Vertigo and the Epley Manoeuvre
Vertigo
Dizziness can sometimes be caused by loose crystals (‘otoconia’) in the inner ear, a condition known as Benign Paroxysmal Positional Vertigo (BPPV).
These crystals play a vital role in the body's balance system, but when they detach from the tectorial membrane, they disrupt the normal flow of information to the brain. This disruption can result in balance issues and vertigo.
What is BPPV?
BPPV is the most common cause of vertigo and the most frequently diagnosed disorder of the vestibular system (inner ear). Vertigo itself can be a debilitating condition, significantly impacting daily activities and sometimes leading to nausea and discomfort. Although BPPV typically affects individuals over the age of 60, younger people can also experience it. Personally, I began suffering from BPPV in my early 50s.
Signs and Symptoms
The signs and symptoms of BPPV may include:
Dizziness
A sensation of spinning or movement (vertigo)
Light-headedness
Unsteadiness or loss of balance
Blurred vision
Nausea and/or vomiting – this was particularly severe in my case.
Nystagmus (abnormal rhythmic eye movements) – this is almost always present during a BPPV episode and is a key indicator of the condition.
How Does BPPV Manifest?
BPPV episodes can come and go. While nystagmus typically lasts for a few minutes at a time, symptoms like loss of balance and nausea may persist for hours or even days. Episodes often recur over weeks or months, with some periods of relief in between.
Certain activities tend to trigger BPPV, particularly movements that involve changes in head position. Examples include tilting your head up or down, lying down, turning over in bed, or sitting up. Personally, my episodes often occurred at night or on waking, particularly during periods of stress.
My Own Experience with BPPV
My first encounter with BPPV happened early one morning. The symptoms woke me up, leaving me terrified—I initially thought I was having a stroke. When I got out of bed, the spinning sensation slowed and eventually subsided. However, the moment I lay down again, the vertigo returned. The flickering eye movements (nystagmus) were especially alarming.
Fortunately, a friend who had experienced BPPV herself recognised my symptoms and reassured me. The "benign" in its name was a relief—it was nothing life-threatening, but it was certainly unsettling.
Treating BPPV: The Epley Manoeuvre (EM)
The good news is that BPPV is one of the easiest forms of vertigo to treat. The Epley Manoeuvre (EM), a simple physical therapy technique, can effectively alleviate symptoms. Here is an explanation and instructions of EM.
The goal of the manoeuvre is to reposition the displaced otoconia (small calcium carbonate crystals) back into the labyrinth of the inner ear, where they can either dissolve or no longer cause disruption. After undergoing the manoeuvre, it is advisable to avoid rapid head movements, particularly up or down, for at least a week to prevent recurrence.
How to Proceed
Before attempting the Epley Manoeuvre yourself, it is essential to see your doctor. This step is crucial to confirm the diagnosis and determine which ear is affected. If BPPV is diagnosed, a doctor or a trained physiotherapist can perform the manoeuvre safely or guide you on how to do it at home.
Important tips:
Keep a bucket handy, as the manoeuvre can provoke nausea and sometimes, vomiting.
Arrange for someone to accompany you to and from the physiotherapist or doctor's appointment, as you may feel unsteady or queasy afterward.
How Common is BPPV?
Studies show that BPPV affects approximately 2.4% of the population at some point in their lives, making it the leading cause of vertigo globally. It’s particularly prevalent among older adults, but younger people, particularly those with head trauma or prolonged stress, may also develop it.
Preventive Measures
While BPPV cannot always be prevented, managing stress levels and avoiding rapid head movements can reduce the risk of recurrence. Some suggest maintaining good overall vestibular health through balance exercises or yoga, which may indirectly minimise the frequency of episodes.
Alternatives to the Epley Manoeuvre
If the Epley Manoeuvre is not effective or feasible, other repositioning techniques, such as the Semont or Foster manoeuvres, may be recommended. These approaches work similarly by realigning the otoconia in the inner ear. Always consult a healthcare provider for guidance on the best approach.
Raising Awareness about BPPV
Over the years, I’ve taken every opportunity to raise awareness about BPPV and the Epley Manoeuvre. It’s surprising how many people, including healthcare professionals like physiotherapists and osteopaths, are unaware of this condition and its straightforward treatment. By sharing my own experience of BPPV and what I have learned, I have been able to help many people understand and address BPPV, empowering them to support their loved ones who may be struggling with this challenging condition.
If you or someone you know experiences vertigo, don’t hesitate to share this information. It could bring much-needed relief and eliminate unnecessary medication or referrals for unrelated treatments.