Sleeping with BPPV: lying down, getting up and nights

Sleeping with BPPV mostly comes down to slow, planned moves. Lie down and roll over slowly, keep a lamp you can reach from bed, and sit on the edge of the bed for a while before you stand up. Cleveland Clinic suggests sleeping with your head raised on two pillows, which helps some people. After an Epley maneuver, the 2017 US guideline says you don't need special sleeping positions, so sleep however lets you rest unless your clinician told you otherwise. The rest of this page is about getting through the night, including the bathroom trip, without a fall.

Why BPPV is worse in bed

BPPV is set off by changing the position of your head. Cleveland Clinic explains that loose crystals drift out of a small pouch in the inner ear into the canals, and that this causes vertigo, especially when you change your head position. In bed you do that over and over. You lie down, roll over, sit up, and look up at the ceiling. That's why nights and the first moves of the morning are often the worst.

For many people the hard part is the fear of the next spin, which can keep you lying stiff and awake. A plan for each move helps with that.

Sleeping with BPPV: the best position

There isn't one best sleeping position with BPPV that every source agrees on.

• Cleveland Clinic suggests sleeping with your head raised on two pillows.
• After an Epley for the common kind of BPPV, the 2017 US guideline makes a strong recommendation against giving people sleeping or head-position restrictions.
• Some older home-care sheets still give them. MedlinePlus, for example, says not to bend over for the rest of the day and not to sleep on the side that sets off your symptoms for several days after treatment.

So follow whatever your own clinician told you. If they gave you no instructions, the guideline says you don't need any. Some kinds of BPPV are treated with a set sleeping position. If that's you, use exactly the side your clinician named. Don't work it out from a video.

If you try two pillows, put them under your head and shoulders together, so your neck isn't bent sharply forward.

How to lie down, roll over and get up

Lying down and rolling over

1. Sit on the edge of the bed, in the middle, so there's room on both sides.
2. Lie down slowly, in one smooth move, rather than flopping back.
3. If the room spins, stay where you are and keep still until it settles.
4. To roll over, move your whole body at once, slowly, instead of whipping your head round first.

MedlinePlus advises avoiding sudden movements or position changes, and Cleveland Clinic suggests moving slowly when you turn your head.

Getting out of bed

1. Turn on the lamp before you move. Cleveland Clinic says to turn on the lights if you get up during the night.
2. Sit up slowly.
3. Sit on the edge of the bed, feet flat on the floor, until the room is still. MedlinePlus says to sit up slowly and stay seated for a few moments before you stand.
4. Stand with one hand on something solid. MedlinePlus says to hold on to something when you stand.
5. Walk slowly. If the dizziness starts on the way, sit down right away, even if that means sitting on the floor.

If you feel like you might fall, Cleveland Clinic suggests a cane or walking stick. Ask your provider whether one makes sense for you.

Bathroom trips at night

The night bathroom trip combines everything that's hard with BPPV. You're half asleep, the room is dark, and you go from lying to standing fast. A few minutes of setup before bed makes it safer. CDC's home fall checklist suggests:

• a lamp close to the bed, where it's easy to reach
• a nightlight on the path from bed to bathroom, since some turn on by themselves after dark
• nothing on the floor along that path, and rugs removed or fixed with double-sided tape or a non-slip backing
• cords coiled or taped next to the wall
• grab bars next to the toilet, and next to and inside the tub
• a non-slip mat or strips in the tub or shower

Two more things help. Keep your phone, charged, by the bed. And sit down to dry off or to pull clothes on and off. Standing on one leg to step into pajamas is a balance test you don't need at 3 a.m.

If you fall

Stay where you are for a moment and check whether you're hurt before you try to get up. If you can't get up, call for help. That's one reason the phone stays within reach.

These signs come from the NHS head injury page. The 2017 US guideline also asks clinicians to check for a higher risk of falling and for a lack of help at home. If you've fallen, tell your clinician, even if you weren't hurt.

What to tell your family

The people around you can make your nights safer, but they need to know what's going on.

• "The lamp, the bucket and my medicine list are by the bed."
• "If I fall and hit my head, here's the list of signs that mean 911."
• "Can you text me every morning at 9? If I don't answer, please call."
• "I'm not being dramatic about getting up slowly. That's the treatment advice."

If the spinning has stopped but you still feel unsteady at night, the guide on still being dizzy after the Epley explains what's usual. If the night spins keep returning, read when BPPV keeps coming back.

When to get help now

Mayo Clinic and Cleveland Clinic list these signs alongside dizziness as reasons for emergency care.

Questions people ask

What side should I sleep on with BPPV?

Whichever side lets you sleep, unless your clinician named a side. The 2017 US guideline says no special position is needed after an Epley for the common kind. Some clinics still ask you to avoid the affected side for a few days, and some kinds of BPPV are treated with a set position. Ask, and follow what they say.

Does sleeping help with BPPV?

Rest helps you cope, but sleep doesn't move the crystals back. The treatment that does is a repositioning maneuver, which the 2017 guideline strongly recommends for the common kind. The side and canal for that must come from a clinician's exam.

Why do I get vertigo when I get out of bed?

Sitting up and getting out of bed changes the position of your head, and with BPPV that can move the loose crystals. Sitting on the edge of the bed until the room is still gives the spin time to pass before you're on your feet.

How should I sleep after BPPV treatment?

Follow your clinician's instructions. If they gave none, the 2017 guideline says you don't need to sleep upright or avoid a side. Two pillows are fine if you find them more comfortable.