When the Room Spins: Understanding and Treating BPPV
By Dr. Steve Osovsky PT, DPT, MS, GCS
Have you ever rolled over in bed or looked up quickly and suddenly felt like the room was spinning? That dizzy, disorienting sensation may not be “just getting older; it could be something called Benign Paroxysmal Positional Vertigo, or BPPV for short. The good news? It’s common, very treatable, and physical therapy can often help you feel better in just a few visits.
What Is BPPV?
BPPV occurs when tiny calcium crystals (called otoconia) inside your inner ear move out of place. Normally, these crystals help your body sense motion and maintain balance. But when they drift into the wrong part of the inner ear, they send the brain mixed signals about movement, causing that familiar spinning or dizzy feeling.
Think of it like a snow globe: when the crystals are floating where they shouldn’t be, your world starts spinning.
Common Symptoms of BPPV
People with BPPV often describe:
Sudden spinning sensations (vertigo) that last seconds to a minute
Dizziness triggered by specific head movements, such as:
Rolling over in bed
Looking up or bending forward
Turning your head quickly
Feeling “off-balance” or unsteady between dizzy spells
Mild nausea (sometimes)
It’s important to note that BPPV does not cause hearing loss or constant dizziness, if those symptoms are present, your provider will help rule out other causes.
What Causes BPPV?
BPPV can develop for a number of reasons, sometimes out of nowhere, and other times after an identifiable event. Common causes and contributing factors include:
Age-related changes: As we get older, the inner ear structures become more fragile, and the tiny crystals are more likely to dislodge.
Head injury or concussion: Even mild head trauma can shift the position of the crystals inside the ear.
Prolonged bed rest or inactivity: Lying flat for long periods can sometimes cause crystal displacement.
Post-surgical changes or dental work: Vibrations or head positioning during certain procedures can occasionally trigger BPPV.
No clear reason at all: In many cases, BPPV occurs spontaneously, without a specific trigger.
Regardless of the cause, the result is the same, those crystals move where they shouldn’t, and your balance system gets confused.
How Is BPPV Diagnosed?
A physical therapist or healthcare provider can perform a few simple tests to confirm BPPV.
One common test is called the Dix-Hallpike maneuver, where the therapist gently moves your head and body into certain positions while watching your eye movements.
If BPPV is the cause, your therapist can usually see a specific pattern of involuntary eye movement (nystagmus) that helps identify which ear and which canal are affected.
How Physical Therapy Treats BPPV
Once diagnosed, treatment is surprisingly quick and effective. Physical therapists trained in vestibular rehabilitation can perform a canalith repositioning maneuver, a series of gentle, guided head and body movements that move the misplaced crystals back where they belong.
The most common of these is the Epley maneuver, which takes just a few minutes and often provides relief immediately or within a couple of days.
Depending on your case, your therapist may also prescribe:
Balance and gaze stabilization exercises to reduce residual dizziness
Home instructions to prevent recurrence
Education on how to safely manage symptoms if they return
What to Expect
Most people notice significant improvement in 1–3 sessions, though occasionally symptoms can recur (especially after head injuries or prolonged bed rest). Your therapist can teach you what to do if that happens again.
The Takeaway
BPPV may sound complicated, but it’s one of the most treatable causes of vertigo. With the right assessment and care, you can get back to moving confidently, without worrying about the world spinning around you.
If you or someone you know experiences sudden dizziness or spinning when moving your head, reach out to your local physical therapist. A quick, gentle treatment could make all the difference.