is there?
Hi Gary,
There are cells in the vestibular end organ “utricle,” called dark cells and mast cells, that we theorize to regenerate the BPPV crystals.
However, if the crystals have broken free of the membrane in the utricle where they are supposed to stay attached, and they floated into the semi-circular canals, then they have to be repositioned back in their original place.
Think of the sand sifting back and forth as you turn an hour glass over and over. That is what the crystals are doing inside the semi-circular canals, because they are not supposed to be there!
There are many “repositioning maneuvers” to relocate the crystals back to the utricle. The maneuvers are like playing a pinball game by rolling the crystals through the vestibular labyrinth using precise turns and the pull of gravity.
The procedure needed is specific to the ear, the canal, and the location of the crystals.
I wrote this blog that covers how BPPV treatment works in more detail.
I am glad you have found a provider in your area who seems competent and confident of the care that your wife needs! That is wonderful!
Best wishes,
Kim Bell, DPT
Hello, I have BPPV, and after my last episode, I started sleeping exclusively on my unaffected side and using 2 pillows. I use to toss and turn from side to side many times during the night, which probably triggered my BPPV to begin with. Now that I’m feeling better again and the crystals are back in place, I’m afraid to turn over in bed at all while laying down, even to snuggle with my husband before we fall asleep for fear that I might “dislodge the crystals.” Is it safe to turn my head to the “affected side” in bed even for a few minutes or is that just asking for trouble?? How sensitive are these crystals? I feel like I can’t do things I use to do, like turn over in bed (at all!) or bend over to pick things up (head below shoulders) without worrying about another episode. I’m 50 and have had vertigo 4 times, but they’ve gotten less intense each time. Thank you!
Hi Pam,
These are all great questions.
I have some additional blogs I will share that may help shed some light on your questions.
BPPV recurrence
Can I prevent BPPV recurrence?
What to Avoid after BPPV treatment
The Connection between Vertigo and Anxiety
PTSD and Vertigo
The bottom line is that BPPV can and often does recur. There is not a whole lot you can do to prevent it.
The future episodes are often not as severe as the initial, which is consistent with what you have experienced so far.
You must be prepared to recognize if the BPPV returns and seek proper care right away to prevent disability.
At the same time – You have to live your life!
The research shows that returning to your normal activities after you follow all post BPPV treatment precautions is associated with the best overall recovery.
I hope the information I have shared is helpful. Take care!
How long does it take vertigo to go away what is the best thing for it
Hi Alvin,
The best thing for vertigo is to find a skilled provider who can properly assess and treat the root cause.
This article can guide you on how to find a provider in your area.
This article shares some home remedies that you can use to get relief in the meantime.
This video lecture is my most popular video and has helped many people. You may learn something valuable, if you want to watch it.
I hope you feel better soon!
Best wishes,
Dr. Kim Bell, DPT
I am suffering from bppv from 4 years and everyday in the morning after getting from bed i get dizziness which last for 15 to 20 minutes. Kindly help me and advise me the treatment for this dizziness.
Hi SSuhail,
I am sorry to hear what you are going through!
This blog and this blog discuss the treatment for BPPV.
This blog discusses Home Remedies that may help you feel relief until you can get treatment.
This blog may help you find a provider in your area who can treat BPPV.
I hope that information is helpful! Best wishes!
Sincerely,
Kim Bell, DPT