One common reason the room spins when you roll over is BPPV, or benign paroxysmal positional vertigo: small crystals in your inner ear break off and move into a canal, and when you move your head a certain way they stimulate nerve endings and make you dizzy, according to the American Physical Therapy Association (APTA) in its guide to BPPV. A physical therapist can test for it with positional tests that recreate your symptoms, then manage most cases with maneuvers that move the crystals back where they belong, as the same guide explains.
Why the room spins when you roll over
APTA's guide calls BPPV a common inner ear problem that affects the vestibular system, the system that works to maintain your balance. Benign means the disorder is not life-threatening. Paroxysmal means the spinning comes on suddenly. Positional means a change in head position sets it off, such as lying down, turning over in bed or looking up.
According to APTA, the inner ear holds a layer of calcium carbonate material called otoconia, and pieces of it are often called crystals. In BPPV, those crystals break off and move into a part of the inner ear called the semicircular canal. When you move your head a certain way, they shift inside the canal, stimulate nerve endings and make you dizzy. Most often the cause is not known, though a head injury, an infection or aging can loosen the crystals.
Each spell is brief and intense, usually about 15 to 45 seconds according to APTA. Episodes frequently occur for weeks or months at a time. You may feel like the room is spinning around you, and you may also feel light-headed, off-balance or nauseous. APTA also says the sensation can be alarming and may increase the risk of falling.
Get medical help right away if dizziness comes with symptoms such as weakness, slurred speech or vision problems. MedlinePlus says these may be signs of a more serious condition.
How a physical therapist tests for BPPV
APTA says physical therapists use positional tests to recreate BPPV symptoms. The tests require moving your head in specific ways while the therapist watches your eyes for specific movements.
MedlinePlus says a provider may diagnose BPPV with a test called the Dix-Hallpike maneuver. The provider holds your head in a certain position, you lie quickly backward over a table, and the provider looks for abnormal eye movements (called nystagmus) and asks if you feel like you are spinning.
APTA notes that dizziness has many causes and is often hard to describe, so it says to be as specific as possible and to mention:
- how long your symptoms last
- what makes them better or worse
- any recent illnesses or injuries
- problems with your immune system
- changes in medications or hormones
- whether you have headaches
Those clues help the therapist make an accurate diagnosis, or show that you need a referral to another specialist.
What the repositioning maneuvers do
APTA says the majority of people with BPPV can be treated with simple, specific maneuvers that involve moving the head and body. The therapist evaluates you first and decides which maneuver is right for you. The maneuvers are designed to move the crystals from the semicircular canal back into the appropriate area of the inner ear, called the utricle.
MedlinePlus names the Epley maneuver and describes it as a series of head movements to reposition the canaliths, the small pieces of calcium, in your inner ear. It also says BPPV is uncomfortable but can usually be treated with that maneuver.
BPPV can come back. APTA says there are no known ways to prevent it, and that within three years of a bout, symptoms return for about half of people. MedlinePlus says the procedure may need to be repeated if symptoms come back.
What Dr. Ed does about it
Dr. Ed Shut, DPT, does the positional test and the repositioning maneuvers for BPPV at Chatsworth Physical Therapy. He is trained in the Dix-Hallpike test and the Epley maneuver, and he screens you first to make sure they are right for you. For the most common kind of vertigo, BPPV, repositioning maneuvers done in the clinic often settle it within a few visits. Other dizziness improves with a graded exercise program.
He sets the plan after your first evaluation rather than guessing up front. How many visits you need depends on your condition and how your body responds. Every visit is one-on-one with Dr. Ed.
If you have notes from an ear, nose and throat (ENT) or neurology visit, bring them. If Dr. Ed thinks your dizziness needs a doctor's look first, he will say so.
What to do next
If the room spins when you roll over, book an evaluation with Dr. Ed. The Vertigo and BPPV page covers how he treats dizziness and what to expect, and the Reviews page shows what patients say.