BPPV: brief violent vertigo when you turn in bed

What it is, in plain words

The inner ear contains tiny calcium crystals that normally sit in a sac detecting gravity. If they come loose and drift into one of the semicircular canals, head movement makes them move and the canal signals a violent rotation that the eyes and body do not confirm. The result is intense, brief spinning: benign paroxysmal positional vertigo.

Signs to look out for

• Sudden spinning triggered by turning over in bed, lying down, looking up or bending forward
• Attacks lasting seconds to under a minute, then settling
• Nausea, sometimes vomiting, and a lingering unsteadiness between attacks
• No hearing loss, no ringing, no neurological symptoms
• Symptoms recur in clusters over days to weeks

Why it happens

It becomes commoner with age, and can follow head injury, prolonged bed rest, or inner ear infection. Often there is no identifiable trigger.

How doctors confirm it

The Dix-Hallpike test reproduces the vertigo and shows a characteristic eye movement, which confirms the diagnosis without any imaging. Scans are needed only if the pattern is atypical.

Treatments and solutions

• The Epley repositioning manoeuvre, performed by a trained clinician, which resolves symptoms in most people after one or two sessions
• Home exercises such as Brandt-Daroff for residual symptoms
• Vestibular rehabilitation physiotherapy for persistent imbalance
• Anti-sickness medicines only briefly, since they slow the brain's adaptation
• Reassessment if attacks continue beyond a few weeks, as another canal may be involved

Living with it day to day

After the manoeuvre, move normally: prolonged head restriction is unnecessary. Recurrence happens in about one in three people within a few years and responds to the same treatment.

When to seek medical help

See a doctor urgently for vertigo with double vision, slurred speech, severe headache, weakness, numbness, difficulty walking, or new deafness: these suggest a central cause.

This article explains general health information in simple language. It does not replace advice from your own doctor.