Vertigo is a term used to describe a false sense of motion. Often this sense of motion is extreme, as in a sense of spinning or whirling. It can be a debilitating condition.
BPPV, or Benign Paroxysmal Positional Vertigo, is the term used to describe a condition where a person experiences sudden episodes of vertigo that last for several seconds or even up to a minute whenever they move their head in a particular position. Typically, it occurs when tipping their head back, lying down, or rolling over in bed. The sensation goes away, but the person is often left with a lingering, general “yucky” feeling that could last for minutes or hours. It can include symptoms such as nausea, “wooziness,” lightheadedness, and unsteadiness.
Regardless of the type of symptoms people experience, my goal is not to attempt to “fix” or manage their symptoms but rather to assist them in moving toward a greater overall state of balance, wholeness, and harmony. The result of achieving a greater state of balance for the entire being is almost always a significant reduction or complete resolution of their symptoms, including dizziness and vertigo. When people suffer from BPPV and strive toward overall balance, we can also perform a simple maneuver that can provide instant, complete relief of the episodes of vertigo, even though the underlying condition may not have been completely resolved.
BPPV is the result of tiny crystals in the inner ear breaking off the membrane around a gravity sensor and migrating from a sac, called the utricle, into a fluid–filled tube, called a semicircular canal, that holds a motion sensor. The motion sensor is designed to detect the slightest movement of fluid within the semicircular canal, which normally only occurs when the head is in motion. Once the crystals have infiltrated the semicircular canal, movement of the head creates the effect of a snow globe within the semicircular canal.
When a person moves their head into a position that causes the crystals to float through the semicircular canal, the motion sensor within the semicircular canal is disturbed, producing a sense of extreme motion. When the crystals settle, the motion sensor is no longer disturbed. The sense of motion, or vertigo, stops.
The “aftermath” of symptoms like nausea is produced not from the ongoing movement of crystals but the agitation of the vagus nerve during the event. The vagus nerve originates from the brain, goes through the inner ear, and ends in the digestive tract. It is responsible for stimulating digestion, part of the parasympathetic nervous system.
When the “fight or flight” response (sympathetic nervous system) is triggered by the perceived rapid movement from the crystals moving within the semicircular canal, blood and energy are immediately diverted from digestion. This can induce nausea, vomiting, and queasiness. These symptoms may persist for minutes to hours, as the nervous system may require this amount of time to recover from the emergency response fully.
We can immediately, completely resolve these debilitating episodes of vertigo by simply tipping the head in just the right position to allow the crystals to float back into the utricle, where they are eventually metabolized and absorbed. We refer to this treatment as “canalith repositioning.” Each ear contains three semicircular canals. Thus the process of assisting the crystals in floating back into the utricle also requires us to determine in which canal and ear these crystals are currently located.
Multiple effective maneuvers have been developed over the years, each relating to a particular semicircular canal. The most common semicircular canal involved in this condition, used in roughly 90% of cases, is called the posterior canal. The most popular maneuver for moving the crystals out of the posterior canal is called the Epley maneuver, named after Dr. John Epley, credited with developing the maneuver.
This process sounds complicated, but knowing what to look for makes it pretty simple. At least half report that their symptoms completely resolve after just one treatment of the people suffering from this condition. About 4 out of 5 report resolution by the second treatment. At least 9 out of 10 reports complete resolution of their vertigo episodes by the third treatment.
Some people may require a few more treatments, but this is uncommon. The extreme changes from debilitating vertigo to complete relief after such a simple 10-minute treatment will often earn the practitioner the undeserved reputation as a “miracle worker.” The principle is really not much different from dumping rocks out of your shoe to relieve foot pain.
I use this “rocks in the shoe” analogy to explain the nature of this condition because it relates in several ways. Rocks in your shoe produce very predictable symptoms. Getting the rocks out of your shoe immediately eliminates the symptoms, but only those caused by the rocks being in your shoe.
Getting the rocks out of your shoe does not guarantee that you will never get more rocks in your shoe. If you keep walking and playing in rocks, you, in fact, will likely get rocks in your shoe again. In the same way, getting crystals into one of your semicircular canals will produce predictable symptoms of brief episodes of vertigo when you move your head in certain ways.
Getting the crystals out of the canal immediately eliminates these with no other symptoms, including dizziness or vertigo being provoked from another source. If the membrane to which the crystals bind is degenerating, which is typically the case for this condition, most with this condition are in their 60s and up, the chance is reasonable for more crystals to break off again someday and find their way into a semicircular canal. Fortunately, canalith repositioning maneuvers are simple enough to easily teach patients with BPPV how to perform them independently in case the condition recurs.