Vertigo and BPPV: Why the Room Spins When You Roll Over and What We Can Do About It

By Physiotherapist Ben Howie

Is dizziness just something you should put up with? 

Many people experience a sudden spinning sensation when they roll over in bed, look up to reach a shelf, or bend down to tie a shoelace. It is usually over within a minute, but it can be frightening and leave you wondering whether something serious is wrong. 

The most common cause of this kind of vertigo is benign paroxysmal positional vertigo (BPPV). 

The good news is that BPPV is common, usually not dangerous, and often very treatable. 

 

What is BPPV? 

BPPV is a condition where brief episodes of spinning are triggered by changes in head position. 

It happens when tiny calcium carbonate crystals in the inner ear, which normally sit in one place, move into one of the fluid-filled balance canals. When you move your head, the crystals shift and send confusing signals to your brain about movement. 

Typical features include: 

  • Spinning triggered by rolling in bed, looking up or bending over 

  • Episodes lasting seconds to under a minute 

  • Nausea or unsteadiness afterwards 

  • No new hearing loss, weakness or slurred speech 

 

Why does it happen? 

BPPV can affect anyone, but it is more common in older adults. It can also follow a knock to the head, a long period of lying down (such as during illness), or occur with no clear cause at all. 

Your inner ear has three semicircular canals that detect head rotation. The crystals most often end up in the posterior canal, which is why rolling over in bed is such a common trigger. They can also end up in the horizontal canal, which is less common and trickier to identify and treat. 

 

Is all dizziness BPPV? 

No. “Dizzy” means different things to different people. Some feel a true spinning sensation, while others feel light-headed, unsteady or as though they might faint. 

Vertigo can also come from vestibular migraine, Ménière’s disease and, rarely, more serious causes such as a stroke. The pattern of your symptoms helps tell these apart. 

Seek urgent medical attention (call 000 or go to your nearest emergency department) if dizziness comes with: 

  • A sudden, severe headache or new neck pain 

  • Weakness or numbness 

  • Slurred speech or difficulty swallowing 

  • Double vision 

  • Trouble walking or standing unsupported 

  • A sudden change in hearing 

 

How is BPPV assessed? 

A thorough assessment can tell BPPV apart from other causes. It usually includes: 

  • A detailed history of your symptoms, triggers and timing 

  • An examination of your eye movements 

  • Positioning tests: the Dix-Hallpike test for the most common type, and the supine roll test for the horizontal canal 

During the positioning tests, we move you into specific positions and watch your eyes for a characteristic pattern of movement. These tests can briefly bring on your dizziness, but they are quick, and we will explain each step before we do it. 

For sudden, constant vertigo, a different set of eye and balance tests, called HINTS, is used to help identify whether the cause might be central, such as a stroke. Any concerning finding means urgent medical review. 

 

How is BPPV treated? 

When BPPV is confirmed, treatment involves a gentle sequence of head and body positions that guides the crystals back to where they belong. 

For the most common type, we use the Epley manoeuvre. 

  • It takes only a few minutes 

  • Many people notice a big difference after one or two sessions 

  • Some people need a few more visits, particularly if a different canal is involved 

You may feel a little unsteady or queasy for the rest of the day, so take care moving around. BPPV can also come back, so we will make sure you know what to do if it does. 

Clinical guidelines recommend repositioning manoeuvres like the Epley as first-line treatment for BPPV of the posterior canal. 

 

What if it isn’t BPPV? 

Part of a good assessment is recognising when symptoms don’t fit the BPPV pattern. If they don’t, we will explain why and guide you to the right next step, whether that is your GP or an ENT specialist. 

 

Myth vs Fact 

Myth: 

“Dizziness is just part of getting older.” 

Fact: 

BPPV is more common with age, but it is a specific condition with a clear cause, and it is often treatable. 

Myth: 

“If I get dizzy, I should avoid moving my head.” 

Fact: 

Avoiding movement may feel safer, but it doesn’t fix the cause. Getting assessed is more helpful. 

Myth: 

“Vertigo always means something serious.” 

Fact: 

BPPV is benign. However, certain symptoms, such as sudden severe headache, weakness or slurred speech, need urgent medical care. 

Myth: 

“Medication will fix it.” 

Fact: 

Medication may ease nausea or dizziness in the short term, but it does not move the crystals. Repositioning treats the cause. 

 

The Take-Home Message 

If you get spinning when you change position, you don’t have to just live with it. 

BPPV is common and often very treatable. A proper assessment can confirm what is happening, treat it if it is BPPV, and point you to the right next step if it is not. 

 

References 

Hilton, Malcolm P, and Darren K Pinder. “The Epley (Canalith Repositioning) Manoeuvre for Benign Paroxysmal Positional Vertigo.” Cochrane Database of Systematic Reviews, no. 12, 8 Dec. 2014, 10.1002/14651858.cd003162.pub3. 

Kim, Hyo-Jung, et al. “Correction to: Update on Benign Paroxysmal Positional Vertigo.” Journal of Neurology, vol. 268, no. 5, 23 Feb. 2021, pp. 2001–2001, 10.1007/s00415-021-10476-y. 

Power, Laura, et al. “Characteristics of Assessment and Treatment in Benign Paroxysmal Positional Vertigo (BPPV).” Journal of Vestibular Research, vol. 30, no. 1, 13 Dec. 2019, pp. 55–62, 10.3233/ves-190687. 

Shim, Dae Bo. “Benign Paroxysmal Positional Vertigo: Diagnostic Criteria and Updated Practice Guideline in Diagnosis.” Research in Vestibular Science, vol. 19, no. 4, 15 Dec. 2020, pp. 111–119, 10.21790/rvs.2020.19.4.111. 

 

Stuart McKayComment