What causes dizziness when lying down?

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By Jennifer Huizen 

Reviewed by Debra Sullivan, PhD, MSN, RN, CNE,

Causes | Symptoms | When to see a
doctor | Diagnosis | Treatment | Outlook and takeaway

A common cause of dizziness
when lying down is benign paroxysmal positional vertigo, a condition where tiny
crystals that help sense gravity in one part of the ear mistakenly move into
parts of the inner ear that detect head motion.

People with benign paroxysmal
positional vertigo (BPPV) experience benign, or not life-threatening,
paroxysmal, or sudden and short, periods of vertigo. Vertigo is a type of
dizziness where the room feels like it is spinning.
The symptoms of BPPV are
usually brought on by changes in head position or movement.

In many cases, BPPV seems to
develop randomly. However, a few conditions may cause or influence BPPV,

  • head injury
  • inner ear infections or
  • laying down for a long time
  • osteoporosis
  • diabetes
  • intubation
  • reduced blood flow
  • blockage of the anterior
    vestibular artery
  • ear surgery
  • migraines
BPPV usually occurs when
calcium carbonate crystals, or otoconia, that sit in a gravity-sensing part of
the ear called the utricle become dislodged. They then move to the
fluid-filled, motion-sensing semicircular canals.
If enough otoconia accumulate
in any of the canals, it can disrupt the fluid movement the canals use to
detect head motion.
The semicircular canals do not
usually react to gravity. However, otoconia move along with gravity. As a
result, when clumps of otoconia build up in the semicircular canals, they can
make the motion-sensing fluid move when it should not. This sends an incorrect
message to the brain that the head is moving.
When the brain compares this
false message from the inner ear with information from the other senses and
organs, it cannot make them match, so it recognizes it as a spinning sensation.
This miscue causes nystagmus,
a condition where the eyes move uncontrollably back and forth or up and down,
making it seem like someone’s surroundings are spinning.

People with BPPV experience
vertigo, a sudden sensation that everything around them is spinning when it is
not. People experiencing vertigo because of inner ear problems, typically, also
have nystagmus, or uncontrollable eye movement.
People with BPPV may
experience the specific sensation of vertigo in various ways. They may also
experience it differently, depending on the movement that triggers the
The spinning or whirling
sensation of vertigo can be rotary, a feeling similar to having just gotten off
a merry-go-round. Vertigo can also make it feel as though the ground is tilting
up and down, a sensation similar to being on a boat.
A further description of
vertigo is that it can make people who are trying to get out of bed feel like
they are falling back into bed, and people getting into bed feel like they are
falling through the bed.
In most cases, BPPV prompts
vertigo only after certain types of movement or actions that cause the head to
change position in relation to gravity, such as:

  • lying down
  • getting up after lying down,
    especially for a long time
  • rolling over in bed
  • making quick head movements
  • looking up
  • getting in and out of bed
  • bending over
Most people who wake up with
vertigo tend to have BPPV. The type of vertigo BPPV usually causes will last
for 1 minute or less. Some people with BPPV are symptom-free between spells of
dizziness, but others continue to feel a lack of balance all or most of the
Vertigo is the primary symptom
that BPPV causes. However, the uneasy feeling of vertigo can cause other
symptoms such as:

  • feeling off balance
  • dizziness
  • nausea and vomiting
  • difficulty walking or moving
When to see a doctor

Typically, BPPV is not a
serious condition. The greatest risk is injury from falling or being off
However, people should talk
with a doctor about recurring periods of vertigo after changing head positions.
People should also talk with a doctor about periods of vertigo that last more
than 1 to 2 minutes.
People with vertigo should
seek emergency medical care if they experience additional symptoms that do not
have links to BPPV, such as:

  • constant dizziness or vertigo
  • fainting
  • hearing loss or changes
  • severe headache
  • fever
  • loss of vision or double
  • numbness or tingling
  • arm or leg weakness
  • pins and needles
  • trouble speaking
  • trouble coordinating movements
  • chest pains

A doctor may start diagnosis
by ruling out all possible cardiovascular, head, neurological, and neck
They may then refer people to
a specialized health professional, such as an ear, nose, and throat doctor or
vestibular rehabilitation therapist.
The specialist will get a
person to move their head in certain ways to see what movements cause symptoms.
While someone is experiencing
vertigo, the specialist will carefully watch their nystagmus for specific
patterns that allow for confirmation of BPPV. This also helps to determine
which ear and which canal the displaced otoconia are occurring.
By some estimates, between 60%
and 90% of all cases of BPPV involve the posterior semicircular canal.
To properly treat BPPV, a
specialist will also need to determine which type of BPPV someone has. This may
be canalithiasis or cupulolithiasis.
Canalithiasis is the most
common form of BPPV and involves otoconia that move freely in the ear canal
Cupulolithiasis is much rarer
than canalithiasis and involves otoconia that are stuck on the bundle of nerves
that sense the fluid movement in the canal.

Symptoms of BPPV tend to
lessen over time as the brain adjusts to the misinformation coming from the
inner ear. In some cases, BPPV resolves randomly after a few days or weeks.
Canalith repositioning

Once the specialist knows
where the dislodged otoconia are, and whether someone has canalithiasis or
cupulolithiasis, they may treat BPPV using canalith repositioning maneuvers, or
CRM is a specific series of
head movements that allow gravity to guide the otoconia to a place in the inner
ear that can reabsorb them.
There are different methods of
CRM, and which one someone receives depends on their specific diagnosis.
Epley maneuver

The Epley maneuverer is the
method used to treat canalithiasis. To perform the Epley maneuver a doctor or
specialist will:

  1. Ask someone to sit on the exam
    table with their eyes open and then turn their head 45 degrees to the right.
  2. While supporting the back of
    the head, they will then ask someone to quickly lie down on their back, coming
    to a resting position with the head hanging 20 degrees off the end of the exam
  3. Turn the person’s head 90
    degrees to the left.
  4. Wait 30 seconds.
  5. Turn the head an additional 90
    degrees to the left while asking the person to also rotate their body 90
    degrees to the left.
  6. Wait 30 seconds.
  7. Ask the person to get up or
    sit up on the left side of the table.
If someone with BPPV does not
experience relief from symptoms after the Epley maneuver, a doctor or
specialist will usually keep repeating it until they do.
Liberatory maneuver

Cupulolithiasis may improve
using the liberatory maneuver. This technique involves rapidly moving the head
in the plane of the affected ear canal to try and shake free the displaced
Once the otoconia are free,
the maneuver guides them out of the canal and back to their proper chamber
using another method of CRM.
How effective are treatments?

It can take several sessions
to resolve BPPV completely using CRM methods, but most people do fully recover.
By some estimates, upwards of 90 percent of all BPPV cases resolve after
between one and three CRM treatments.
But cases involving
cupulolithiasis can take longer to treat successfully. Similarly, if someone
has otoconia in more than one semicircular canal, a doctor or therapist will
have to correct each individually, making the recovery process longer.
Even after the vertigo itself
has gone, many people recovering from BPPV still feel sensitivity to motion and
unsteadiness. A doctor or therapist will usually explain at-home exercises that
can help reduce these residual feelings fairly quickly.
Outlook and takeaway

Cases of BPPV can resolve
randomly, and a specialist may also perform CRM methods on someone with BPPV
that causes dizziness while they are lying down.
However, as many as 50% of
people experience a return of symptoms within 5 years. The earlier and more
thorough BPPV treatment is the more successful the outlook is in the long-term.
If someone has the same type
of BPPV in the same canal repeatedly, a doctor or therapist may teach the
person how to do the CRM at home.

Kayode Ojo
Kayode Emmanuel Ojo is the Co-Founder and Managing Director at SHEFFA Limited. He is presently studying Computer Science at the National Open University, Victoria Island, Lagos.