If you’ve ever experienced a sudden spinning sensation when turning in bed or looking up, you may have encountered Benign Paroxysmal Positional Vertigo (BPPV) — a common yet distressing condition affecting the inner ear and balance system.

At our neurological physiotherapy clinic, we frequently help individuals regain their balance and confidence through targeted, evidence-based treatment. In this article, we’ll explain what BPPV is, why it occurs, and how physiotherapy can provide fast and effective relief.

What is BPPV?

BPPV stands for:

• Benign – it’s not life-threatening
• Paroxysmal – it comes on suddenly and episodically
• Positional – it’s triggered by specific changes in head position
• Vertigo – a spinning or dizzy sensation

BPPV is the most common cause of vertigo and typically occurs when tiny calcium carbonate crystals (called otoconia) become dislodged from their normal position in the inner ear and move into the semicircular canals. These canals are responsible for detecting rotational movement. When the crystals interfere with this system, the brain receives mixed signals about motion, leading to vertigo.

Common Symptoms of BPPV

• Sudden, brief episodes of vertigo (often less than a minute)
• Dizziness when turning in bed, looking up/down, or rolling over
• Nausea or imbalance during or after episodes
• A sensation that the room is spinning

These symptoms can significantly impact day-to-day activities and increase the risk of falls, especially in older adults.

What Causes BPPV?

The exact cause of BPPV isn’t always known, but it can be linked to:

• Head injuries
• Ear infections or labyrinthitis
• Age-related degeneration of the inner ear
• Long periods of inactivity (such as bed rest or surgery recovery)

It’s more common in people over the age of 50 and tends to affect women more than men.

How Neurological Physiotherapy Can Help

The good news? BPPV is highly treatable — often with immediate improvement — through simple, non-invasive techniques performed by trained physiotherapists.

Assessment and Diagnosis

A detailed assessment helps confirm the diagnosis of BPPV and identify which semicircular canal is affected. This may involve gathering a detailed history of your symptoms, assessment of your vision and specific positional tests like the Dix-Hallpike or Roll Test.

 Treatment

Repositioning Maneuvers: Once diagnosed, your physiotherapist will guide you through repositioning maneuvers designed to move the dislodged crystals back to their proper location. These include:

• Epley Maneuver – for posterior canal BPPV (most common)
• Barbecue Roll (Lempert Maneuver) – for horizontal canal BPPV
• Deep head hang manoeuvre– depending on canal involvement

Most people experience significant symptom relief within 1–3 sessions.

Balance and Vestibular Rehabilitation: If you’ve had BPPV for a while or feel unsteady, your physiotherapist may prescribe vestibular rehabilitation exercises. These are tailored to retrain your brain and balance system to adapt more effectively.

Can BPPV Come Back?

Yes — BPPV can recur, especially if there is an underlying vestibular condition or age-related degeneration. However, once you’ve had it successfully treated, you’ll often recognise the signs early and can return for prompt treatment.

When to See a Physiotherapist

If you’re experiencing dizziness or vertigo that’s:

• Triggered by head movement
• Lasting seconds to minutes
• Not associated with hearing loss or severe headaches

…then it’s a good idea to book an assessment with a neurological physiotherapist.

Delaying treatment can increase fall risk and prolong discomfort — but the right therapy can bring fast relief.

Conclusion

At Therapy Matters we specialise in treating BPPV and other vestibular disorders through compassionate, evidence-based care. Don’t let dizziness stop you from living your life — let us help you restore your balance and get back to living life to the fullest.