Can Sleep Problems Cause Benign Positional Vertigo?

October 29, 2009

A few days after my 3rd son Brennan was born, I suffered from classic benign positional vertigo. Looking back on the course of events, I had a eureka moment last night that literally kept me up in bed.

 

Benign Positional Vertigo (or BPV) is a well-described inner ear condition that otolaryngologists like myself treat all the time. The classic description is when you feel dizzy, like the room is spinning, just after a sudden head movement, either up or down, or side to side. The spinning will usually last a few seconds, and you may have residual nausea and imbalance for hours to days. It’s typically preceded by an infection, head trauma, stress, or in many cases, no significant events at all (50%).

 

The Dix-Hallpike maneuver is performed to make the diagnosis and the Modified Epley is then continued on to cure the problem if the Dix-Hallpike is positive. In my experience, the Epley maneuver works about 80-90% of the time to cure the problem instantly if the Dix-Hallpike is strongly positive. It’s one of the more gratifying maneuvers/procedures that I perform.

 

When I developed BPV, I didn’t have an infection, or had any kind of head trauma. The only thing I can remember is that I was severely sleep-deprived the prior few days with all the excitement surrounding Brennan’s birth. I had the classic symptoms: spinning lasting a few seconds aggravated by sudden head turns, particularly every time I lay down in bed or rolled over to the left. After performing the Dix-Hallpike and Epley maneuver on myself, the condition got better.

 

The explanation for BPV is as follows: Your inner ear has three semicircular canals in three different planes, each filled with fluid and a sensor that sways back and forth, depending on which direction you turn your head. Essentially, these three paired semicircular canals tell your brain your head position. At the ends of each of these canals, there’s a sensor that sways back and forth, depending on which direction your head moves. Small calcium carbonate stones are stuck to the top of these sensors, making them sway easier. 

 

The theory is that if one of these stones falls off, and as you move your head into a certain position, the stone moves to the top of the semicircle. Then the stone takes a few seconds to slowly move down the canal, until it reaches the bottom-most/gravity dependent position in the semi-circle. During movement of the stone, fluid waves are transmitted to the sensor which sends a one-sided signal to the brain, which thinks you’re moving your head.

 

Various models and even surgical findings (of otoliths, or ear stones) confirm this theory. But here’s a more plausible explanation, based on my own experience. Stones are constantly regenerated and some fall off the sensor occasionally. However, if you suffer head trauma, more stones may become dislodged and produce the symptoms. But why would a viral infection cause a stone to become dislodged? In most cases, there’s no history of infection or head trauma at all.

 

Any infection, whether a common cold or sinusitis, causes swelling in the nose and throat which narrows the upper airway, which narrows the throat even further, leading to more obstructions, causing more reflux, leading to more throat inflammation and narrowing. (I discuss my sleep-breathing paradigm in much more detail in my book, Sleep, interrupted.)

 

What’s probably happening is that sleep deprivation of any kind, including that period after a new baby is born, sleep apnea, upper airway resistance syndrome, or insomnia, can all heighten your nervous system, leading to hypersensitive sensors. It’s like when you get a migraine and certain noises or bright lights can make you cringe. In the same way, a hypersensitive inner ear sensor can over-react to any extra form of stimulation, including otoliths. 

 

If you take this concept even further, if the other parts of the inner ear are also extra sensitive, then you can have anything from hyperacusis (sensitivities to certain sounds or voices) to ringing. This could apply to Meniere’s as well.

 

So ultimately, it may not be the free-floating stone, per se, that causes your symptoms, but that if your nervous system is extra sensitive to stimulation due to various forms of sleep deprivation or added stress, then you can suffer classic BPV symptoms. 

 

Am I completely out of line, or am I on to something? Please give me your opinion in the box below.

 

38 Responses to “Can Sleep Problems Cause Benign Positional Vertigo?”

  1. David Stillwagon on October 29th, 2009 12:46 pm

    It sounds like a interesting theory, could there be a connection to meniere’s disease as well?
    David

  2. Greg H on October 29th, 2009 11:26 pm

    You are absolutely correct … I have hyperacusis from that exactly !!!!

  3. Steven Park on October 30th, 2009 6:40 am

    David,

    I neglected to mention Meniere’s disease as well. You can think about Meniere’s as a migraine of the inner ear, where all the nerve endings get overstimulated and you get the classic symptoms (hearing loss, ringing and vertigo). All this can happen form any form of inefficient sleep. Of course if you have inflammation, you’ll see increased pressures in the endolymphatic space. Using low salt diets or by lowering your blood pressure using antihypertensive medications, you’ll feel better.

    Another analogy is with sinus headaches, which are thought to be due to migraines as well. Inflammation of the nerve endings give you a pressure sensation and taking decongestants help.

  4. Larry Krasicki on December 8th, 2009 2:20 pm

    I had a vertigo problem which I am not 100% sure what is causing it. I am 63 years old and have type 2 dibetis. I am not sure if that makes my vertigo worse or what. I do have a problem sleeping because of my condition. I have to get up every hour to two hours to go to the bathroom.

    I was told that my vertigo could have been cuased by an old neck injury. I did have one about 30 years ago where I wore a neck brace for about 2 weeks. The person who told me this could be related to the cause of my condition recommended going to a chiropractic and have my neck “snapped back in place. I did do this and I haven’t had problems for about two months now where I was having vertigo events almost a couple times a week. Some of the events were real bad where they made me real sick.

    I am not sure if the neck manuevering and twisting is a cure for this but so far so good. I’m maybe thinking sleep deprivation could have some effect or may amplify the problem not sure.

  5. Carly on March 4th, 2010 1:30 pm

    I have a 5 month old son. BPV was diagnosed when he was three months. I’ve had sleep problems since he was born for obvious reasons. His sleep improved from 3-5 months and BPV improved with it. However, he has started waking again in the past couple of weeks (potentially teething or growing) and I am averaging 5 hours a night for 10+ days. BPV has returned and is worse than when first diagnosed. I am convinced BPV and sleep deprivation are linked.

  6. Carol O'Brien on March 27th, 2010 1:22 pm

    I had a moderate episode of BPV.  I decided to do the exercises and now it's much worse.  It's almost impossible to do the exercises because of the spinning and nausea it produces.  The effects have lasted thoughout the day with imbalance and nausea.  When the onslaught is less severe, the exercies help.  Can you give me any help with that?   Can the exercies actually make the symtoms worse before they improve?  I had thought I would try to improve my "dizziness" before it got worse but I've made it worse in the process.  Should I force myself to continue them?  Thanks for your comment.

  7. Stacy on April 21st, 2010 6:32 pm

    You are exactly right!  I suffered from insomnia, sleep deprivation, etc. while I was experiencing a copper overdose.  I literally did not sleep for at least 2 days straight.  I have no idea how I was functioning, because I have two kids, on top of having no sleep.  A few weeks after I fixed the copper overdose problem I've been experiencing vertigo for about 3 weeks now, and have been trying to find out how to help it since.  Thank you for this article.

  8. Pat Marks on July 11th, 2010 9:52 pm

    I was curious if anyone has tried the exercises by Christian Goodman and his theory that most vertigo is not the result of BPV, but rather "tension in the muscles supporting the head" or lack of  oxygen reaching the brain.  I used to  carry tension in my back until I started doing back exercises, so now I'm wondering if my dizziness is caused by tension in my neck  .. 

  9. Paul Johnson on August 6th, 2010 9:57 am

    Hi, I was most interested in reading your theory.  I am a cytotechnologist, and spend the majority of my work day staring down a microscope, where the images move rapidly across my field of vision.  I am 49 years old, and have a 2 year old son and a 4 year old daughter, both of which are poor sleepers.  I am chronically sleep deprived, and everytime I get even a minor cold, I end up missing a day or two of work because of vertigo and ensuing nausea if I try to "push" my way through it.  I have been to an E.N.T., who found no problems.  I always thought the sleep deprivation must have something to do with the problem, and was happy to read that it is not just my imagination.  Now if only I could do something about the root problem….thanks.

  10. Steven Park on August 6th, 2010 10:41 am

    Paul,

    There are a number of simple step to begin with to more fully optimize your sleep quality. First, avoid eating or drinking alcohol within 3-4 hours of bed. I'm assuming you normally can't sleep on your back, but if you do, don't. Make sure your nose is clear—take care it naturally, medically, or surgically. For a more comprehensive explanation about why you have these various issues, take a look at my book.

  11. maria on October 8th, 2010 1:14 pm

    hello!

    My vertigo started during my pregnacy now i get it 3-4 times per year, each crisis lasting for aout 1-2 weeks lots stress and poor sleeping…women go through so much…
    had a normal MRI of the brain
    Great to hear of possible etiliology – sleep deprivation + stress
    Best of luck to all!!

  12. maria on October 8th, 2010 1:21 pm

    please ignore the bad spelling

  13. Paul Johnson on October 26th, 2010 8:12 am

    Hi Dr. Park
    Thanks for your suggestions, but my sleep problems are almost strictly due to my kids. My daughter has night terrors, and my son, actually is sleeping much better these days. We have banned Disney cartoons (some of these Princess movies, which she loves, are ridiculously violent) from her viewing selections, and this is helping. I sleep fine on my back or side, and have never really had any sleep issues other than being a light sleeper before my kids came along. They are good kids though, so we will work through it.

  14. Dr John L Whiting on November 1st, 2010 1:42 am

    I am at this website because I postulated that some of the patients I see who have acute relapses from severe sleep deprivation, appeared to demonstrate classical BPV phenomena. I think there is a link therefore in BPV relapses and acute or severe chronic sleep deprivation, as you too postulate.

  15. Dr John L Whiting on November 1st, 2010 1:57 am

    Yes, I do believe there is a real connection between sleep deprivation (as in CFS for example) and attacks of Benign Positional Vertigo

  16. Dawn Jones on January 4th, 2011 8:12 pm

    I just started working a night shift mid-week and then go straight to day shift,so I skip a full nights sleep once a week.I have done this for 5 months.I was just diagnosed with BPV and have no prior history.

  17. Karen Day-Lyon, RN on January 29th, 2011 7:21 am

    I’m a triage RN with circadian rhythm disturbance disorder (and, thus, chronic sleep deprivation), as well as Meniere’s disease. I find that the more sleep deprived I get, the worse the vertiginous sx and BPV type. I currently have a monster sinus infection on top of it all (that I’ve had for a week), and the room is spinning to the point that I want to get off. I think you are on to something. Wonder why I didn’t think of it earlier? Thanks for the thought provoking post.

  18. Leslie Rae on February 14th, 2011 4:15 pm

    I get BPV like symptoms that come on only when I am sleeping. After I wake up and get the spinning to stop they subside but often start up again right after I fall back asleep. Can’t seem to get any reasons as to why this only happens when I’m asleep so this is all very interesting to me. My neuro has suggested migraine spectrum, but I’ve been wondering lately if it is either neck, TMJ or apnea related…any advice is appreciated! I went through several months of vestibular therapy which was puzzling to the therapist as sometimes one ear tested positive, sometimes another, sometimes both, sometimes different canals. I would leave feeling very nauseous yet I felt fine other times of the day…it only comes on when I sleep (or thru Dix Halpike)

  19. KathyK-inToronto on September 17th, 2011 5:16 am

    Up until a few days ago, I only had one vertigo-related experience, after spending a lot of time on a dock, which moved a bit with the gentle waves during a cottage weekend in the country. It passed after a couple of days on firm land.

    Two days ago, after some stressful days recently and about 5 years of on-and-off sleep deprivation (my thoughtless noisey neighbours, who have finally quieted down), I awoke at my home with what I have been told was vertigo.

    It passed after a day and a half, but it returned about two hours ago, after being awakened numerous times over a 3-hour period, while trying to get to sleep. Many loud vehicles have been passing very closely outside the apartment (rather like slleeping on a highway) where I am spending the night, at the home of a dear friend.
    Hopeful that making the effort to create a quieter sleep environment will reward me with some much-needed sleep and get back to normal ( inner ear functioning? ).

    For now, I have relocated within the apt where I am spending the night and will travel with ear plugs as prep for sleep ln the future.
    I am so pleased to have found/read the postings above.
    Thanks – Good day/night!

  20. Steven Park on October 10th, 2011 11:10 pm

    Here’s a comment that came in to me about the video version of this blog:

    Dear Sir,

    I just viewed your video presentation regarding sleep apnea and BPPV. I have both. I had my first episode of vertigo in 1970 after my first husband died and I was under a lot of stress. I have had numerous episodes since, but it wasn’t until 2008 that someone told me I might have BPPV. I did the self help maneuvers that were recommended and cured it. I was diagnosed with severe sleep apnea (37 episodes an hour) in 2009. I use a CPAP machine for about four hours a night. I care for a person with Alzheimer’s and had a recent period of about a week when I wasn’t able to use my CPAP machine. Then I had an attack of BPPV. I had not made the connection before, but I find your theory interesting and so thought I’d share my experience with you. By the way, for the record, I am a 64 year old Anglo-Saxon female. SH

  21. Samantha on October 11th, 2011 8:47 pm

    I don’t know if this is what’s going on with me, but it sure sounds like it. I have fibromyalgia and osteoarthritis, just got over a sinus infection and I have been getting about four hours of sleep a night for the last week. I will be walking through a parking lot, turn to look at something and my vision gets wavyand Im so dizzy I think ill fall over. It happens standing only though, not laying down at all. I don’t know what’s going on. But article did give me insight!!

  22. Harry Bergen on November 25th, 2011 4:41 pm

    I get BPV approx every 2 years. Last time I went to ENT where they performed Dix-Hall Pike which they said was negative. (It didn’t feel negative as I was very dizzy in that position). Is it possible that I am so fearful of being dizzy that I suppress the nystagmus? Would it have done any harm to perform Epley anyway?

  23. jared miller on June 1st, 2012 6:24 pm

    i just got recently diagnosed with this benign vertigo, and after watching this video i believe thats what is causing mine because i have had sleeping problems for years, i think my brain tries too hard too get to sleep, i also believe i have a.d.d. and i think thats what makes my brain work so hard to get to sleep.

  24. marcee on November 4th, 2012 6:17 am

    I’ve had a similar experience to Leslie Rae. I occasionally get vertigo eppisodes while sleeping. Usually they coincide with a strange dream of me hanging upside down, leaning back or moving my head weird, when in reality I’m just lying there. The vertigo test where the doctor quickly lays you down on your back did not produce vertigo effects for me. LI’ve questioned periods of hormonal changes as possible triggers ( episodes usually occur at the end of menses, have occurred near ovulation.) I’ve been going through a lot of stress, which seems to amplify symptoms. I just had two episodes while asleep after a particularly stressful day. The vertigo wakes me up, ry to wait it out and then fall back asleep only to have it happen again.

    I’ve also been getting unusual pressure/tension headaches or migraines. I have a history of nasal polyps and sinus problems as well as whiplash from an amusement park ride quite a few years back..

    I’ve always had really low blood pressure (about 75/60) but my bloodpressure has elevated and is now usually around 100 or 110/60, after vertigo the bottom number seems to be a bit higher (110/66 or so).

    I’ve also had another symptom I’d like to take note of: a chronically bloody right nostril. Every time i blow my nose a piece of hard bloody mucus is dislodged and my nose bleeds slightly. I don’t know if this could be related or if it’s just attributed to dry air or otherwise unrelated cause.

    Appreciate any thoughts or input. I hope everyone has luck with figuring out their vertigo, it really is a miserable feeling.

  25. Nicole on December 11th, 2012 9:23 pm

    Ok well my story is a little long but here it goes .. Ive been getting vertigo since I’m 18. My episodes consited of short brief single episodes that would usually come on when I got out of bed. I was able to go on with my day no problem. Every year or two I would get brief vertigo episodes. I’m 25 now. 2 and a half months ago I got sick with strep throat and I was congested. A week later I got vertigo attack that lasted 48 hours. Non stop spinning unless i layed down completely still. After 48 hours it subsided but i had 4 weeks of constant nausea and vertigo when I looked up down or to the left. I went to ent and dix hall pike confirmed left side bppv. I had the epely maneuver done and it took the spinning away. It’s been a week of no spinning but the off balance feeling like I’m on a boat is always there with nausea. Is that normal after epely? Could my strep throat being congested caused such a long 2 month bout of vertigo. I’m scared I’ll get this again :/ any input ??

  26. Paul Jacobson on January 30th, 2013 12:58 pm

    If sleep deprivation from OSA can cause BPV and or tinnitus can the use of CPAP make it worse by increasing and or changing the air pressure in your inner ear.

    Over the last several years I have experienced occasional imtermittant short term episodes of BPV upon waking. This changed 2days ago the BPV has come and not gone away. This began after 2 nights of not using CPAP and after a week where my CPAP usage was way down so I was tired and somewhat sleep deprived.

    However when I tried to sleep with my CPAP last night the vertigo go much more intense. I have made an appointment to have the air pressure on my CPAP readjusted in case it is too high. However I am also concerned that I may noon get be able to use CPAP as it may be damaging my hearing. My tinnitus has been getting worse since I began using it and I never made the connection.

  27. Vincent on February 27th, 2013 8:12 pm

    I went thru few weeks of sleeping 5 hours only and last 2 days I slept at 5 am, then vertigo strike, this article helps to confirm the link.

    Now I will try my best to overhaul my lifestyle, health most important

  28. Lisa on March 16th, 2013 10:42 am

    Dr, Park I need your help

    March 15, 2013.

    Over the past two weeks, i had two episodes of vertigo one of there very severe form non stop vomiting and head spinning and i went to emergency,neurologost order me vestibular therapy with no help, i am sleep deprived for the past 4 to 5 month, please help me, i do not know what to do and with what specialist to f/u.

  29. Carol on March 27th, 2013 9:09 am

    I suffered with periodic vertigo for almost three years until I finally felt stable again.

    My vertigo came back two weeks ago after a three year break with the left side being the problem; the cause is not really known, although I was suffering with a sinus infection and had hit my head a week earlier.

    Since I am normally a restless sleeper, I do not know if I suffered from much sleep deprivation before the vertigo returned. During the latest episode as per physical therapy, I was sleeping sitting up or using two pillows for six days and performing Epley and other exercises. The first few nights I was sleeping well, and the symptoms seemed greatly improved. After a few nights of restless sleep and returning to lying down while sleeping, the symptoms have returned, although the vertigo is not as bad as the initial day. During the time period when I was not sleeping well, I was also under a great deal of stress. I am hoping that continuing Epley and other exercises will get me back on track. I am also planning on going back to using two pillows and staying away from rolling to my left while sleeping.

  30. Annie on April 26th, 2013 4:29 pm

    Back sleeping keeps my jaw relaxed an improves bruxism. Also, back sleeping prevents one sided facial wrinkling. I cannot see a problem with back sleeping so long as one’s head is sufficiently elevated. I sleep on a single buckwheat pillow which keeps my neck supported without flopping to the side.

  31. Don on June 14th, 2013 11:02 am

    My BPV started in my late 20s…waking vertigo…20 seconds of death spiral and eyes bobbing, etcc….read the whole deal about stones and just believed it for years…but over time, I realized that there were commonalities….lack of sleep/stress… Had it right around the time of my baby years ago and then noticed it after to much late night gaming….and now later in life after stressful/low sleep weeks from work/etc… It’s gotten to the point for me that I try not to sleep with my head facing left as it seems that whatever ear is impacted will cause the issue when tired….even when tired I can sleep to the right without issue…but if I get vertigo it seems almost always to be a left head turn. Gone into ear doc, tested for menieres and nothing…great hearing, etc… If I get an episode it makes me woozy and worn out, but as long as I keep my head up and move on it goes away eventually… try to get to sleep earlier and brace head from falling to the left…. im with you..it’s hypersensitive ears…or maybe there is something about swelling in the canal.. i know from reading tht lack of sleep can cause an increase in swelling ( they relate that to heartattck/etc increase in folks without sleep ) …some anecdote I read… so maybe its that after stress/sleep our ear tubes swell enough to ‘catch’ a stone or release a stone/etc…. I’ve thought about taking an aspiring after my episodes to see if it helps….but now I am just reaching!

  32. Rebecca on July 9th, 2013 1:14 am

    I am not a doctor, but this sounds brilliant. My experience is that I have been sleep deprived, often severely, since puberty (I am now age 38). Much of the sleep deprivation was (stupid) personal choice (including a 2 year span of time where I had a 5 hour round trip daily commute and on average slept 3-5 hours during the week and then slept as much as possible on the weekends. However recently I did a sleep study that found very mild but extremely disruptive sleep apnea (cpap in the works), that explains my chronic insomnia.

    Anyway, along with the sleep deprivation I have had random bouts of vertigo. By the end of the 2 years during my commuter days I could not even look down (like at my feet when I was going up stairs) without extreme vertigo. Even on a better schedule, as soon as I get off I am so much more likely to get vertigo (just got some now after a tiring 3 days of too little sleep… that’s how I found this article).

    So what I wanted to add was that I see a cognitive behavioral therapist for help in coping with medical symptoms. He told me that all of my symptoms really seem to fall into the category of an imbalance of the (autonomic) nervous system. We started working on exercises for dealing with such a condition and lo and behold, I’m doing much better. Hypersensitivity can easily explain much of what I’ve had to deal with.

  33. Hilary on August 6th, 2013 8:06 pm

    Yes, definitely on to something! I am 9 months postpartum… Will more sleep cure me?

  34. karen on February 15th, 2014 10:13 pm

    I had an episode of extreme vertigo after being sleep deprived . i slept 40 min in a 24hr period then slept well the following night early the next morning the horrible spinning now I definetly think lack of sleep is connected with bpv

  35. Jena on July 11th, 2014 9:50 pm

    I got stressed 2 days in a row (Gynecologist visit and mammogram) and then did not sleep well. I woke up with vertigo at 3:00 AM. I have noticed any time that I need sleep, I begin feeling dizzy. It is the same for my mother. For me, sleep issues and vertigo are definitely connected.

  36. Don on September 30th, 2014 11:00 am

    I had posted a few years back and am here again to say sleep has something to do with it. Had been cured of this with a Hallpike about a year ago after a long bout. Just recently was in China for a week and had really bad sleep and today after about only a few hours of sleep in 48 hrs woke up woozy and had an episode. I think there should be more study in this. Why would a hall pike solve this sensitivity though?

  37. Dave Dalton on October 17th, 2014 2:54 am

    Hi I just read your thoughts on vertigo and believe you May be right. I Work continental shifts and an often deprived of sleep. I started suffering vertigo soon after I was forced to work these patterns but never made the connection. Epley works for me not as well as it once did but surly helps me out. I’m 50 now and suffer mildly every 2 years for a few weeks episodes originally lasted 4 hours with noise sensitivity blurred vision etc . My eyes sometimes move up n down involontary. I’m a white male if it helps? Also notice my ear wax become very soft and my ears itch with it. All who suffer you have my sympathy. Try YouTube search Epley for dizziness watch the video and try it.

  38. Jodi on December 17th, 2014 9:16 am

    This has been my theory too as a sufferer of bpv who has had all the testing done and come back negative for crystals etc. the only common denominator I’ve noticed is the vertigo comes on after sleep deprivation. I have a 3 and 5 year old and sleep deprivation for me is common if someone is up during the night sick etc. I notice the vertigo goes away after a full nights sleep.

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