If a person is immobile for even a few days – without head motion, such as during bedrest from a flu, surgery, hospital stay, depressive episode, etc, then they can experience “vestibular decompensation.”

This phenomenon occurs when a person with a vestibular hypofunction, who has fully compensated, has a period of immobility.

Vestibular decompensation is the opposite of vestibular compensation.

Vestibular Decompensation means there is a reversal of the central compensation process that has previously occurred in the brain to correct for inner ear damage – or vestibular system damage.

Vestibular decompensation occurs due to a lack of head motion.

I used to tell my Grandma when she was sick, “Even if you are stuck in bed, look around the room a few times a day. Don’t just look straight ahead all day at the television!”

Vestibular decompensation is a very common cause of episodes of dizziness, vertigo, and imbalance in people with vestibular hypofunction, after they spend a few days resting in bed.

This is due to the vestibular decompensation of a previously fully compensated vestibular hypofunction.

Before going on bedrest, some people are aware that they had a vestibular problem in the past.

Even so, they may not realize that lying still for even a few days can cause their vestibular symptoms to recur.

For example, people who have a vestibular hypofunction from vestibular neuritis may be aware that was in their past. Usually, vestibular neuritis is such a dramatic life experience that they will never forget it.

They may have even previously completed Vestibular Rehabilitation Physical Therapy to achieve compensation after the neuritis.

A lifetime of active head motions is required to maintain vestibular compensation.

The symptoms of a vestibular decompensation will not be as severe as the initial vestibular neuritis episode, but can still cause dizziness, vertigo, falls, and reduced quality of life.

Vestibular hypofunction has many potential causes in addition to vestibular neuritis.

Some people with a fully compensated vestibular hypofunction may not know it!

Lack of awareness is common in people who have vestibular hypofunction that occurs gradually over time.

Some common causes of vestibular hypofunction that occur gradually over time include diabetes, high blood pressure, high cholesterol, tobacco smoking, and normal aging of the inner ear.

Certain ototoxic medications can also cause vestibular hypofunction.

Someone can have a vestibular hypofunction that has been fully compensated by their brain and never even know it!

That person would never have previously sought care in Vestibular Rehab, since they were previously unaware that they even have a vestibular problem.

Their brain may have compensated so efficiently for the hypofunction that they only noticed a problem after a few days in bed.

That period of immobility caused a new onset of dizziness, vertigo, imbalance, or falls due to vestibular decompensation.

Vestibular Physical Therapy is effective for recovering from vestibular decompensation.

Of course, a few days in bed can also cause orthostatic hypotension.

For that reason, a professional evaluation by a Vestibular Physical Therapist is recommended.

For some people, vertigo seems to come and go. I want to emphasize that the treatment must be specific to the root cause for best results. It is not a one-size-fits-all solution!

In my opinion, the lack of root cause analysis for vertigo is the most significant problem faced by people with vertigo. That’s why I am so focused on root cause analysis in my specialty practice.


This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are 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 Dr. Bell might see and do not describe the circumstances of a specific individual.

Accessibility Toolbar