My world is spinning, and not just because Michael Phelps has won another four gold medals and two silvers to become the official lord of the Olympic rings. I have a condition called benign paroxysmal positional vertigo (BPPV) that makes me intensely dizzy from time to time. A report I read in a recent issue of the journal Neurology looked at how people are using Internet videos to self-treat the condition at home using a maneuver called the Epley maneuver. Cool, I thought. So I watched one of the videos and tried the maneuver. It didn’t work for me. I did some investigating to find out why, and have some tips to improve your odds of success.
Blame it on crystals
BPPV happens when tiny crystals of calcium carbonate in one part of your inner ear become dislodged and float into another part. That doesn’t sound too serious, but small head movements cause the loose crystals to move, triggering your inner-ear sensors to send mixed messages to your brain. Simply looking up or rolling over in bed causes brief bouts of extreme dizziness. Some people experience nausea as well.
What causes the crystals to dislodge in the first place? “We don’t really know,” says Dr. Felipe Santos, an ear, nose, and throat specialist at Massachusetts Eye and Ear Infirmary and an instructor in otology and laryngology at Harvard Medical School. “There seems to be an association in a percentage of patients with head trauma, but for the most part, we don’t know.”
Greg Gallagher doesn’t know what triggered his BPPV, either. But the 50-year-old software engineer recalls that the experience was very unnerving. “I woke up and when I lifted my head, it felt like the room was spinning,” he says. “It would rotate, then snap back and rotate again. The sensation produced the most intense nausea that I’ve ever experienced.”
Once BPPV has been diagnosed (abnormal eye movements are a giveaway), a clinician will lead you through an exercise to move the crystals into another ear chamber where they’ll be absorbed by the body. Think of the exercise as one of those water-filled puzzles that you shake in order to move small beads from one place to another. Research has shown that the most successful of these moves is called the Epley maneuver.
It’s a fairly simple exercise: You sit at the end of an exam table with your head turned 45 degrees toward the affected side. The clinician will then tilt you back quickly so you’re lying on your back with your head hanging off the table, still turned to the affected side. Your head is held in this position for 20 to 30 seconds, then rotated 90 degrees to the unaffected side and held for another 20 to 30 seconds. Then, looking in the same direction, you’ll quickly roll onto your side while the clinician rapidly rotates your head another 90 degrees, until you’re lying nearly facedown. You’ll stay like that for another 20 to 30 seconds before the clinician rapidly brings you back up to a sitting position.
When I was first diagnosed with BPPV a few years ago, my doctor guided me through the Epley maneuver. I had to wear a neck brace afterward, and I was better in two days.
The maneuver is easy enough to do at home—as long as you know how. Researchers in the Neurology study determined that many people who recognize the onset of BPPV turn to Internet videos for instructions. They found 33 different videos online showing how to do the Epley maneuver. The most popular, produced by the American Academy of Neurology, now has more than 1.1 million hits.
I checked out this video when my world began spinning again a few weeks ago, and decided to try the maneuver at home instead of visiting my doctor. Look to the left, lean back, look to the right—pretty simple stuff. My daughter and I watched the video a few times, then she called out the instructions as I went through the motions. I even started feeling better in the next few days. But my BPPV symptoms didn’t disappear completely.
Why didn’t the home maneuver work for me? It turns out that I neglected two important steps.
First: Identify which ear is causing the vertigo. If you get dizzy every time you roll left in bed, then your left ear is the likely culprit. Once you know which ear has some loose calcium crystals, it’s important that you look to that side when you begin the Epley maneuver.
Second: Try to stabilize your neck after the Epley maneuver. “Typically we advise patients to avoid positions that invoke the vertigo,” says Dr. Santos. “You don’t have to wear a neck brace, but we ask patients to avoid extreme flexion of the neck that would induce vertigo for 48 hours. Eventually, the goal is to get patients to return to normal activity and not restrict their head movements.”
Some people don’t even need the maneuver. Greg Gallagher’s doctor prescribed an anti-vertigo medication that suppresses symptoms. “I definitely felt better and the nausea went away quickly,” he says. His BPPV cleared up on its own a few days later.
And BPPV does go away eventually, but it may take weeks or months. So if you don’t want to suffer through intense room spinning, you might want consider looking at a video and trying the Epley maneuver yourself.
If it doesn’t help, it’s possible that you didn’t do it right, or that the crystals are in a part of your ear canal that requires another simple maneuver (called the Log Roll). But Dr. Santos says it’s best to leave it to the experts. “The advantage of seeing someone is that you can confirm you’re treating the correct side and the correct canal. We can pinpoint where the calcium crystals are and how to move them along,” says Dr. Santos.
The only moving I’ll be doing in the next day is another Epley maneuver and some stiff-necked Olympics watching.