Can Sleep Problems Cause Benign Positional Vertigo?

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.


Please note: I reserve the right to delete comments that are offensive or off-topic.

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77 thoughts on “Can Sleep Problems Cause Benign Positional Vertigo?

  1. 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. Hi,

    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. 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. 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. 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. 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. Hi,

    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. 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. 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. I started having BPPV back in May. I ended up having to go to the ER to have mine diagnosed. Mine was caused by severe dehydration but also lack of sleep and stress. Mine lasted about a month before going away. Now it has come back. This time I noticed from lack of sleep and stress at work. I just try to keep a record of it and avoid what may cause it to come on and get worse. Work has been stressful so I try to cut out caffeine like I was told to and salt. Harder some days then most but working on it. Hope this helps someone.

  11. Am suffering same way and you seem the only person to point it out. Thanks. It’s hard to type with dizziness.

  12. I have had bpv for 35 years. My episodes are not regular and usually years apart. I am a dentist and vary my head position constantly during the day. I have recently become unable to stay asleep for more than 5 hours sometimes 4. I can usually fall back to sleep after an hour but the sleep is not quality sleep. Just 2 days ago I struggled to get 4 hours and woke to go to the washroom. I had a vertigo bout that lasted intermittently for about 4 hours. It cleared but last night I experienced the same thing. I have to add I struggled with anxiety which I attributed to the vertigo. As I told my ent I felt I overreacted to all movements. Anxiety meds helped . In my case there is no doubt a relationship between sleep and bpv.

  13. With my Vertigo I fall asleep for hours.unable to think or speak.slightly studdering my words.tremors of my hands,headace and the sound of dripping water.some days this last for 2-3 days.unable to stay awake.muscle aches.the positional exercises do not work for me.I am going to ask my PCP for aNeurological exam.I had negative CT and I believe MRI.are there other test.

  14. Completely on point! My daughter wants nothing to do with sleeping at night without being beside me and/or breastfeeding.

    I often have episodes of Vertigo, like every day for a couple weeks sometimes.

  15. I apologize for this long post, but I have so much to write after finding this site. I’m so glad I found this place. I have been chronically sleep deprived for 10 months after I started a new full-time job that required getting up early. Most of my life I have been a night owl. I usually fall asleep within 15-30 minutes, but from late last year until a few months, I’d always wake up about 1-2 hours earlier than I needed to and couldn’t fall back asleep. I know this is often a sign of depression which I had during this period as I was suffering from Chronic Prostatitis / CPPS for 5 months during this time which severely affected my quality of life. That’s now gone, but I’ve still been averaging between 5-6 hours sleep per night. As I get older (I’m now 44), no matter how late I sleep at night, I still wake up at the same time and can’t fall back asleep. So now weekend nights are beginning to resemble weekday nights. 
    A little over a month ago, I started working on some personal projects and for 1.5 weeks stayed up late (1-2am) despite having to be up for work by 6:30am and even later on 2 weekends. About 4 weeks ago, while at work on a late afternoon, I suddenly felt a disorientation feeling that lasted about 10 seconds. It happened again the following afternoon. I thought maybe it had something to do with the 110 F degree (44 C) summer heat where I live. I had just been outside to grab lunch. So I didn’t think much of it. That weekend, I stayed up later than usual. Monday morning at work, the short dizzy feeling I experienced came back, but this time an off-balance / floaty sensation persisted throughout the morning. I still stayed up late working on my project and the next day it returned and persisted longer. On the 3rd day (Wednesday), I went to see my doctor. He prescribed me Temazepam for sleep. After 3 nights of sleeping better, it still hadn’t gone away and I was getting more concerned so called my brother who is also a physician. He told me it sounds like BPPV, so I started doing Brandt Daroff exercises. He didn’t think it had anything to do with lack of sleep or stress. I started feeling better that very day and felt almost normal 2 days later, and quit doing the exercises. It wasn’t until a week later on a Monday morning again that the off-balance / floaty feel came back after being severely sleep deprived the prior weekend. I still had a feeling it must be related to sleep, but wasn’t sure. Some nights I’d try to sleep earlier, but couldn’t. I took Temazepam one night, Benadryl another and melatonin 3rd night. I still only managed about 6 hours sleep these 3 nights last week, but felt even more discombobulated the next day. These off-balance days would leave me with little appetite, depressed, and exhausted. On the 5th day, I was chairing a meeting at work where for 3 hours I was constantly looking down at my laptop and back up at the giant TV my screen was being projected on. I increasingly felt horrible and left work early after the meeting. I went to bed as soon as I got home. The next day (last Saturday) I felt much better. That Saturday night, I stayed up late again and the following day (yesterday) felt off-balance again but less severe than before. That’s when I decided to Google “insomnia bppv” and found this site. Last night, I went to bed early, got about 7 hours sleep, and today feel much better again although still slightly foggy headed. Over the weekend I had someone help me do Epley and Sermont maneuvers. I never got vertigo while doing these and my eyes didn’t flutter. Nor have I ever felt the dizziness more on one side than another. In addition, the room never spins – it’s more of a quick dizzy or disorientation that lasts for seconds after I move my head or come to a stop after walking, but the off-balance floaty sensation is persistent. While having this sensation, I tend to look down at the ground to make sure I’m not going to fall and clench my jaws and neck more from the stress the disorientation causes. I also always felt normal when I’d be lying down in bed whether I rolled around or not. So I wasn’t convinced my case was typical BPPV caused by rocks in the ear canals. I’ll continue doing the Brandt Daroff exercises a few times a day, but now my focus will be on improving my sleep. Thank you Dr. Park!

  16. My vertigo started about 18 mos ago after being sick with the flu and dehydrated. It went away for about 6 months and has progressively gotten more often and sever.
    I realize after reading the comments and thinking about my episodes I can say for sure lack of sleep has a factor in my vertigo.
    I sleep with a cpap and only sleep about 4-6 hours a night. I now will keep better track of hydration and sleep.

  17. This makes a lot of sense. Whenever I a vertigo attack, it’s always after even a night’s loss of sleep. Thank you for sharing. What do you think can be done to help this sensitivity? I have 40% hearing loss as well as amblyopia, so I get over stimulated by light and sound easily.

  18. How many people get bpv and pass all their tests and still do not get any answers to their malady. This article gives hope and further explanations as to associated conditions which are not explored or investigated. I do believe all the above conditions explained above definitely all take a part in vertigo. I do have a general question.
    Can a person take a positional vng/ epley procedure while they are on benzodiapines. Wouldn’t the results be a false negative.

  19. After reading your explanation, I finally know what has caused my positional benign vertigo.
    I’ve had three terrible episodes in the past month, and now I’m still fighting some Imbalance, sudden twinges of dizziness after I move a certain way, etc. I’m doing the Brandt Daroff exercises, because they helped me the last time I had vertigo eight years ago. But I was so sleep deprived before those bad episodes happened and even now, I’m exhausted from all the hours of commuting, working and everything. It began just before I moved from one location to another, all that work of packing, lifting. I was sleeping badly and really only getting three, four or five hours of sleep a night. But five hours a night had been normal for me for years. I know now my sleep deprivation lead to a reoccurrence of BPV. Everything you said made perfect sense. Thank you!
    I am getting it under control, but I may try those other exercises you mentioned.

  20. Dr. Park,

    I don’t think anything is out of line when dealing with sleep deprivation. I recently had a pt suffering from both BPV and loss of hearing in one ear. Doctors have not been able to find any cause at this time. She did however have moderate to severe(supine) sleep related breathing issues. Have you ever heard of a case of apnea induced hearing loss?

    As always your admirer from afar,

    Rock Hinkle RPSGT

  21. Hi

    Can also relate to these symptoms after having my baby. I was 33 years old, under a lot of marital stress, and it was awful. Then came the stress of feeling dizzy for hours whilst having bub in my care, constantly feeling anxious that it would happen again and again. The worst was first thing in the morning, turning from one end of the kitchen to the other whilst fixing breakfast. I think I’ve always had mild bouts of vertigo throughout my life, feeling lightheaded, but nothing like it was after having my baby! Waking every night to breastfeed, and so on…mum life.

  22. Mr. Hinkle,

    There was a study a while back showing higher rates of hearing loss in people with obstructive sleep apnea. Knowing what we know about sleep apnea and brain damage, it’s not surprising if there’s damage to the auditory cortex of the brain, or to the cochlea (since the blood supply to the inner ear is very tenuous).

  23. Yes I agree , if I don’t get gpod sleep over a number of days it triggers my vertigo.i have experienced this on countless occasions.

  24. Is this also maybe a “chicken and egg” situation? Does the dizziness cause the severely interrupted sleep, or lack of sleep trigger BPPV episodes? I know from experience that the two definitely go together, but wondering which causes which? I have had intermittent bouts of BPPV for over twenty years, and finally five years ago found relief through a therapist doing Epley maneuver. I find a cold or sinus inflammation tends to trigger a recurrence, but also have not been sleeping well for some time due to hot flashes, but sometimes I am aware that the dizziness wakes me up. So I’m not sure whether my current bout of dizziness is from the sinus problems I have been having recently, or due to lack of sleep. Physiotherapist suggested sleeping in a reclined position (after he performed another Epley maneuver) for the next month, so that is next on my list of things to try.

  25. As I read though your article I found many similarities to my own situation of recurring vertigo following an initial episode of vertigo that was diagnosed as BPPV and treated with the Eply manouver. I had no infection, no illness and no head trauma prior to the initial even or the subsequent two recurrrances. The common factor for me is acute sleep deprivation. I am a restless sleeper, and often have fewer than 6 hours of sleep due to work.

    My subsequent events were less intense and felt much more like the after effects of the Eply manouver was performed to halt the initial intense vertigo.