Vertigo and BPPV
Why does the room spin when I roll over in bed?
Brief, intense spinning triggered by head position changes. Benign paroxysmal positional vertigo is common, mechanical, and usually resolves in one to three treatment sessions.
What it feels like
Sudden, violent spinning that starts when you roll over in bed, lie down, sit up, or tip your head back. It lasts under a minute, settles when you stay still, and comes back the next time you move into that position. Nausea is common. Between episodes you may feel unsteady or foggy for hours.
Vertigo that lasts for hours without changing, or that comes with hearing loss, is a different problem and needs a different assessment.
What is actually happening
Small calcium carbonate crystals normally sit in one part of the inner ear. In BPPV they come loose and settle into one of the semicircular canals, where they move when your head moves and send a false signal that you are spinning. Your eyes respond to that false signal, which is why the room appears to move.
It often follows a head knock, a period of lying flat during illness, or nothing identifiable at all. It is mechanical, not neurological, and it is not a sign of anything sinister.
How it is assessed
Positional testing moves your head through specific planes while your eye movements are observed. The direction and timing of those eye movements identifies which canal the crystals are in and which side is affected, which determines exactly which repositioning manoeuvre will work.
This is the step that gets skipped most often, and it is the reason generic exercises found online frequently fail. Treating the wrong canal does nothing.
How it is treated
A repositioning manoeuvre guides the crystals back out of the canal. It takes a few minutes, it will provoke the vertigo while it is being done, and it commonly resolves the problem in one to three sessions. You are given the specific manoeuvre for your presentation to repeat at home if symptoms recur.
Where unsteadiness persists after the spinning has stopped, a short course of vestibular rehabilitation retrains the balance system.
What to do first
Note which movement sets it off and which side you turn towards, because that information shortens the assessment. Avoid driving while symptoms are active. Get it assessed rather than waiting it out — this is one of the few conditions in physiotherapy that often resolves in a single visit.
Where this is assessed
- Athlete's Care Sports Medicine Centres Yonge & Eglinton · Mon/Wed/Fri · 8:00 AM – 12:00 PM Book at Athlete's Care