BPPV treatment

Parent Cafe
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Yesterday I diagnosed and treated my own posterior canal BPPV (by far the most common form).
I’m a PT. I treated it using the Epley Maneuver.

This animation shows the technique I used and illustrates the rationale clearly: https://www.youtube.com/watch?v=9SLm76jQg3g
This video with a live patient is also helpful: https://www.youtube.com/watch?v=K4S4CbuN6QA

The vertigo was occurring when I turned to the right in bed, so I did the same maneuvers as shown in the 2 videos. (If vertigo had been occurring when I turned to the left in bed, I would have reversed the direction of the maneuver, i.e. begin to the left and then move to the right.)

My H was at work so I did this alone, but I recommend having someone there to support your head, or to help you change position. I have read that some people feel quite dizzy/panicked for a few moments when they sit up at the end; having someone to stabilize you if needed is safer than not having anyone there.

As one gets into the first head back and turned position, vertigo occurs. It’s quite unpleasant but short-lived; it stops in about 30 seconds, when the otolith reaches the lowest point that gravity pulls it to in the canal, which is why they tell you to wait that long-- but don’t just go by a timer; go by when the vertigo ceases. When it ceases, that’s the time to switch to the next position, which will again trigger vertigo, as will each subsequent position change. Each turn moves the otolith to the next position. Think of it as rounding the bases. When you finally sit up, the otolith reaches home plate!

For the rest of the day, avoid putting your head down. I actually put on a soft cervical collar as a reminder.
For the first night, sleep with your head a bit elevated.

I did this yesterday. Today: no more symptoms. But something like 20% of people have to repeat it. And it can recur, in the future, and you can re-treat it.

BPPV is positional vertigo-- it does not occur in every position. It is paroxysmal– it is not constant. I just want to emphasize that not all vertigo is BPPV and therefore not all will respond to these kinds of maneuvers.

Mine was posterior canal BPPV. There is also lateral canal BPPV and anterior canal BPPV, and the maneuvers for those are different.

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Update: I went through a series of tests that took 2 hours and had to go back later that day to see the neurologist. Of course the crystals behaved that day and stayed where they belonged. The dr. didn’t want to give a diagnosis until further testing so I had an MRI and Ct scan. While I waited for the tests to be scheduled, I was sent for physical therapy. I had the MRI and no problems were detected.

My new therapist did the repositioning ( several variations) during the first few sessions and for the past few weeks we have worked on other balance issues. My latest exercises are to walk a straight line while turning my head from side to side or up and down. My hardest exercise is to stand in a corner on a cushion with my feet together and close my eyes. My PT thinks next week will probably be my last session. I am able to do most of the exercises without dizziness.

I am scheduled to see the neurologist’s PA in another month. I am curious to know whether this second type of dizziness is related to my 20+ years of BPPV or just another sign of getting old. I have a regularly scheduled appointment with my ophthalmologist tomorrow so I plan to ask him a few questions also.

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About a year and a half ago had a major episode (rooming spinning, vomiting, couldn’t function at all just woke up from bed that way). I went to the doctor who gave me stuff for the dizziness and for nausea. It subsided over the next couple of days. But I’ve never fully recovered. When I turn to my right while laying in bed or sometimes when I get up too fast I get dizzy. It doesn’t last more than a few seconds and they are not too bothersome so I’ve mostly ignored it. I haven’t had a major episode since. Just wondering if it’s worth going to a doctor. Any opinions?

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What would be the downside of seeing if the doc could offer any help (other than possibly wasted time and visit). I hate dizziness and would probably at least try to see if a doc could help. I was having it for a bit and got done anti-vert Rx. It seemed over time mine resolved without much treatment, but it didn’t just as long as yours.

Maybe an EMT or neurologist? Not sure. I used internist.

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Good point, there’s no real downside (except as you mentioned a wasted afternoon if all I get is “live with it”). I guess more what I was asking is should I be concerned and see a doctor if it’s not really bothering me. It’s been on my “to do” list for a while, but I just haven’t gotten motivated to make an appointment. And you also addressed a question I have…who to go see. I was thinking maybe an ENT.

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Sorry about typo–meant ENT. Of course, quality varies among them. The one I saw about losing my sense of smell was bad. I guess it’s really your call about how much and often it bothers you. If you can get a convenient appointment after a good referral, possible gain and not much loss. Dizziness is no fun and SOMETIMES can be helped.

Mine resolved on its own, so never went beyond internist. 1.5 years is awhile–is likely see a MD to inquire about options.

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I had the same treatment for my vertigo last fall. It worked amazingly quickly–after three weeks of treatment, I could bend over without getting dizzy for the first time in years. I stopped doing the exercises and everything was fine for several months. Now I’m back to getting dizzy again, so I’m doing the exercises again. I had hoped the treatment would be a permanent fix, but apparently it wasn’t for me.