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.


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

  1. Kelly on March 15th, 2016 9:54 am

    Came across this when googling my symptoms of head spinning dizzy spells… which I experience from time to time, especially when I am sleep deprived…
    This first started to happen shortly after having my 2nd child, breast feeding, and juggling a busy freelancing lifestyle… total lack of sleep.
    The episodes became less when I was sleeping better. I noticed that they returned when I was in the middle of a two year part time PGCE course and was trying to fit that around my ‘same’ buy lifestyle. Again, they became less frequent when the course ended.
    Recently, they have returned again due to us opening a shop and that becoming our ‘baby’ in that it keeps us awake and we never switch off from it.
    The episodes happen without any warning and last seconds, there is no sudden movement from me at the time, although the symptoms are that of feeling that my head has dropped (usually towards the left) and span to cause my brain to feel like it has span within my skull. It is a truly awful experience and one I wish I didn’t have to deal with. Recently I have felt unbalanced when walking / moving after a dizzy spell… like I’m on a boat crossing a bad sea :(
    I did go for tests years ago when this first started and the doctors didn’t find much… as this is something I cannot trigger or prompt. I have just had one today and know it is purely down to lack of sleep… which is unfortunately something sometimes I can’t do a lot about, as I live such a busy life with many different jobs involved in my every day that I do sacrifice sleep to get things done.
    I am sure I am not the only one who does this.
    Thank you for your article and for describing my symptoms down to a tea.

  2. jacqui staniforth on March 21st, 2016 6:32 am


    I had a very bad attack of vertigo around 3 years ago and when it went I thought that would be it. Unfortunately not the case :( at least once a year I will have a bout which makes me dizzy and is also accompanied with chronic fatigue. I too have noticed this happens when I have sleep deprivation. We recently purchased a puppy which kept me awake for most of the weekend, needless to say I now have vertigo with chronic fatigue. When mentioning this to the doctor he just looked at me vacant like I was insane or something but I know for a fact that lack of sleep triggers it as its the only time my verigo plays up.

  3. Michelle Moore on March 24th, 2016 2:06 pm

    I have suffered from sleep issues and vertigo for years and years. They most definitely go together. When I’m sleep deprived, I have vertigo almost every time.

  4. engel mireille on March 26th, 2016 8:45 am

    I. Have sleeping problems too, waking up every 2 hours, I am over 50 very activ running at least 4 times a week, also in the age where woman’s body go through a lot, last time I had this spinning as turning my head was 2 years ago, but most of time is when I am deprived of sleep

  5. Maddie on April 28th, 2016 2:48 pm

    I recently started to suffer a reoccurrence of vertigo. I came to two conclusions, an increase in stress at work and the big one, not getting enough sleep. This confirmed for me that sleep is, and was in the past, a huge part of the problem. I will take additional steps to ensure more sleep and report back.
    I thank you for your post to help me find the answer to my vertigo, it’s life altering and I can’t go through months of this again.

    Thank you so much!

  6. Sanya on May 3rd, 2016 12:08 am

    I’ve experienced something very similar. Please tell me what do you do to get back to a normal life? Does sleeping for longer hours helps in eliminating the dizziness? What are the steps to be taken?

  7. jacqui staniforth on May 4th, 2016 5:09 am


    I’m sorry to hear that you have this awful infliction I wouldn’t wish it on my worst enemy. In my personal experience a good 8 hours usually helps I know this is not always possible but if you can it does help. Try to eliminate as much stress from your life as possible as this too triggers it for me. I have had the epley with no improvement so I am now looking into alternative therapies ie: acupuncture as I have heard many good reviews about chinese therapies. I also eradicated anything with aspartame in from my diet although I’m not so sure that it’s a cause I don’t believe it to be any good for you. I hope that this helps and that you may find your own cure for this curse. Good luck, take care.

  8. Judith Benjamin on May 22nd, 2016 11:58 am

    I have been tracking symptoms and I have just made the connection between sleep deprivation and my vertigo episodes. I am an insomniac and after 3 pretty much sleepless nights in a row this week, vertigo occurred. I slept for many hours after the attacks and woke up symptom- free. I am almost sure there is a connection. Another thing I have a hunch about is dehydration. When I start feeling vulnerable to BPV (imbalance, a weird feeling of things not being quite right that is hard to explain) I start drinking more water. I wonder if anyone else associates dehydration with vertigo? This latest link between BPV and lack of sleep is an incentive for me to use a sleeping pill after one night of insomnia if I am again having trouble falling asleep.

  9. pamela on May 26th, 2016 2:42 pm

    Could it be “vestibular migraine”? I’ve had bouts of horrible vertigo of unknown causation” ( the possibility of Menieres disease eliinated etc) over the past decade. I used to have classic migraines as an adolescent and eventually worked out that orange juice was the main trigger for me. When I investigated “vestibular migraine” I realised that the episodes of vertigo were correlated with my consumption of other common migraine triggers, such as chocolate, red wine, blue cheese, or lack of sleep. If I (accidentally) consume all of these on one day and/or experience sleep deprivation…whammo! …a day or more of horrible vertigo.

  10. Steven Park on May 26th, 2016 10:11 pm



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