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.
Disclaimer
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.
Wow
So after days of not moving, are there any exercises I can do before I start moving around and going outside? I don’t notice the dizziness or unsteadiness until I get walking outside. It feels like I am on a boat on rough seas lol.
Hi Janet,
I am sorry to hear that you feel you are on a boat on rough seas when you go walking outside!
Without evaluating the root cause of your symptoms in person, I am unable to suggest specific exercises for you to use.
My suggestion is that you find a Vertigo Professional in your area and seek a Vestibular physical therapy evaluation.
You can find a provider by using the links in this blog.
Then your exercise program can be customized for your exact situation.
Although the exercise protocols are standardized, each patient has different needs.
I hope that helps!
Sincerely,
Kim Bell, DPT
Dear Dr.K.Bell.
I truly appreciate your knowledge and excellent Blog. I have had an acute vestibular neuritis one year ago! I am still decompensated in spite of VRT,
I am swimming every day..I am quite unsteady when I am outside on the street and I have Hashimoto’s.
Any your suggestions would profound appreciative.
Thank you,
Anna
Hi Anna,
I suggest you find a vestibular physical therapist using this blog, and commit to a full course of vestibular rehab.
This blog and this blog discuss reasons why vestibular therapy may not work.
This blog is on recovering from neuritis.
You may also be interested in this blog on the Gut and Vertigo, regarding your Hashimoto’s.
I am glad you are staying active and keeping fit with the swimming!
Best wishes,
Kim Bell, DPT
Wow this is me. Thank you so much for writing this. I had healed and felt better but once I stopped my head exercises a few weeks later the imbalance came back just subtle in the background.
I am so happy that you found this article to be helpful.
Thank you!
Very interesting
Can you tell us pubmed (or similar) reference??
Hi Mar,
I first learned about the phenomenon of “vestibular decompensation” in February 2006, during an introductory course in Vestibular Rehabilitation.
I apologize but at this point, I have been identifying and treating it for many years. I do not have a source at the ready to share with you about it.
It may be covered in the Vestibular Rehabilitation textbook, authored by Susan Herdman. If you do not already have a copy and you are a professional healthcare provider, I highly recommend that textbook for your learning.
The key is to identify the onset of symptoms after a period of immobility.
The traditional interventions for Vestibular Rehab are effective to treat it.
Best wishes,
Kim Bell, DPT
Hi Kim. Does this mean you will always need to do VRT? I was diagnosed with vestibular neuritis early Feb and have been doing PT exercises at home for almost 8 weeks. Always wondering when I know I’ve compensated? I’m very active; walking, step class, tennis; and I know this all helps. Thoughts? Thx
Hi Susan,
That is great you were able to discover vestibular physical therapy so soon after your vestibular neuritis diagnosis.
You may be interested in this blog that discusses vestibular neuritis recovery tips and this blog that discusses common barriers to recovery.
Also, I am so pleased that you are maintaining such an active lifestyle. A “lifetime of active head motions” is needed to maintain the recovery from vestibular neuritis that you have achieved with your vestibular exercises.
Vestibular exercise protocols are very specific, so it is important to consult a vestibular professional to ensure you are performing the correct exercises in the proper way.
As far as how to know when you have compensated, your treating physical therapist can re-assess you to determine if your vestibulo-ocular reflex (VOR) is fully adapted and also to determine if your balance is stable with only vestibular input available.
Once you have fully compensated, you should be able to perform all your normal actives without dizziness or motion sensitivity.
You are at higher risk of BPPV throughout your life span, so I suggest you educate yourself on symptoms of BPPV. That way you can recognize a BPPV onset right away and seek skilled VRT care.
In response to your question about whether you will always need to do VRT, my answer is that you will likely have intermittent needs for VRT. Once you accomplish a full recovery from the episode of vestibular neuritis, then you will likely be discharged from VRT with instructions to return if your symptoms ever flare up again.
You may need another round of VRT in the future if you get BPPV or if you experience vestibular decompensation due to a period of immobility.
I hope that reply was helpful!
Best wishes,
Kim Bell, DPT
I had my inner ear removed due to Ménière’s disease in 2011. I had very few problems until I lost both parents a few months apart. It was a few weeks after dealing with all the final arrangements that I started feeling lightheaded and offish. Can you de compensate after a stressful event ?
Hi Larry,
I am so sorry to hear what you are going through after losing both parents a few months apart. Grief can be overwhelming.
Sometimes grief can cause people to sleep more, and that can contribute to decompensation.
The vestibular compensation is a complex process, most of which happens in the brain, or central nervous system.
The function of the central nervous system can absolutely be disrupted by stress.
Lack of sleep can also affect how the brain is functioning.
Most often, decompensation occurs due to lack of head motion from staying in bed or on the couch too much.
My suggestion is that you “get back to basics” of self-care. That includes a proper sleep schedule, staying hydrated, eating healthy food at regular times, and stress management techniques.
If that does not stabilize your symptoms, then it may be time for a Vestibular Physical Therapy tune-up.
Dizziness can also be a symptom of anxiety, called “anxiety-related dizziness.”
If the experience of losing both parents so quickly was traumatic for you, you may want to check out this blog.
If you feel your symptoms are related to anxiety, PTSD, or depression, then you may need mental health support as you work through your grieving process.
I just spoke to someone else today who told me that her dizziness completely cleared up after working with a Christian counselor for 6 months to cope with some mental health issues that were triggered by losing her father suddenly and unexpectedly.
Best wishes,
Kim Bell, DPT
Hi Kim!
Thank you for your article!
I was wondering if you have ever had anyone with a decompensated hypofunction that seems to come with seasonal change?
I was diagnosed with a hypofunction via VNG a few weeks ago.
I’ve been dealing with vertigo issues since late September 2022 despite diligent HEP compliance.
I also dealt with vertigo symptoms in the fall/winter of 2019 and 2022.
No symptoms in the spring/summer.
Opposite to your post here, I’m an avid marathon runner and have not been on bed rest (I also have 3 young kids so actually quite the opposite haha)
My current ENT basically told me it will resolve with time and there’s nothing I can do about it besides PT (I understand this, I’m also a PT (ortho though!)
My biggest fear is that this is going to be something that continues every fall/winter.
I’ve talked to several vestibular PTs/colleagues and no one seems to have had a patient with similar issues, or such a hard time recovering even with doing my vestibular exercises 3-5x/day.
Any thoughts would be so greatly appreciated!
Thank you so much in advance!
Hi Tricia,
I’m sorry to hear what you are going through!
Seasonal vertigo is typically BPPV or vestibular migraine. Changes in barometric pressure are triggers for both a new onset of BPPV and migraine.
With such an active lifestyle, you don’t seem to be a candidate for a decompensated vestibular hypofunction.
If you have an active virus in your body due to the colder weather, viral activity can cause mild neuritis type symptoms or a new onset of BPPV as well.
I agree with the vestibular colleagues you have spoken to – something is not adding up here!