Acute/Chronic Pain Resolution & Body Management
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Unexplained Dizziness & Vertigo?
What is BPPV, and How To Deal With It
Published February 24, 2020 by Jc Drobac
Having unexplained vertigo or dizziness episodes?
If you've ever experienced the sensation that the room is spinning out of control, you know how disconcerting or scary it can be. As common as it is, I'm always surprised there's not more information out there about this topic. For most folks, they've never heard of it until after they've experienced an awful dizziness episode or two.
These days, more and more clients are mentioning episodes of severe dizziness, often in bed when turning over. That's a key sign. This type of dizziness can be triggered by lying down or on rolling over in bed.
Some have called it a bad flu, while others have called an ambulance to get to the ER for relief. Others just put up with it until it subsides naturally.
If you’re finding the dizziness gets worse when standing rather than lying down, your doctor may check for orthostatic hypotension, or something else.
Could it be BPPV?
Benign Paroxysmal Positional Vertigo (BPPV) dizziness is caused by "debris" ("ear rocks" or "ear crystals") that's collected within a part of the inner ear. The official name for these inner ear crystals is otoconia.
The ear rocks are made up of small crystals of calcium carbonate from the utricle (the inner ear).
BPPV can occur when the utricle becomes damaged by a head injury or whiplash, an ear virus or infection, or other disorder of the inner ear. Even migraines or dental work can cause BPPV. It can also be a result of degeneration of the vestibular system of the inner ear that's common with age. The most common cause of BPPV in those younger than 50 is head injury.
BPPV is not life-threatening and can disappear in minutes. However, especially when left untreated treated, it can last as long as two months.
How is it diagnosed?
To diagnose it, take a trip to your doctor. They will look at your history, do a physical exam, and perform ear and auditory tests. Unfortunately, that isn't so helpful when in the throes of the spins, but if you've been stricken more than once, it might be worth a doctor visit for peace of mind.
Good News: There are natural remedies/treatments
Knowing what to do if a BPPV incident happens is akin to knowing CPR. You might never use it, but if you do, trying to learn what to do about it at that time will be difficult. Ever tried to read when you're already dizzy? It’s not fun…
Several options for healing include waiting it out and allow it to subside over time, going to your doctor's office for treatment, home exercises, or even surgery. A doctor may offer you a motion-sickness medication like Anti-vert.
Simple head-turning exercises are a great non-pharmaceutical way to resolve or lessen the dizziness. I've used these exercises numerous times and have always gotten 100% relief. Often, this relief was almost immediate.
One time, for over a month, I was very mildly dizzy accompanied by low-grade, continuous nausea. Knowing that nausea can be a pre-heart-attack symptom for women (and since nothing I'd done so far had helped), I bit the bullet and went to the ER one day. I checked in and explained my concern about having a heart attack. Since I wasn't breathing heavily or fatigued, I was relegated to the waiting room for the next 6 hours.
I saw 3 doctors over the next 30 minutes, each one giving me the "watch my finger as it moves to the side" test over and over. Although no one ever mentioned BPPV and no one could answer what was happening, a light went off when they offered me Anti-vert (motion-sickness drug) and suggested I stay on it indefinitely.
When I asked what they were diagnosing me with and to explain why they wanted me to start a lifelong medication, nobody offered answers. They said I could stay and do a lot more tests and they might be able to narrow it down. Starting a medication for something with no firm diagnosis seemed unwise to me. Anti-vert, huh? Doctor, could this be a BPPV episode I'm experiencing? The E.R. doctor admitted he thought it might be BPPV. "Aha, now it made sense!" I thought.
I ended up very grateful for my day spent in the E.R. because it became an eye-opening experience. My concerns were focused on the nausea versus the dizziness, when it was actually the dizziness that caused my nausea. I didn't want or need a motion sickness medication, and certainly not for a lifetime. What I needed to do was simple BPPV exercises to help the crystals settle, allowing both the dizziness and the nausea to subside.
In the 15 minutes it took them to draw up and give me my discharge papers, I did all the Epley Maneuver exercises that I could remember. It resolved my symptoms completely. That was 3 years ago, and I've had two other episodes since. Both were easily resolved with some simple head-turning exercises.
I don't often laud Western Medicine for much, but I was truly grateful that that E.R. was there for me that day. They had very caring, warm doctors who genuinely wanted to help with me feel better and understand my symptoms. Their diagnostic tests put my mind at ease about any possible early heart attack symptoms I was concerned about. It was also the experience I needed to help me re-frame my symptoms and listen to what my body was telling me—this wasn’t clicking for me prior to that visit.
I also discovered that this BPPV episode was very different than the prior episodes, and I learned how else it might present itself in the future and what to look for. It confirmed that a combination of Eastern Traditional Chinese Medicine AND Western Medicines can be most impactful—and most definitely complement each other—to help unravel the core of health problems.
My experience is that one or two sessions of in-office or at-home exercises should resolve your dizziness, but if you keep having frequent and recurring dizziness when lying on your back, looking up, or turning your head (whether standing or lying down), please mention this to me at your next bodywork session!
I have worked with a handful of clients over the years that do not fit into the BPPV/loose ear crystals category, but found that releasing a pinched nerve in the neck, usually as part of neck/upper back misalignment, resolved the dizziness for them. It may take one or more bodywork sessions with gentle craniosacral therapy to help release the tension that’s causing you pinched-nerve-based dizziness.
How is BPPV addressed?
• Wait It Out
• In-Office Treatment
• Home Treatment
• Surgical Treatment
In-office treatment: The Epley and Semont Maneuvers
There are two treatments for BPPV that can be performed at a doctor's office. Both treatments are very effective, with roughly an 80% cure rate. These treatments are both intended to move debris or "ear crystals" from the sensitive part of the ear to a less sensitive location. Each maneuver takes about 15 minutes to complete.
The Semont Maneuver involves moving a patient rapidly from lying on one side to lying on the other side briskly. It is about 90% effective after 4 treatment sessions.
The Epley Maneuver (see video directions below) also seeks to reposition loose ear crystals by moving the head into four positions in sequence, keeping each position for roughly 30 seconds. This maneuver can be done at home or in-office.
When performing the Epley Maneuver, stop if you experience any weakness, numbness, or visual changes other than vertigo. This can be an indicator that the reason for the dizziness isn't loose ear crystals/BPPV, but possibly compression of the vertebral arteries, which can contribute to a stroke. Supervised exercises (with a BPPV diagnosis) allow the maneuvers to occur with full-body movements versus just the head and neck.
These in-office maneuvers for BPPV, provided over about 2 or 3 sessions, are effective in about 95% of patients with BPPV.
If you've experienced BPPV before, it's likely you'll experience it again. It's estimated that about one third of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence. Familiarizing yourself with the exercises before it happens (or happens again) is prudent to your well-being!
Check out these video links to educate yourself on self-care and self-healing for BPPV.
Remember that if you notice symptoms like weakness, numbness, or visual changes other than vertigo, this can be an indicator of compression on the vertebral arteries which could result in a stroke. In that case, discontinue the at-home exercises and get to an E.R. to be checked out.
HOME TREATMENT RESOURCES:
This two-minute video recorded from an ENT's office (ear, nose, and throat doctor) shows exactly what’s happening inside the ear to create the loose crystals, as well as simple Epley Maneuvers to try at home.