Dealing with Dizziness Related to BPPV

It has been nearly a year that I’ve been dealing with dizziness related to BPPV — Benign Paroxysmal Positional Vertigo.  It is not a serious affliction, but I’d like to share what I’ve learned as dizziness can be so debilitating and puzzling.  Dizziness can be caused by a great many things. Mine was due to one of the most common causes in people age 50 and over— BPPV. 

I woke up last Christmas Eve morning, feeling extremely dizzy and nauseous, the kind of dizziness that sends many people to the emergency room.  Luckily, my husband Jim was aware of the Epley Maneuver and suggested I try it. 

I was relieved to have an option.  Who wants to go to the emergency room on Christmas Eve?!  If you do the Epley Maneuver correctly, it can provide almost immediate relief— I say almost because once you do it effectively, you are likely to feel violently dizzy and nauseous, but the symptoms lessen over the next hour. 

Who knew tiny crystals in your ears could cause so much nausea and grief?! Calcium carbonate crystals form in the utricle and saccule areas of the inner ear. BPPV is caused when these crystals break loose and fall into the semicircular canals.

 If you search on Youtube, you will find many videos on the Epley Maneuver.  The video I’m sharing above shows very clearly how to dislodge the crystals and why the precision of the head movements are key in moving and dissolving them. 

The first time I tried the Epley Manuever, I didn’t feel much of anything.  But the second time I tried it—laying down more forcefully— I set the room spinning, which is not fun, but it’s a sign that the maneuver actually dislodged the crystals. 

It is key to lay back forcefully enough to move the crystals, and also to lay back with the head at the proper angle —  angled to the side 45 degrees and tilted 20 degrees back, so the crystals can pass through the ear canals and eventually dissolve.  I continued to do the Epley Maneuver, and my slight dizziness continued to dissipate over the next week. 

I purchased the book Dizziness: Why You Feel Dizzy and What Will Help You Feel Better by Dr. Gregory T. Whitman and Dr. Robert W. Baloh.  This concise and informative look covers many types of dizziness.  The book opens with BBPV, noting that dramatic spinning spells that occur with position change is a classic symptom of BPPV. 

I was reassured to learn that what I was experiencing was common, and not a serious threat to my health.  Whitman and Balogh confirmed that the Epley Maneuver is the best treatment for BPPV.  However, as they note, the maneuver only works for BPPV, not other types of vertigo.  In their book, they also address Meniere’s Disease and Migraine-Associated Dizziness, as well as anxiety-related dizziness and other forms. 

Dizziness sends a great many people to the emergency room, and if incorrectly diagnosed, can lead to rounds of needless tests and medications prescribed.  That’s why it’s good to know about the Epley Maneuver as an option. 

While the Epley Maneuver took care of 90-95% of my dizziness, a slight dizziness persisted over the next six months.  (I will admit I got busy and neglected to continue practicing the maneuver.) My primary doctor sent me to a neurologist to see if brain imaging might be necessary. (It was not.) My dizziness very occasionally returned— usually triggered by walking on a slanted sidewalk (of which there are many in Manhattan.)  I also consulted an Otolaryngologist, a doctor specializing in issues of the throat and ears.  She didn’t see any problem with my ears, and prescribed a series of visits to a physical therapist to work on balance issues. 

My ongoing dizziness was slight, and I never had any headaches associated with it.  I was not dizzy riding a Citibike in Manhattan or paddling on my SUP board in the Gulf of Mexico near our house in Florida.   It was just an occasional and slight feeling of dizziness, and the issue was definitely on the right side of my head. 

The balance therapy with Justin Ettinger finally took care of the dizziness.  Part of the therapy was balance exercises and part was vision exercises, retraining my brain to adjust to certain eye movements. For instance, while staring at the letter B taped to the wall, I would move my head rapidly left to right, doing my best to keep the letter in focus.  Repetition is key in these exercises, and Justin recommended practicing them 2-3 times a day.  Doing this work alleviated the last of my dizziness — at least until it hit again on the other side. 

BPPV is often triggered by turning over in bed.  In my case, just weeks after I was no longer dizzy on my right side, it reoccurred this time on the left side of my head.  I turned over to my left in my M.E.L.T. Method class — almost a year later from the first occurrence— and experienced another bout of severe dizziness and nausea.  This time I recognized what was going on and prepared myself for another round of Epley Maneuvers and balance exercises.   

The second time I experienced BPPV, I knew better how to treat it.  As I had learned last December, I laid back forcefully enough to dislodge the crystals— keeping my head angled as described above and in the video.  I gave myself a few hours in bed to recover, knowing that after an initial bout of nausea, I’d be feeling better later that day. 

In January, I’ll be going back to Justin for another round of therapy and consultation.  In my experience, I’m able to fix 90% of my dizziness, but I need help dealing with the remaining 10 per cent.  Justin encouraged me to keep doing my balance exercises as BPPV was likely to reoccur.  He also noted that the precision of doing the movements is key: “The risk with performing the maneuver incorrectly is moving the crystals into another semicircular canal which can make treatment more difficult. The Epley maneuver is not the correct treatment for each semicircular canal so diagnosis with vestibular specialist is recommended.”

If you don’t experience relief on your own using the Epley Maneuver, it is wise to seek to seek a doctor’s advice.  BPPV is only one of many causes of dizziness, as the doctors Whitman and Baloh detail in their book.

I hope this information is helpful to others who may be having a similar experience.  Once you have experienced BPPV, it is likely to return.  So this probably won’t be my last post on dizziness. 

See this link to order Whitman and Baloch’s book on Dizziness published by Johns Hopkins University Press:

If you are in the New York City area, I recommend Justin Ettinger, PT, MSPT, and Director of Vestibular Rehabilitation at H & D Physical Therapy:

*I’m not a medical professional and I’m simply sharing in this post my own experience.  It is not meant to be used in place of medical consultation. 

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