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

  1. I am so glad I found this site & the comments. I have suffered from Vertigo since 2007. I used to have dizzy spells so bad I could not go to work. It has eased up over the years. Now, I’m not as dizzy, but my head feels like a vice is attached and my head & eyes feel like they are floating. This only lasts seconds, then gone. It’s almost everyday, primarily in the morning. About 4 times a week it comes on when I am driving, whenever I am changing lanes or hit a bump in the road or I turn my head a certain way. By the time I get to work, my body is exhausted and all I want to do is sleep. I suffer from sleep apnea & was wondering if this is all caused from stress & lack of sleep

  2. That’s a wonderful idea. Even if its not the cause of BPPV per se, it may be the cause of many other types of vertigo (or add to the variance in how people are affected by bppv). The whole heightened autonomic nervous system/ lower sensory thresholds is just about impossible to get help with – youre lucky if yours had an obvious cause and then presumably goes away when the cause goes away. Not everyone so lucky…

  3. Just found this site. I am a retired distance runner who in retirement gets bored between workouts and in order not to go out and blow money, I take a lot of short little naps…
    I just like laying in a cool bed 15 minutes at a time, 5 or 6 times a day on the days I don’t go out.
    I started suffering vertigo and dizziness and went to a prompt care and they gave me the standard stuff for treatment of an ear infection….Amoxicillin, mecliozine (?) and a steroid..
    Its been 3 days now and I still have the vertigo…and I was wondering whether it was from the many short little naps that on many days I take.
    The brain not being able to figure out what Im doing?
    So, after a hard workout, I don’t take the naps anymore.
    Hope this goes away..its a terrible feeling.

  4. Seems like a logical explanation. I have vertigo,and it comes between my menstration cycles. One male gyno said not related, again what would he know. However, a woman did diagnose this, also an ENT said that i could have migraines that cause this duebto menstration. I was unaware that migraines are not headaches. Headaches are a symptom. Do you have any explanation of this?

  5. I get this mild vertigo several times a year. I have found that each time, I have had an average of 5 to 5.5 hours of sleep maximum for a week or more, and often dehydrated as well. So I went online to see if that could be a cause, as it’s a common link. I think it is. I also have a very stuffy nose lately which could also contribute to the problem.