If you've ever woken up and felt like the room was spinning, or noticed a sudden wave of dizziness when you rolled over in bed or looked up to reach a shelf, you may have experienced BPPV. It can be startling, disorienting, and hard to explain to someone who hasn't felt it. It can also interfere with driving, working, exercising, and simply moving through your day with confidence.
The good news: BPPV is one of the most common and most treatable vestibular conditions. For most people, targeted physiotherapy resolves it in one to three sessions.
What Is BPPV?
BPPV stands for Benign Paroxysmal Positional Vertigo. The name breaks down like this:
- Benign — it is not dangerous or caused by something serious like a tumour or stroke
- Paroxysmal — it comes on suddenly, in short bursts
- Positional — it is triggered by specific head movements or positions
- Vertigo — it creates the sensation that you or the world around you is spinning
The underlying cause is mechanical. Inside your inner ear are small calcium carbonate crystals called otoconia (sometimes called "ear rocks"). In a healthy vestibular system, these crystals sit in a specific chamber and help your brain interpret gravity and linear movement. In BPPV, some of these crystals become dislodged and migrate into one of the semicircular canals, where they don't belong. When your head moves, the crystals shift and send false signals to your brain, triggering sudden vertigo.
Who Gets BPPV?
BPPV can happen to anyone, but it is significantly more common in adults over 50. Women are more affected than men, and research suggests a link between hormonal changes, including those associated with menopause, and the loosening of the crystals in the inner ear.
Common triggers and risk factors include:
- A knock to the head or whiplash injury
- Prolonged bed rest or immobility following surgery
- Age-related changes to the inner ear
- Hormonal changes
- Calcium or vitamin D deficiency
- In many cases, no clear cause at all
At Versa Movement Collective, a significant number of our vestibular patients are women in their 50s, 60s, and 70s who have been managing unexplained dizziness or balance changes for months, sometimes years, without knowing it was a treatable vestibular condition.
What Does BPPV Feel Like?
The most distinctive feature of BPPV is that the vertigo is brief and position-dependent. A typical episode lasts between 10 and 60 seconds and is triggered by a specific movement, most commonly:
- Rolling over in bed, particularly to one side
- Sitting up or lying down
- Tilting the head back to look up
- Bending forward, for example to pick something up off the floor
Between episodes, most people feel completely normal, though some describe a lingering sense of unsteadiness or mild disorientation throughout the day.
Because the spinning sensation comes on so suddenly and feels so intense, it can be alarming the first time it happens. Many people worry it is a sign of something more serious, such as a stroke or inner ear disease. While it is always worth getting assessed to rule those things out, BPPV is by far the most common cause of episodic vertigo and is entirely benign.
How Is BPPV Diagnosed?
BPPV is diagnosed through a clinical assessment called the Dix-Hallpike test, which involves moving a patient from a seated to a lying position with the head turned to one side. A physiotherapist trained in vestibular assessment, like Jordan Knapman at Versa, observes specific eye movements called nystagmus that confirm the diagnosis and identify which canal the crystals have entered.
At Versa, Jordan uses Insight Pro+ vestibular goggles during assessment. These goggles allow for precise observation of eye movement patterns that would be difficult or impossible to detect with the naked eye alone, improving diagnostic accuracy and helping ensure the right treatment is applied to the right canal.
How Is BPPV Treated?
The primary treatment for BPPV is a repositioning maneuver, most commonly the Epley maneuver. This involves a precise sequence of head and body movements designed to guide the displaced crystals back out of the semicircular canal and into a position where they no longer cause symptoms.
The maneuver is performed in the clinic by your physiotherapist and takes only a few minutes. It is not painful. Most patients experience some vertigo during the maneuver itself, which is actually a sign it is working.
Depending on which canal is affected and your individual presentation, other repositioning techniques may be used alongside or instead of the Epley. Your physiotherapist will explain what they're doing and why as they go.
What to expect:
- Most people experience significant improvement after one to two sessions
- A small number of cases require additional treatment or a home exercise program to fully resolve
- Your physiotherapist will also address any residual unsteadiness or balance confidence through vestibular rehabilitation exercises
- If your BPPV is linked to a broader vestibular condition or post-concussion syndrome, a longer treatment plan may be recommended
BPPV vs. Other Causes of Dizziness
Not all dizziness is BPPV. Other vestibular conditions that physiotherapy can help with include:
- Vestibular neuritis or labyrinthitis: inflammation of the inner ear following a viral infection, causing prolonged dizziness and balance disruption
- Vestibular hypofunction: reduced function in one or both inner ears, often causing chronic unsteadiness
- Post-concussion vestibular dysfunction: vestibular symptoms that persist after a head injury
- Cervicogenic dizziness: dizziness originating from the neck rather than the inner ear
A thorough vestibular assessment at Versa will clarify what's driving your symptoms and whether physiotherapy is the right path, or whether a referral to another specialist is more appropriate.
When to See a Doctor Instead
While BPPV is benign and physiotherapy is the appropriate first-line treatment, there are some symptoms that warrant medical attention before or alongside physiotherapy:
- Sudden, severe headache unlike any you've had before
- Dizziness accompanied by double vision, slurred speech, or weakness on one side of the body
- Dizziness following a significant head injury
- Hearing loss or ringing in one ear alongside new vertigo
These symptoms may indicate a more serious condition and should be assessed by a physician promptly.
Getting Help for BPPV in Calgary
If you're experiencing positional vertigo, unexplained dizziness, or balance changes that are affecting your daily life, vestibular physiotherapy is a logical and effective first step.
Jordan Knapman, MScPT, MSc Biomechanics and Neuroscience, leads vestibular physiotherapy and concussion management at Versa Movement Collective in Springbank Hill, SW Calgary. Jordan holds a certification in Vestibular Rehabilitation and Concussion Management and uses Insight Pro+ vestibular goggles for precise diagnostic assessment.
Book a vestibular physiotherapy appointment at Versa, or learn more about our vestibular physiotherapy and concussion management program.
Versa Movement Collective serves patients across SW Calgary including Signal Hill, Springbank Hill, Discovery Ridge, and Aspen.
