You may feel dizzy, or just lightheaded and unsteady

You’re rolling over to your right in bed, when suddenly the room starts rolling over, too. For a couple of days, the world spins each time you turn to the right — until the sensation fades away on its own.

The condition, called benign paraoxysmal positional vertigo (BPPV), is downright scary because it takes you by surprise. And the dizziness, lightheadedness and nausea left in its wake will keep you from working and doing normal activities.

“Episodes of BPPV can last for a few seconds, a few days, a few weeks or a few months,” explains neurologist Neil Cherian, MD, a dizziness expert. “Because BPPV is so common and so fleeting, it’s hard to get good data on its incidence.”

What are ear crystals, anyway?

At the root of the problem are tiny calcium crystals that sense gravity, found within the chambers of the inner ear.

“Imagine a hill with blades of grass, and on top of each blade is a crystal,” explains Dr. Cherian. “Together, these crystals form an interconnected matrix. Whenever the blades of grass move, so do the crystals.”

The blades of glass represent cilia, hair-like processes that are attached to tiny nerves in your inner ear. When the crystals move, it stimulates the nerves to fire, which tells the brain your head is moving.

This crystal matrix serves as a reliable motion-sensing map — until crystals break free, drifting into one of the ear’s three semicircular “balance” canals, and create havoc.

Why do loose crystals make you dizzy?

Normally, the fluid in the semicircular canals and the small, direction-sensing cupula in your inner ear move only when your head moves.

“When the crystals are all connected, the fluid in the canals settles down as soon as your head stops moving,” says Dr. Cherian. “But when the crystals are disconnected, they keep moving in the fluid for up to a few seconds afterward.

“Then your brain has to figure out, ‘Why is there movement when I don’t see it?’ And that is what makes you dizzy.” The fact that your eyes continue to move in response to this false cue gives doctors another way to confirm that you have BPPV.

Three factors make it more likely that ear crystals may loosen:

• Age over 65 years.
• Head injury.
• Viral inner ear infections.

You don’t need expensive tests to get a diagnosis of BPPV. Your doctor can diagnose it based on your pattern of symptoms and a medical evaluation.

How do you fix loose crystals?

A doctor or vestibular physical therapist (PT) can show you how to do self-repositioning exercises at home. Collectively called the Epley maneuver, they move the ear crystals back into place, and are easy to do on a bed or on the floor.

“When done in a medical setting, the success rate for these exercises is up to 90 percent,” says Dr. Cherian. “So doing them properly on your own can be quite effective for BPPV.” He adds that, once your BPPV clears, the exercises should stop.

If the Epley maneuver isn’t helping you, it may be because:

• You have too many loose crystals.
• Crystals have drifted into more than one semicircular canal.
• Both of your ears are affected.
• You’ve got technical issues (e.g., the wrong ear or wrong method of treatment).
• Your dizziness has a different cause.

In these cases, seek help from an ear, nose and throat (ENT) specialist — or go straight to a vestibular PT, who can diagnose and treat BPPV. They can put you through additional exercises to move the crystals back into place.

Do ear crystals always cause vertigo?

Having loose crystals in your ear doesn’t necessarily make the room spin.

“Many patients with BPPV don’t even feel dizzy — just lightheaded, unsteady or a bit ‘off’ — but when we test for crystals in the office, there they are,” says Dr. Cherian.

He notes that it’s possible to have leftover crystals without knowing it if you consistently avoid turning your head in the direction that triggered your symptoms. But the goal of the exercises is to get you back to fully normal function.

Is there a cure for BPPV?

Dr. Cherian tells patients that BPPV is like the common cold. “We can identify it, and we can get you out of it sooner, but we can’t prevent it,” he says.

The outlook for BPPV is hard to predict from one person to the next.

If symptoms are related to head trauma, and diminish as you heal, you may have fewer problems over time, he notes. If not, mastering the Epley maneuver will allow you to quickly stop the spinning sensations and lightheadedness when crystals get loose.

However, if you get so nauseous that you can’t hold down liquids, or if weakness, numbness, tingling or changes in vision occur, “seek help sooner rather than later,” stresses Dr. Cherian. “These could signal a more serious problem, such as stroke.”