- Benign as although it can be quite disabling, it is not due to serious disease.
- Paroxysmal because it occurs in short bursts of up to one minute.
- Positional as it is provoked specifically by movement to or from certain positions.
- Vertigo – dizziness defined as an illusion of movement.
Benign Positional Paroxysmal Vertigo is one of the commonest types of dizziness is estimated to affect roughly 50% of all people at some time in their lives and becomes progressively more common with age. It typically involves short attacks of rotational vertigo which are brought on by rapid head movements. It is caused when loose chalk crystals get into the wrong part of the inner ear. These microscopic crystals should be embedded in a lump of jelly. The crystals weigh the jelly down and make that part of the ear sensitive to gravity. The crystals are constantly being re-absorbed and re-formed and over time fragments come loose. Lying flat can then occasionally cause some of the loose debris to fall into one of the semi-circular canals; the parts of the ear responsible for sensing rotation. Movement in the plane of the affected canal causes the crystals to move along the canal, stimulating it and giving the sensation of rotation. This means whenever ever you put your head in a certain position the crystals move and make you dizzy.
Symptoms of BPPV
The vertigo is generally rotational (like getting off a roundabout) but sometimes sufferers, on lying down, will feel that they are falling through the bottom of the bed or, on getting up, that they are being thrown back onto it. The classic provoking movements to induce BPPV are: lying flat, sitting up from lying flat; turning over in bed; looking up (e.g. hanging washing) or bending down, especially if also looking to the side. The duration of the vertigo is brief; usually five to 30 seconds but very occasionally lasts up to two minutes.
How is BPPV treated?
At least a half of all cases will get better without treatment though this may take months. As BPPV is basically a mechanical disorder, drugs have no effect and should be avoided. Most cases that do not resolve rapidly can be relieved by a crystal repositioning manoeuvre; of which the most commonly performed is the Epley manoeuvre which offers instant relief of symptoms in nine out of 10 patients, however some may need two or more treatments.
Post Epley Manoeuvre instructions
Following the procedure there are a couple of things you should do in order to prevent the crystals going back to where they were.
- Do not lay completely flat on you back for 2 days – this means sleeping with your head halfway between being flat and upright.
- Do not lay on your affected side for 5 days.
After this time resume normal activities to see it the dizziness is still there. Some studies suggest that no special sleeping positions are necessary however we think that there is some value to doing this and recommend it.
Will BPPV return ?
Some people seem to be prone to getting BPPV. About 1/3 of patients have a recurrence in the first year after treatment and by five years about half of all patients will have recurrence.
There are other treatments that can be tried including exercises you can do at home.
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