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.
22 Responses to “Can Sleep Problems Cause Benign Positional Vertigo?”
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It sounds like a interesting theory, could there be a connection to meniere’s disease as well?
David
You are absolutely correct … I have hyperacusis from that exactly !!!!
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.
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.
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.
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.
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.
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 ..
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.
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.
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!!
please ignore the bad spelling
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.
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.
Yes, I do believe there is a real connection between sleep deprivation (as in CFS for example) and attacks of Benign Positional Vertigo
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.
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.
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)
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!
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
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!!
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?