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The Impacts of BPPV Beyond Dizziness

By Cheryl Wylie, MSc (PT)

BPPV, which stands for Bening Paroxysmal Positional Vertigo, is the most common cause of vertigo and affects 1 in 10 people over the age of 65. Although it is described as a benign condition, often with swift and quick resolution techniques, we rarely discuss the long term or secondary effects of having untreated or recurring BPPV.

Brain Fog

When we are experiencing BPPV, we are undergoing frequent error signals from our inner ear every time we move our head. These error signals are perceived by us as dizziness or vertigo. These error signals can be distracting and fatiguing on our central nervous system (e.g. our brain) and is one of the reasons why we may experience symptoms such as brain fog. Brain fog is a term used to describe the sensation of reduced clarity, feeling mentally drained, and having difficulty concentrating. Signs of brain fog include reduced cognitive functioning, difficulty paying attention, difficulty focusing, having trouble multitasking, and reduced memory. Many people with BPPV report this symptom, and it’s something to be aware of as you work through treatment.

Reduced Sleep

BPPV results from tiny crystals in our inner ear falling into the wrong place, called our semicircular canals. As we move our head around, these crystals tumble around in these canals, creating error signals and sensations of dizziness. When we are in standing, the crystals generally don’t have a lot of room to move in the canals, however when we are lying down, the crystals are in a position where they can move a lot, often resulting in more dizziness when in bed. Due to this, reduced sleep is a major side effect of BPPV, and many people find they have difficulty falling asleep and waking up in the middle of the night from vertigo episodes. This can lead to fatigue as well as anxiety related to bedtime.


Anxiety & Guarding with Movements

This brings us to our next point – anxiety around movement. When you experience repeated sensations of dizziness with movement, many people become anxious to move, unsure if this movement will trigger a vertigo attack or not. This can then result in muscle guarding and an overall stiffness throughout the body. We always recommend BPPV is treated as soon as possible, however its helpful to know which movements tend to be the most triggering and which movements often will feel fine with BPPV to help reduce some anxiety:

Triggering Movements:

  • Looking up or bending over

  • Getting into and out of bed

  • Rolling over in bed


Non-triggering movements:

  • Turning head side to side

  • Driving

  • Squatting

  • Any movement where your eyes remain forwards on the horizon

As an overall rule of thumb, if your eyes remain forwards on the horizon, your crystals are not moving a lot, and likely won’t trigger a vertigo episode.


Fall Risk

Falls are common with any form of dizziness, but I find it especially the case for people with BPPV. Because BPPV triggers very short but intense episodes of vertigo, these episodes are often enough to throw off your sense of orientation and can result in a fall. And this is because we have direct reflexes that connect from our inner ear to our spinal column! This reflex is called the vestibulospinal reflex (VSR) and is important component of balance. When you experience vertigo, you are experiencing an error signal which can also make you think you are turning or leaning in one direction, even though you are not. This will activate this reflex to correct your balance, causing you to now lean the other way and actually knocking you off balance. This is why falls are so common when you have BPPV!


Neck Stiffness

Returning to our discussion on anxiety and guarding around movement, one of the common areas to experience a lot of muscle guarding is in our neck. As with our balance, we have special reflexes that connect our inner ear to our neck, called the vestibulocollic reflex (VCR). This reflex is responsible for activation of the neck musculatures to stabilize the head. Similar to the VSR discussed above, VCR will be affected by BPPV and can result in increased muscle tone in the neck as it tries to stabilize the head during the perceived motion of vertigo.


Decreased Quality of Life

From all the various implications of BPPV, its is easy to see how this benign condition can have wide spreading influences on one’s life. Many patients are required to take time off work, stop driving, have difficulty caring for their children, completing chores around the house, and participating in social activities. Prolonged time like this can result in social isolation and feeling withdrawn and sad.

Early management of BPPV is our top recommendation to help reduce many of these secondary implications. There are various options available for BPPV treatment, however we suggest the following:

  1. Vestibular Physiotherapy: this is by far the best option as you will work 1:1 with a trained healthcare provider to get properly diagnosed and undergo the correct treatment maneuver. Physiotherapy can also help address many of these secondary issues by working on your neck, testing balance, and discussing sleep strategies.

  2. Healing Vertigo App: this is our App that will help guide you through self-assessment and treatment of BPPV. It is a good option if you don’t have access to a vestibular physiotherapist or you have had BPPV in the past and feel comfortable working through treatment on your own.

Healing Vertigo has both options available, so please reach out today to speak to a qualified healthcare professional about BPPV treatment! In-person and virtual services are available.

About the Author

Cheryl Wylie, is a vestibular physiotherapist and owner of Healing Vertigo. She is also the creator of our Vertigo Treatment App, and instructs vestibular courses to other healthcare professionals.
She offers vestibular therapy for all Ontario Residents. If you're interested in working with Cheryl, connect below!

Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.