What is BPPV? A Simple Guide to Understanding & Overcoming It
Have you ever felt a sudden, spinning dizziness — often when you roll over in bed, lean down, or turn your head quickly — only for it to fade just as quickly? If so, you might have experienced something called BPPV — short for benign paroxysmal positional vertigo.
Let’s break that down:
- Benign — it’s not dangerous or damaging to your brain or body.
- Paroxysmal — symptoms come on in quick, sudden bursts.
- Positional — certain movements or head positions trigger the dizziness.
- Vertigo — a spinning or rotational type of dizziness.
What’s going on in your inner ear
Your inner ear houses a small but vital system — the vestibular system — that helps you sense movement and balance. You have one on each side of your head. Its job? To tell your brain what direction you’re moving in and how fast, so you stay balanced and oriented.
This system contains tiny crystals made of calcium carbonate. Under normal conditions, they sit quietly in two small chambers called the utricle and saccule, where they help detect head motion.
But sometimes, those crystals become displaced. They drift into one of the semi-circular canals (commonly the posterior canal, but sometimes anterior or horizontal). Once there, they interfere with the signals sent to your brain — giving wrong movement information. That confusion is what causes the dizzy, spinning sensation you feel.
How BPPV feels: from mild dizziness to intense vertigo
When those crystals are in the wrong place, the resulting dizziness can range from mildly annoying to extremely intense. For some people, it may cause nausea or even a brief loss of balance.
Many people notice their first BPPV episode after rolling out of bed, leaning forward, or turning their head suddenly. While BPPV tends to become more common after the age of 40 and affects women slightly more than men, it really can occur at any time. The exact reason why the crystals displace is still not completely understood.
Good news: BPPV is treatable — often quickly
Here’s the positive part: BPPV is highly treatable, especially with a technique called vestibular rehabilitation. A trained vestibular physiotherapist can:
- Diagnose which ear is affected, and which canal the crystals have migrated into
- Use specific repositioning manoeuvres to guide the crystals back where they belong
For many people, relief comes almost immediately after those manoeuvres. After that, the physiotherapist may teach you how to safely perform certain head movements at home — along with exercises designed to restore and strengthen your vestibular system.
Why “DIY” videos aren’t always enough
You may come across online videos promising to fix BPPV at home. While some of them might help, there are good reasons why they often fall short:
- The crystals can travel into any of the three canals — and each canal can be on the left or right side
- A manoeuvre intended for one canal (or side) won’t do anything if your crystals are actually in a different canal
- Some people even require a mix of manoeuvres to fully correct the problem
Because of this complexity, the most effective and safest route is to see a qualified vestibular physiotherapist.
Don’t forget: rebuild your balance system
Once your crystals are back in place, it’s tempting to avoid head movement altogether — especially if your vertigo was severe. But over time, that inactivity can weaken your vestibular system (much like muscles that aren’t used).
Rehabilitation typically involves gentle head and eye-movement exercises that help retrain the coordination between your inner ear, your vision, and your brain. This helps you regain confidence, stability, and return to normal daily activities.
⚠️ If you’re currently in the middle of a BPPV episode — i.e. feeling dizzy — hold off on these exercises until after the repositioning manoeuvres. Doing them too soon may worsen your symptoms.
What to do if you think you have BPPV
- Book a consultation with a vestibular physiotherapist as soon as you can.
- In the meantime — move carefully. Change positions slowly, especially when rolling in bed, lying down, or sitting up. Avoid quick head turns or bending forward.
- Follow through on rehab and exercises after repositioning. Strengthening your vestibular system is the key to long-term balance and stability.
Final thoughts
BPPV can feel frightening or disorienting — but it doesn’t have to control your life. With the right assessment, skilled manoeuvres, and the right follow-up exercises, many people regain their balance quickly and return to everyday activities with confidence.
If you suspect BPPV, don’t wait: early evaluation and treatment often make all the difference. At Head2Toe, our expert physiotherapists are here to help you get back to optimal function.
Our Physiotherapists have a variety of post graduate specialisations. If you or anyone you know, would like to have a physiotherapy assessment with the team at Dorking , Leatherhead or Crawley , book online here or contact us here.
Blog post guest written by James Johnson, Physiotherapist, Dorking Clinic.
