Why is the World Spinning?  BPPV and Positional Dizziness  

Understand BPPV, Learn BPPV “exercises”, and Overcome Vertigo When Lying Down or Getting Up.-  


What is BPPV? 


BPPV stands for Benign Positional Paroxysmal Vertigo.  It is also referred to simply as “positional vertigo” and is the name of a condition which causes temporary episodes of dizziness with certain head movements.  The problem originates in the inner ear when the function of the semicircular canals is not operating properly and it provides misinformation about movement and head position.  This mis-information creates a discrepancy between your sensory inputs and results in a feeling of dizziness. 

How do I know if I have BPPV?


Symptoms usually come on with movements such as rolling over in bed, going from lying down to sitting up, tilting your head back, or bending forward.  Often, it appears that the world is spinning around you and can be quite unsettling.  It may also feel like you are moving when you are not and can be accompanied by nausea, unstable sensations, and visual changes.   The acute bouts of dizziness usually last 15-30 seconds, but you may be left with a residual sense of nausea or instability.    


If you see a physical therapist or physician to be examined for BPPV, they will perform a test called the Dix-Hallpike Manueuver where you move from sitting to lying down with your head tipped back at a particular angle to stimulate the response.  This helps to confirm if BPPV is the source of your dizziness and which particular treatment will be most effective for you.  

What causes BPPV 

Dizziness due to BPPV results from dysfunction in the inner ear, which causes altered sensory input   The vestibular system, or balance system, includes the semi-circular canals, three connecting, fluid-filled tubes that sit next to the hearing portion of the inner ear.  These structures are responsible for giving information about how your head is positioned in relation to gravity and we receive information from the movement of fluid within these canals.  The dysfunction happens when calcium carbonate crystals in the inner ear, called “canaliths”, become dislodged and float into the canals, causing movement of that fluid at times when the head is not moving.  This creates mismatched information between this sensory input and other sensory inputs from the opposite ear, visual input, and proprioceptive input from sensors in your muscles and joints.   

These crystals can become dislodged due to a specific event, such as hitting your head or a whiplash injury, but they also become dislodged with no clear mechanism.  The best way for you to know if it is BPPV is by the presentation of these transient “spinning” episodes when changing positions.  

What else causes dizziness? 

Anything that impacts the sensory input or processing involved in the balance system can create a sense of dizziness.  This includes concussions, ear infections, visual changes.  It is best to consult a health care provider with training in vestibular evaluation and treatment  to assess your dizziness.  

IMPORTANT CAUTION: If your dizziness is accompanied by double vision, difficulty speaking, weakness in your arms or legs, difficulty walking, or changes in mental alertness you should contact your physician immediately.  

How do I get rid of BPPV? 

A treatment called the Epley maneuver is effective at repositioning the crystals and alleviating symptoms for most people when performed by their physician or PT.  This treatment involves moving through a series of specific head positions to use gravity to move the crystals through the canals and back into their appropriate “home base”.   The maneuver itself brings on the symptoms and you may have lingering symptoms for several hours after doing it, but most times, symptoms then begin to resolve.  Sometimes it is necessary to do the maneuver several times to completely clear the canals.  

The “Epley” or “canalith repositioning” maneuver: 


After treatment it is recommended to avoid extreme head positions (tilting very far forward or backwards) for several hours.  The next day you may return to normal activity and movement.  

Can I get rid of BPPV on my own? 

There are several “exercises” or maneuvers that can be performed independently to attempt to reposition the crystals into the appropriate place.  A word of caution: these maneuvers are intended to move the crystals through the canal which inevitably causes dizziness.  This can be quite intense and we recommend doing it under the supervision of a qualified provider, especially if you are trying it for the first time.  It can also be difficult to obtain the precise positioning on your own which is necessary for the maneuvers to be effective.    


If you would like to attempt canalith repositioning at home, there are the three options.  I recommend choosing ONE MOVEMENT, trying it ONE TIME, then waiting several hours to assess the response.  If you continue to have dizziness with position changes, you may re-attempt the same maneuver or try one of the alternatives.  If you continue to have symptoms, or would like more guidance, contact your providers or set up an appointment.  


  1. Self-Epley Maneuver: 

This is the most proven method for self-treatment:  

  • Start sitting up, turn your head towards the symptomatic side, lie back over 1-2 pillows so that your head tilts back, then follow through this sequence, 
  • In each position wait at least 30 seconds, or until symptoms resolve 


  1. Semont Maneuver 
  • Lie down on the side opposite the direction of symptoms with your head turned to look up at the ceiling.  Wait 30 seconds or until symptoms resolve.  
  • Without moving your head, sit up and continue over onto the other side, now you should be looking towards the floor.  After another 30 seconds, return upright.  



  1. Half-Somersault or “Foster” Maneuver 
  • This position is easier to achieve for some people, however the efficacy of the maneuver is less studied.  
  • Maintain each position for 30 seconds or until dizziness fades. 
  • In position “C”, turn towards the symptomatic side 



Follow up:  

To ensure a thorough diagnosis and for additional information, schedule an appointment at our Seattle-based physical therapy office.  


About the Author: 

About the Author 

Kristen Vaughan is a physical therapist at Union Physical Therapy in Seattle.  She completed her doctoral degree at the University of Colorado.  She specializes in treating outdoor athletes including skiers, bikers, runners, and climbers and is a co-founder of the online training program: Alpine Training Project.   She also has a focus on treating individuals with vestibular disorders causing dizziness or balance issues.  In her free time, she enjoys spending time in the mountains and travelling.