Vertigo getting up in the morning: Is this Benign Paroxysmal Positional Vertigo (BPPV)?

You wake up in the morning and roll onto your side to check the time and BOOM – the room is spinning, you’re disoriented and nauseous. You start sweating and panicking. The feeling subsides and you are left clutching your bedsheets wondering if you’re OK …

This is a typical story of someone experiencing “Benign Paroxysmal Positional Vertigo” (BPPV). Some go straight to the ER thinking the worst; “I’ve had a stroke or a heart attack”, only to be sent home with the vague the diagnosis of ‘vertigo’ and maybe a medication to help with the symptoms.

The lucky ones may be advised that it looks like BPPV and to seek out a vestibular therapist for treatment, or to check the internet for unreliable instructions on how to do the Epley Maneuver at home.

Over the next few days, they may feel a little off while going about their day, but certain head movements will give a brief sense of that spinning sensation.

Then when their head hits that pillow at night – > the merry-go-round returns!

What on Earth is causing this?

• Tiny calcium carbonate crystals have found their way into the canals of the inner ear

• These canals are filled with a fluid that help your brain sense head tilts and turns

• Head movement causes the crystals start to push and pull the fluid faster than normal

This completely confuses your brain since the messages about head tilts and turns are no longer in sync with what the opposite ear is sensing.

This mis-match of information to the brain results in the sensation of vertigo.

How do I know it’s these ‘crystals’ and not something else like a stroke?

The hallmark of BPPV is that it is positional. You will experience the sensation in a predictable position for a predictable amount of time (usually less than a minute). Other more urgent causes of vertigo such as a stroke, a tumor or multiple sclerosis will often not follow this pattern and may be accompanied by other Red Flags such as:

• Severe weakness

• Numbness

• Double-vision

• Constant, worsening dizziness/vertigo

If you are concerned you may have a serious medical emergency ALWAYS consult a physician first, be it the emergency room or your family doctor.

What do I do about it?

BPPV is treated by performing precise repositioning maneuvers which use gravity to flush the mis-placed crystals out. The maneuvers can be performed by a specially trained physiotherapists or on your own at home.

The key to success is to choose the correct maneuver and perform it on the proper side for your specific symptoms. A vestibular physiotherapist can perform certain tests and movements to help figure out which side and which maneuver will work best to flush out those crystals and eliminate the vertigo sensation. Relief can be immediate and one to three session is often all it takes.

The video below demonstrates what is happening inside the inner ear during the Epley Maneuver - an exercise that effectively treats BPPV of the posterior canal