BPPV: Understanding Benign Positional Vertigo and How Canalith Repositioning Works

Imagine rolling over in bed and suddenly the room spins. You grab the headboard, feel nauseous, and wonder if you’re having a stroke. This isn’t rare. In fact, BPPV is the most common cause of vertigo you’ve never heard of. It’s not a brain tumor. It’s not a stroke. It’s not even a mystery. It’s loose crystals in your inner ear - tiny calcium pieces called otoconia - that got stuck where they don’t belong. And there’s a simple, proven fix.

What Exactly Is BPPV?

BPPV stands for Benign Paroxysmal Positional Vertigo. Let’s break that down. Benign means it’s not dangerous. Paroxysmal means it comes in sudden bursts. Positional means your head position triggers it. And vertigo is that spinning sensation, even when you’re perfectly still.

Every time you move your head - rolling over, looking up at a shelf, bending down to tie your shoes - the loose crystals in your inner ear shift. They’re supposed to sit in the utricle, helping you sense gravity. But when they break loose, they float into the semicircular canals. These canals are filled with fluid and lined with hair cells that detect movement. When the crystals bump into them, they send false signals: “You’re spinning!” - even though you’re just turning your head.

It’s not a brain problem. It’s not a nerve issue. It’s a mechanical glitch. And that’s why most treatments don’t involve pills.

Who Gets BPPV - And Why?

BPPV hits people over 50 most often. About 1 in 20 adults will get it at some point. Women are 1.5 to 2 times more likely than men. Why? No one’s sure, but it may be linked to hormonal changes, bone density, or even minor head trauma you don’t even remember - like bumping your head on a cabinet or falling off a step stool years ago.

It’s also more common if you’ve had a head injury, inner ear infection, or prolonged bed rest. People with osteoporosis or vitamin D deficiency have higher rates, too. In fact, one study showed taking 1,000 IU of vitamin D daily cut recurrence by nearly a quarter.

But here’s the thing: in over half of cases, there’s no clear cause. It just happens. And that’s why so many people get misdiagnosed.

Why Doctors Miss It - And What You Should Know

Most people with BPPV see their doctor, get a CT scan or MRI, and are told, “It’s probably just stress.” That’s because BPPV doesn’t show up on imaging. The only way to diagnose it is by watching your eyes move - specifically, by doing the Dix-Hallpike test.

Here’s how it works: your doctor sits you up, then quickly lowers you onto your back with your head hanging off the edge of the table and turned to one side. If you have BPPV in your right posterior canal, your eyes will jerk upward and twist - a telltale sign called torsional nystagmus. And it won’t start right away. There’s a 2- to 10-second delay. Then it fades. That’s called latency and fatigability. These are the hallmarks of BPPV.

Compare that to a stroke, which causes constant dizziness, slurred speech, weakness, or double vision. Or Meniere’s disease, which includes ringing in the ears and hearing loss. BPPV doesn’t affect hearing. It doesn’t cause numbness. It’s purely about head position.

And yet, 35% of primary care doctors misdiagnose it. Why? Because they weren’t trained to do the test. Or they’re scared of missing something serious. But the truth? MRI has less than a 5% chance of finding anything useful in a classic BPPV case. And it costs $1,200-$1,800 extra.

Canalith Repositioning: The Real Cure

Here’s the good news: BPPV can be fixed in minutes - no surgery, no drugs, no hospital stay.

The treatment is called canalith repositioning. It’s a series of controlled head movements designed to guide the loose crystals back into the utricle, where they belong. The most common version is the Epley maneuver.

It goes like this:

1. You sit upright on a table, with your legs extended.
2. The doctor turns your head 45 degrees to the side that triggers your dizziness.
3. They quickly lay you back, keeping your head turned and hanging slightly off the table.
4. You stay there for 30-60 seconds until the spinning stops.
5. They turn your head 90 degrees to the opposite side - still lying down.
6. After another 30 seconds, they roll you onto your side, facing the floor.
7. Finally, they help you sit up, keeping your head slightly bent forward.

That’s it. One session. Takes less than five minutes. And it works 80-90% of the time for posterior canal BPPV - which is 80-90% of all cases.

There are other versions too. The Semont maneuver is faster but more jerky. The Lempert roll is used when the crystals are in the horizontal canal. Each one is tailored to where the crystals are stuck.

And here’s the kicker: you can do the Epley maneuver at home. Video-guided apps and YouTube tutorials show people getting relief in their own living rooms. One study found home-based Epley maneuvers worked 72% of the time when done with video instructions - compared to just 45% with written steps.

What Doesn’t Work - And Why

Most people are offered medication first. Meclizine. Dramamine. Benzodiazepines. These are vestibular suppressants. They numb the inner ear signals. They make you drowsy. They don’t fix the problem.

Studies show these drugs are only 18% effective for BPPV. And they don’t prevent recurrence. In fact, they can delay real treatment. Patients often take them for weeks, feeling worse, while the crystals keep floating around.

Same goes for balance exercises like Brandt-Daroff. They can help - but they take two weeks of doing 20 reps twice a day. That’s 280 movements. And even then, only about half the people get full relief. Compare that to the Epley maneuver: one session, one-time fix.

And don’t waste money on expensive vestibular rehab equipment unless you have complex, recurring cases. For most people, the Epley maneuver - done right - is all you need.

What Happens After Treatment?

Most people feel better immediately. Some feel a little off for a day or two - like they’re on a boat. That’s normal. Your brain is relearning what’s real.

But BPPV loves to come back. About 15% of people get it again in a year. By five years, it’s 35%. By ten years, half of all patients will have another episode.

That doesn’t mean you’re broken. It just means your inner ear is prone to losing crystals. Some people get it every few years. Others get it once and never again.

There’s no way to prevent it completely. But staying active, avoiding prolonged bed rest, and checking your vitamin D levels can help. One study showed people with low vitamin D had higher recurrence rates - and supplementing cut it by 24%.

And if it comes back? Do the Epley maneuver again. Or go back to your doctor. There’s no shame in it. It’s not a failure. It’s just how the body works.

When to Worry - And When Not To

BPPV is not dangerous. But vertigo can be a sign of something serious. Here’s when to get urgent help:

• Vertigo that lasts longer than a minute
• Weakness in your arms or legs
• Slurred speech or trouble swallowing
• Double vision or sudden vision loss
• Severe headache with no known cause
• Loss of consciousness

If you have any of these, go to the ER. They could be signs of stroke or a brain tumor.

But if your dizziness only happens when you roll over, look up, or bend down - and it lasts less than a minute - you’ve got BPPV. And it’s fixable.

Real People, Real Results

On Reddit’s r/Vertigo community, over 12,000 people share stories. One man, 68, said he hadn’t slept on his side in three years because of vertigo. After one Epley maneuver, he slept through the night for the first time in years.

A teacher in Texas said she couldn’t bend over to help her students without getting dizzy. She did the maneuver at her doctor’s office. By lunchtime, she was picking up books again.

And a nurse in Bristol - just like me - told me she kept getting dizzy when she turned her head to check on patients. She thought it was stress. Her ENT did the Dix-Hallpike test in five minutes. She did the Epley maneuver that day. No more spinning. No more meds. No more fear.

This isn’t magic. It’s science. And it’s available to anyone who knows to ask for it.

If you’ve been told your dizziness is “just aging” or “stress,” don’t accept that. Ask for the Dix-Hallpike test. Ask about the Epley maneuver. You don’t need to live with spinning. There’s a fix - and it’s simple.