If you experience sudden spinning sensations when turning in bed, looking up, or bending down, you may have BPPV (Benign Paroxysmal Positional Vertigo) — one of the most common causes of vertigo.
The good news? BPPV is highly treatable with specific physiotherapy manoeuvres that often resolve symptoms quickly.
What Is BPPV?
BPPV occurs when tiny calcium crystals (otoconia) become dislodged from their normal position and move into one of the inner ear semicircular canals.
When you change head position:
- The misplaced crystals shift
- They stimulate the balance canal inappropriately
- This triggers your eyes to move rapidly in a specific pattern (called nystagmus), which makes you feel like the room is spinning.
This causes brief but intense vertigo.
Common Symptoms of BPPV
You may notice:
- Spinning when turning in bed
- Vertigo when looking up or bending down
- Dizziness lasting seconds (not hours)
- Nausea and vomiting during episodes
- Feeling off-balance
⚠️ BPPV does not usually cause:
- Constant dizziness all day
- Hearing loss
- Double vision
- Limb weakness
- Unsteady gait and falls
If those occur, medical review is needed.
Why Does BPPV Happen?
Most of the time, there is no clear trigger.
However, BPPV is more commonly associated with:
- Age-related inner ear changes (natural degeneration of the balance system)
- Head trauma or minor knocks to the head
- Prolonged positioning (e.g. extended bed rest, dental procedures, long flights)
In many cases, patients wake up one morning and notice spinning when turning in bed — without any obvious cause.
How Is BPPV Diagnosed?
A trained vestibular physiotherapist performs a positional test called the Dix-Hallpike test or Supine Head Roll test, where your head is guided into specific positions to reproduce symptoms safely.
If spinning and characteristic eye movements (nystagmus) are observed, BPPV can be confirmed.
Diagnosis is clinical — scans are usually not needed.
How Is BPPV Treated?
✅ Repositioning Manoeuvres
Because the inner ear canals are shaped like small circular loops, treatment involves guiding your head through a specific sequence of positions — essentially turning you through a controlled rotation.
These manoeuvres use gravity to move the displaced crystals out of the canal and back to where they belong.
Many patients improve significantly within one to two sessions, though recovery can vary depending on how complex the BPPV is.
Can BPPV Go Away on Its Own?
Sometimes BPPV resolves spontaneously. However:
- Symptoms may persist for weeks and in some cases up to six months without treatment.
- The risk of falls may increase, especially in older adults.
- Avoidance of certain head movements may develop, which can slow recovery.
Clinical studies consistently demonstrate high success rates (approximately 70–80%) for BPPV when treated with appropriate repositioning manoeuvres, especially when assessed early.
Is BPPV Dangerous?
BPPV itself is not life-threatening.
However:
- Falls risk increases
- Driving may be unsafe
- Sleep can be disrupted
- Anxiety about movement may develop
Early assessment and appropriate treatment are associated with faster symptom resolution.
Will It Come Back?
BPPV can recur.
Studies suggest recurrence rates of approximately 30% within the first year, and higher over longer periods. Recurrence does not mean treatment failed — it reflects the natural behaviour of the inner ear system.
If symptoms return, reassessment and repeat repositioning manoeuvres are usually effective.
When Should You Seek BPPV Treatment in Singapore?
Consider seeing a vestibular physiotherapist if:
- You experience spinning when turning in bed
- Vertigo lasts seconds and is position-triggered
- Symptoms keep recurring