Have you ever had this happen– You wake up one morning, roll out of bed, and nearly fall on the floor because you are abruptly dizzy. It passes, but worries you. Then you notice that anytime you turn your head quickly you get a wave of dizziness. Usually that’s enough to inspire a visit to your physician (there are a few concerning causes of dizziness to rule out) and most likely you will receive this simple diagnosis: BPPV.
Benign Positional Paroxysmal Vertigo
The most common cause of dizziness (affecting about 2% of the population at some point in their lives) is Benign Positional Paroxysmal Vertigo (BPPV).
If you break down the name, it’s easy to understand that it’s:
a) not dangerous (Benign)
b) is dependant on your movement (Positional)
c) happens episodically (Paroxysmal) and
d) causes a profound sense of unsteadiness or dizziness (Vertigo).
It is easily diagnosed by your physician based on your description of the vertigo and a simple physical test called the Dix-Hallpike maneuver. This movement test causes the vertigo and elicits a type of rapid eye movement called nystagmus, both of which resolve within a minute or two but are highly diagnostic. BPPV happens because of tiny little crystals in the endolymph (fluid in the inner ear) that migrate to places they aren’t meant to be which causes temporary vertigo. Patients older than 60 are more prone to BPPV which may have less to do with age and more to do poor hydration status and lack of diverse movement.
Treatments
So how can we keep our inner ear components in the right places? Firstly, if you have known BPPV there is a new treatment for you to try at home. Carol Foster, MD from the University of Colorado School of Medicine figured out that BPPV patients could perform a “half-somersault” movement to rid themselves of the symptoms at home. This technique is more effective than the traditional physical therapy treatment the Epley Maneuver and doesn’t require an office visit.
There are brief youtube videos demonstrating the technique available, but here’s the quick version:
1) Kneel on the floor and tilt your head back to look at the ceiling for 15 seconds.
2) Curl your head and body forward so your head is touching the floor and you are looking towards your belly button.
3) If the dizziness is worse on the right, turn your head (still in same position) to your right elbow and hold for 30 seconds, or to the left if that side is worse.
4) Keeping your head in the same tilted position, lift your back and neck flat to create a tabletop position. Wait 15 seconds or until all dizziness passes. Then sit up and allow your body to rest until all traces of unsteadiness have left.
This process can be repeated until all dizziness has gone, though it is best to wait 15 minutes between repetitions to allow for settling.
For those of us who do not have BPPV but would like to prevent it, or who have had it in the past and don’t wish for a return, I recommend two easy strategies:
First, make sure you drink plenty of water. Dehydration is a predisposing factor for BPPV. Second, move your head. This may sound strange, but how many of us move our bodies in a near-exclusively linear fashion going forward, but rarely side to side or upside down? Practicing yoga, dancing or any other movement that engages your body in a variety of directions helps to keep all aspects of our bodies moving and functioning in the manner to which they were designed. If prevention doesn’t work, it’s reassuring to know there is a straightforward home treatment that is highly effective.
Dr. Alethea Fleming, ND is a passionate advocate for naturopathic geriatric medicine. A 2007 Bastyr University graduate, she also earned a certificate in Gerontology from the University of Washington. Dr. Fleming is the owner and lead physician of the Vital Aging Clinic in Anacortes, Washington where she provides primary care to all adults as well as adjunctive geriatric care. Dr. Fleming is active in multiple community organizations as well as a member of WANP, AANP and OncANP. In her off hours, Dr. Fleming can be found hiking the beautiful trails of Fidalgo Island, spending time with her wonderful husband and son, or with her nose firmly in a good book.