Dizzy when you roll over in bed? BPPV treatment, explained

You roll over in bed and the room lurches. It spins hard for maybe twenty seconds, then settles. Look up at a high shelf, or bend to the washing basket, and it happens again. That pattern is typical of benign paroxysmal positional vertigo, or BPPV. It is a common cause of vertigo, and one we see regularly at our Goulburn clinic.

Inside each inner ear are three fluid-filled canals that sense head movement, and a chamber lined with tiny calcium crystals. When some break loose and drift into a canal, they slide with gravity each time you tip your head. The canal reports movement that is not happening, and your brain reads it as spinning. Once the crystals settle, the spin stops.

"Dizzy" covers a lot of ground, and dizziness treatment starts with the right diagnosis. BPPV is a true spin, set off by a change in head position and over within a minute. Between spells you may feel a little off-balance, but the spin itself is brief.

Other causes behave differently. Light-headedness when you stand up quickly is usually about blood pressure, not the ear. Vestibular neuritis, often after a virus, brings constant spinning for days rather than short bursts. Constant spinning like this needs same-day assessment at an emergency department (ED). A stroke can look the same — see the red flags below. Do not drive yourself.

Ménière's disease comes in attacks lasting hours, usually with hearing changes, ear fullness or ringing. Vestibular migraine can cause dizziness with or without a headache. Some medications cause dizziness as a side effect. That is worth raising with your GP or pharmacist — don't stop or change a medicine without their advice.

None of this is a diagnostic chart; the overlap is real. It is why we test rather than guess. The clues that point towards BPPV:

Most dizziness is not dangerous, but a few kinds need a hospital, not a physio. If dizziness comes with any of the following, call 000 now. Do not drive yourself, and note the time the symptoms started. If you are unsure how urgent it is, call 000.

Dizziness after a knock to the head or a fall needs a medical check before physio. After a head knock, call 000 for a seizure, trouble staying awake, confusion, new weakness or numbness, or repeated vomiting. Go to the ED if you were knocked out, have vomited once, or have a severe or worsening headache or memory loss. The same applies if you take blood thinners or are 65 or over. Do not drive yourself. If none of these apply, see your GP promptly.

If you take blood thinners and new dizziness starts without a head knock, see your GP soon. Go to the ED if it is constant, severe or getting worse.

Whenever you need the ED, get a lift or call 000 — do not drive yourself.

Go to the ED now for any of the following — don't wait to see if it passes:

An assessment at our Goulburn clinic starts with the history, and the history does most of the work. We ask when the spins started, what sets them off and how long they last. We also ask about hearing change, headaches, falls and your medications. Bring a list of what you take. The pattern usually points to a cause before we lay a hand on you.

The main test is the Dix-Hallpike. You start sitting on the plinth, and we help you lie back quickly with your head turned and supported. If your neck is sore or stiff, we use a gentler version. We hold you there briefly and watch your eyes. If crystals are loose in the canal BPPV usually affects, that position sets off a short spin. It usually arrives a few seconds in and fades within half a minute. It also sets off a flicker of eye movement called nystagmus. The direction of the flicker tells us which ear and which canal is involved. Sitting back up can set off a smaller spin. Then we test the other side.

A second test, rolling your head side to side while you lie flat, checks a different canal. Yes, the testing will probably make you dizzy for a moment — that is the point. We also screen for what BPPV does not explain: how you walk, how your eyes track, coordination and the warning signs above. If the picture does not fit, we say so. We send you to your GP — or the ED if anything urgent shows up — rather than treating something that is not there.

BPPV treatment is hands-on and often quick, but it follows a specific test. If testing confirms BPPV, the treatment is a canalith repositioning manoeuvre. It is a short sequence of head and body positions, each held for a short time, usually until any spinning fades. Gravity does the work, walking the crystals out of the canal and back where they belong. The Epley manoeuvre is the one most people have heard of; there are others for other canals.

Which manoeuvre we use depends on what the test showed — which ear, which canal, which direction. That is why treatment follows testing rather than a video. A manoeuvre aimed at the wrong canal often does nothing, and can shift crystals into a different canal.

It is usually done in the same visit as the assessment. For the usual type, it often starts where the test finished. We guide you through a short series of head and body positions, chosen for the ear and canal the test identified. Expect a brief spin with some of them; we support you throughout. That spin is the crystals shifting, and it is normal and short-lived.

The evidence behind repositioning as a vertigo treatment is good: for most people with confirmed BPPV the spinning settles quickly. Some need it repeated at a review, which is common rather than a sign it has failed. That review is usually a week or two later. We check the manoeuvre has held, and repeat it if not.

Many people feel a bit off for a few days after the manoeuvre. Not the spinning — more a floaty, seasick unsteadiness while your balance system recalibrates. Nausea can hang around for a few hours; it fades on its own.

If unsteadiness lingers once the spinning has gone, we add balance exercises. It is a graded program that retrains the system rather than waiting it out. That matters more for older people, where an unsteady week is a falls risk.

BPPV can come back. It recurs often enough that we tell everyone what to watch for. A repeat episode is usually as treatable as the first. Come back in if the positional spin returns, if new symptoms appear or if you are not clearly better by the review. There are no strict restrictions afterwards, just a few practical bits:

A jolt to the head can knock crystals loose, so BPPV after a car accident or a fall is not unusual. If you hit your head, check the head-knock signs above first — any of them means 000 or the ED, not us. After a crash, go to the ED first if you have severe neck pain, pain right over the spine, pins and needles, numbness or weakness in your arms or legs, or a sudden severe headache. Do the same if you are 65 or over, or the crash was at high speed, and your neck hurts. If you haven't been checked since the accident, see your GP.

The neck can also produce dizziness in its own right. It usually comes with neck pain, stiffness and headaches at the base of the skull — the ongoing ache that often follows whiplash. That is different from the sudden, severe neck pain or headache on the ED list above. Whiplash can affect the ear and the neck at once. We assess both, because treating the wrong one wastes weeks. Before positional testing or any neck treatment, we screen the neck for warning signs that need medical assessment, and refer you on if we find any. After whiplash, we adapt the positional test so it is gentle on your neck.

If the accident happened in NSW, treatment can run through the SIRA CTP scheme. In the first few months after the accident, most treatment is pre-approved up to a set amount. Early treatment can start before the claim is approved. After that early window, ongoing sessions need insurer approval — your practitioner prepares the treatment plan and progress reports. Just tell us it's CTP when you book, and we check the current rules with your insurer.

You do not need a referral to book as a private patient. If this sounds like you, book a vertigo physio assessment at our Goulburn clinic. Mention dizziness so we can set aside time for positional testing. Testing can leave you dizzy for a while, so if you can, arrange a lift to and from the appointment. You leave knowing what we found, what we did and when to come back.

If any of the warning signs above apply, that comes first — 000, the ED or your GP, then us.