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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111 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.

  6. Could sleeping next to a partner that snores so loudly you can hear them from the front lawn of your house block cause this in the Non snoring partner. We sleep in separate rooms now but I can still hear him quite loudly but my bouts of waking with vertigo are greatly reduced, almost non existent now. Nb I also have tinnitus and recently diagnosed fibromyalgia. Would love to hear your thoughts.

  7. Hi Dr Park, thank you for posting this. It hopefully helped me answer my question as to why I’m currently experiencing vertigo.

    The past 5 days/nights I’ve had much less sleep than normal. I woke up and felt like I was severely hung over, yet I didn’t drink much the night before. I had a few sips of a glass of wine my girlfriend was drinking and I’m very capable of drinking a couple to even a few glasses of wine and feeling perfectly fine the next morning.

    I’ve had this feeling all day and I thought it would have gone away earlier in the day but it’s now 5pm and I’m still feeling this way.

    I do have another issue with my right ear where it feels more congested and if I use a Q-Tip or my little finger I can hear squishy noises… almost like crinkling aluminum foil mixed with squishing liquid in a bag. Not sure really how else to describe it. I’ve had this issue since I had a few sinus procedures done to correct a deviated septum and a few other things while he was in there to open up my passageways.

    But I haven’t felt vertigo and it’s been a couple years since the procedure.

    So hopefully I’ll get a good night of sleep and this vertigo feeling will be gone?

    Anyhow thanks for the post and if you were in Los Angeles, I’d book an appt to come see you about my sinus issues, but alas, you are in NY.

  8. YOU MAKE SENSE, SEEM SMART N BEEN THROUGH ALOT, I HAVE MENIERE DISEASE N IN MY RIGHT EAR, FULLNESS, LIGHT RINGING N HISSING OR HUMMING,FULLNESS TO, I’M ON PREDISONE FOR INFLAMMATION SEEMS THAT RIGHT EAR GIVES ME TROUBLE N SOMETIMES MY LEFT A LITTLE, I HAD MENIERE ATTACK 10 OF 2015 N I JUST HAD ONE OVER 2 WEEKS AGO…FULNESS N HISSING OR HUMMING BUT LIGHT FOR OVER THIS TIME, LAST TIME I WOULD G9 TO SLEEP N SUDDENLY I WOULD HEAR LOUD RING N WAKE ME UP, N I GO BACK N IT HAPPENED AGAIN, MAY HAD SOME VERTIGO BUT I WAS ON VALIUMS 2MG IN MORNING OR 1MG N AT NIGHT SO IT HELPED TGE VERTIGO BUT I STILL HAD THOSE RINGING ATTACKS WITH FULLNESS N HUMMING TO, I GOT MY HEARING BACK TO PRETTY GOOD COULD TALK ON PHONE N HEAR WELL Now, I’M BACK AT AGAIN, I CAN HEAR ON TELEPHONE N BUT IS NOT REAL CLEAR BUT I UNDERSTAND, MY LEFT NO PROBLEM..VERY CLEAR BUT THAT EAR NOT AT ALL WITH THE EYSTATION TUBE ISSUE N MENIERE’S AT MOMENT I HOPE, I’M ON HIGH DOSE OF PREDISONE N VALIYM, TO HELP WITH VERTIGO N ANXIETY, BUT I CANT FALL ASLEEP WITHOUT A JERK OR A RACE TO TGE HEART LIKE A VERTIGO ATTACK OR ANXIETY ATTACK, SOMETHING HITTING SOMETHING N I READ WHAT U SAID BOUT HITTING A NETVE, COULD THAT BE? IT’S CRAZY, I HAD ISOMIA LAST COUPLE NIGHTS BUT I DIDNT HAVE NO VALIUM I THOUGHT I WAS REACTING TO THAT BUT NO BUT IT DOES HELP WITH VERTIGO N KEEPS MY ANXIETY B BLOOD PRESSURE DOWN, I NEED A ADVICE U SEEM SMART….I JUST RED TAKING B12 N I’VE ALWAYS TOOK VIT D, BUT WHY CAN’T I SLEEP WITHOUT A HERK. I SLEPT FOR 40 MIN N SOMETHING IN KITCHEN WOKE ME CAUSE WHEN I ROSE MY BOYFRIEND WAS I. THERE N TRIGGER THE SOUND I GUESS TO GET UP OR STARTLED NE I FELT LIKE MY HEART WAS RACING N DIZZY BUT WENT AWAY IN MIN…THAT’S ALL SLEEP 2 DAYS, I DONT KNOW WHAT TO GO TO HOSPITAL, HOW CAN I SLEEP THERE, I WAS TAKEN WATER PILL FOR TWO WEEKS, N THOUGHT PEE,SO MUCH MY EKECTROLUGGTS BE OFF N POTASSIUM I DONT KNOW, I WISH I KNEW,…..I HAVENT TOOK A WATER PULL TODAY….BUT I DRINK PLENTY OF WATER I AK WAYS DO…MENIERE’S IS LOW,SAKT, NO CAFFIENE, CHOCLATE, HUMMING RINGING VWRTIGO, N FULLNESS IN ONE EAR BUT LIKE I SAID I SLEPT 4 NIGHTS,AGO GOOD, N NOT SURE WHY NOW, UNLESS NOT HAVING VALIUM MY BODY WENT TO SHOCK N ANXIETY HIGH, N LOOK FOR A,SLEEP AIDE N I DIDNT HAVE ONE NOW FRST DAY, N I HAVE VAKUUM, I TOOK 2MG 11 N 1MG AT 8 TONIGHT BUT I STILL WAKE UO..I DONT KNOW IF TIME WILL HEKP, GET VS BACK IN SYSTEM OR MY BRAIN SOMETHING, I HAD ME I DONE 2015 N NO TUMOR WAS FOUND….WHAT U THINK DOC…

  9. Mr. Hutchinson,

    Thanks for posting your experiences. It’s hard to say without examining you, but in general, the fact that using a Q-Tip produces those sounds is likely due to wax flakes touching your eardrum. This is unlikely to cause vertigo. It may be two separate conditions. Th only way to differentiate between the two is to see an ENT and also undergo ear testing.

    Please keep us up to date on your progress. Hopefully, you’ll be able to get some better sleep. Good luck!

  10. I have sleep apnea and use a CPAP mask. I also get vertigo in bed, generally while sleeping on my right side. The bed spins are reduced with tumeric and reduced even more by controlling reflux. Controlling the reflux also seems to help reduce my feelings of apnea, especially if I also use xylitol pastels for dry mouth.