If you’ve ever rolled over in bed and felt the entire room take off like it’s trying to qualify for a waltz competition, you may have had a brush with Benign Paroxysmal Positional Vertigo — BPPV, the tiny condition with a surprising flair. Despite the name, there’s nothing benign about feeling like gravity has just betrayed you.

The good news? BPPV is one of the most treatable causes of vertigo, and chiropractors trained in vestibular assessment can help get you steady again in record time.

What Exactly Is BPPV?

Inside your inner ear lives a clever little balance system made up of fluid-filled canals and sensory organs. Tucked inside those organs are microscopic crystals called otoconia, which normally sit still and behave. But sometimes they get dislodged and drift into one of the semicircular canals — most commonly the posterior canal — where they absolutely do not belong.

When that happens, your brain gets mixed signals about movement. The canals say, “We’re spinning!” while your eyes insist you’re perfectly still. Cue the unmistakable rush of sudden vertigo, often lasting just seconds but feeling long enough to make you reconsider every life choice that led you here.

Symptoms: The Signature Moves of BPPV

BPPV tends to follow a very recognisable pattern. People often report short bursts of spinning when rolling over in bed, looking up, bending forward, or turning the head. These episodes are brief — typically less than a minute — but can be intense enough to bring on nausea or a feeling of imbalance afterwards.

How Chiropractors Diagnose BPPV

Diagnosis starts with a thorough case history, exploring when symptoms began, what triggers them, and whether anything raises suspicion of a more serious cause. Then comes the fun part (for clinicians at least): positional testing.

The Dix–Hallpike manoeuvre is the gold-standard for identifying posterior canal BPPV. By moving the patient quickly from sitting to a reclined, head-turned position, we can provoke the characteristic spinning sensation and observe the pattern of nystagmus. For suspected horizontal canal involvement, a supine roll test is used instead.

These tests don’t just confirm BPPV — they tell us which ear and which canal are affected, which is essential for choosing the correct treatment manoeuvre.

Vertigo has many possible causes, and part of our job is identifying when something else may be at play.

For example, Ménière’s disease presents very differently: the vertigo lasts 20 minutes to hours, comes with fluctuating hearing loss or tinnitus, and is not triggered by position. Vestibular neuritis causes prolonged, severe vertigo often following a viral illness, with dizziness lasting days rather than seconds. Labyrinthitis is similar but includes hearing loss.

There’s also cervicogenic dizziness, where neck dysfunction causes a sense of imbalance or unsteadiness without the spinning sensation typical of true vertigo. The dizziness is often linked to neck movements and comes with neck pain or reduced mobility.

On rare occasions, vertigo can stem from central causes such as stroke or demyelinating disease. Red flags here include persistent, non-fatiguing nystagmus, severe headaches, limb weakness, speaking or vision difficulties, and difficulty walking unaided. These require urgent medical attention.

How Chiropractors Treat BPPV

Once we’ve confirmed the diagnosis, treatment is often wonderfully straightforward. The main approach is a canalith repositioning manoeuvre (CRM), which uses gravity to guide the wandering crystals back to where they belong.

The Epley manoeuvre is the most commonly used technique for posterior canal BPPV, while horizontal canal cases might call for the Lempert (barbecue roll) manoeuvre, and more stubborn versions may require a Semont manoeuvre or deep head-hanging. Research shows high success rates — between 70% and 90% resolve within one to three treatments.

Chiropractors also consider the neck. If a patient arrives with stiffness or discomfort, we may address cervical mobility to help reduce muscle tension, improve comfort during manoeuvres, or support recovery when symptoms overlap with cervicogenic dizziness.

Vestibular Rehabilitation and Aftercare

Even after the crystals settle down, some people feel slightly off-balance or “floaty” for a few days. This is where vestibular rehabilitation shines. Gentle exercises such as gaze stabilisation (VOR training), balance tasks, or habituation drills help recalibrate the brain and restore confidence in movement.

In some stubborn cases, Brandt–Daroff exercises may be recommended as a home programme to reduce lingering symptoms.

Since BPPV can recur — around 15–20% of people experience a future episode — we also discuss what to watch for, how to respond if symptoms return, and when it’s time for a follow-up.

When Should You Seek Further Help?

A chiropractor will recommend referral to a GP or ENT specialist if:

• symptoms don’t improve after appropriate repositioning manoeuvres
• hearing loss, tinnitus, or a feeling of pressure in the ear develops
• dizziness becomes constant rather than positional
• neurological symptoms appear
• balance is severely impaired even between episodes

These signs suggest a different underlying cause that deserves further investigation.

Curiously Aligned Take

BPPV may feel overwhelming, but it’s often one of the quickest and most satisfying conditions to treat. With accurate testing, the right manoeuvres, and supportive vestibular rehab, chiropractors can help you get back on steady ground — ideally without needing to clutch the furniture for balance.

If rolling over in bed keeps turning your world into a merry-go-round, don’t wait it out. Let your chiropractor bring the room back to a standstill.

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References (2012+)

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