Benign Paroxysmal Positional Vertigo
|Gary S Flom MD FACS FAAP
American Board of Otolaryngology
Fellow American College of Surgeons
Fellow American Academy of Pediatrics
About the author: Dr Flom is a Board Certified Otolaryngologist. He practices in Metro Atlanta and is a Fellow of the American College of Surgeons as well as the American Academy of Pediatrics. His special interests include chronic sinusitis, tinnitus, vertigo and upper airway allergies.
It is paroxysmal, because the movement that causes symptoms won’t always set off their dizziness. And it may totally go away for several weeks then return.
It is important to keep a written or mental journal of head positions or activities that elicit the vertigo. This will help with safety against falling by avoiding those positions when standing or walking. It will get better over time as the brain learns that the signals it is receiving are not correct.
People struggling with BPPV should avoid activities that may turn out to be dangerous. They should avoid climbing a ladder. And avoid tilting their head back unless they are safely seated. There have been many instances of a person with BPPV falling from a ladder while changing a light bulb. Not only are they a few feet above the ground, but while tilting their head back to look at the bulb, vertigo sets in and they stumble.
Also, getting out of bed can cause a fall. While a person with inner ear floating crystals (the cause of BPPV) sleeps, the head is immobile for several hours. The crystals settle in the inner ear due to gravity. An analogy would be to think of a beach bucket with water and sand in it. Shake the bucket for a few moments, then set it down. The sand will slowly float to the bottom. This is what happens in the inner ear of a person with floating crystals, as the inner ear is fluid filled. Now, when the person awakens and gets out of bed, the head movement sets the crystals in motion and can send a very powerful message to the brain signaling movement which is well beyond the actual amount of lifting their head off of the pillow. If they jump out of bed too fast, they could very likely fall. I counsel people with BPPV to arise slowly and in stages when getting out of a chair or bed. When getting out of bed, they should first raise their head off the pillow and hold that position for a few seconds until vertigo subsides, as many will get their first episode of the day at that point. Then they should bend at the waist and sit up in bed, remain sitting up for a few moments. Finally, swing their legs off the bed and slowly stand up looking forward with their eyes looking in a neutral forward direction. It is also useful, for many, to sleep with their head elevated. View pharmacy products and read reviews on these products on CVS ad and Walmart pharmacy ads.
Try one of those bed pillows that are used for reading in bed, seem to work better than stacking pillows which typically end up sliding around.
Similarly, getting out of a chair should be done in movement stages. The longer a person with BPPV has had their head motionless, the more likely that head movement will bring on vertigo.
Showering can also present challenges, and should be done carefully avoiding head positions that cause vertigo or dizziness. The risk of falling or slipping is very real because of the combination of BPPV and wet slippery footing.
Fortunately, with BPPV, the vertigo eventually subsides, but may take several weeks or even a few months. The symptoms suddenly appear one day, tend to get worse over several days, stabilize for some time, then slowly resolve. As it is going away, every day is a little better than the day prior, so you know you are on the road back to normal balance.