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.