You roll over in bed, and suddenly the room feels like it is spinning. You wait for it to settle, but it happens again when you lie down or look up. If you have experienced BPPV before, you may recognize the feeling—and wonder why it has returned.

BPPV can come back, even after treatment worked well. Some people have one episode and never experience it again. Others have repeat episodes months or years later. Physical therapy can help determine what is causing the spinning and treat BPPV with specific head and body movements.

What is BPPV?

BPPV stands for benign paroxysmal positional vertigo. The name is complicated, but the basic problem is easier to understand.

Your inner ear contains tiny crystals that help your brain sense movement. Normally, these crystals stay in a particular part of the ear. With BPPV, some become loose and move into one of the small, fluid-filled loops that help detect head movement.

When you change position, the misplaced crystals move and send a confusing message to your brain. Your eyes and body may tell you that you are still, while your inner ear tells you that you are spinning.

This can happen when you roll over in bed, lie down, get out of bed, bend forward, or look up. The spinning usually lasts seconds to less than a minute, although nausea or an unsteady feeling can last longer.

Vertigo is the feeling of spinning or movement. BPPV is one condition that causes it. Other problems can also cause vertigo, so finding the cause matters. Our earlier article about vertigo explains more about how the inner ear affects balance.

BPPV recurrence: How often does it come back?

Researchers have found that repeat episodes are common, but the numbers vary widely.

A 2021 research review found that BPPV returned in about 14 to 48 out of every 100 people in studies that followed patients for less than a year. In studies following patients for two years or longer, some reported recurrence in as many as 65 out of every 100 people.

These studies involved different groups of people, so the numbers cannot tell us exactly what will happen to you. They do tell us that having BPPV again is possible—and does not automatically mean the earlier treatment failed.

Treatment helps move the misplaced crystals out of the affected area. It does not guarantee that other crystals will never become loose in the future.

Why are some people more likely to have repeat episodes?

Often, there is no clear reason why BPPV starts or returns. However, research has linked several factors with a greater chance of repeat episodes:

• Older age: Repeat episodes are more common in older adults.
• Being female: Some studies find a higher chance of recurrence in women.
• Bone health problems: Osteoporosis, a condition that weakens bones, has been linked with recurrence.
• Low vitamin D: People with low levels may be more likely to experience repeat episodes.
• Migraine: A history of migraine is another possible risk factor.
• Diabetes or high blood pressure: Both have been linked with a greater chance of BPPV returning.
• Previous head injury or another inner-ear condition: These may also increase the chance of recurrence.

Having one of these factors does not mean BPPV will return. Researchers also do not agree on how much each factor matters. This information can help guide a conversation with your healthcare team, especially if you have repeated episodes.

What does vitamin D have to do with vertigo?

Vitamin D helps your body use calcium and supports bone health. Researchers have also studied whether addressing low vitamin D can help people with BPPV.

In a study of 1,050 people, one group received vitamin D and calcium when testing showed low vitamin D levels. The other group received follow-up care without that testing and supplement plan.

Over one year, BPPV returned in about 38 out of 100 people in the first group, compared with 47 out of 100 in the second. That is about nine fewer people experiencing another episode for every 100 people in the study.

This is a useful reason to ask your medical provider whether vitamin D testing makes sense, particularly if BPPV keeps returning. Your provider can decide whether you need a supplement and what is appropriate for your health.

How does physical therapy help?

Physical therapy for BPPV starts with figuring out what is happening in your inner ear.

First, identify the cause of the spinning

A physical therapist asks about your symptoms and carefully moves your head and body into certain positions while watching your eyes.

BPPV can cause a specific pattern of eye movements called nystagmus. (To watch a video of nystagmus, click HERE to view). These movements provide clues about which ear and which small inner-ear loop are affected. The therapist also looks for signs that your dizziness may have another cause.

This matters because treatment needs to match the problem.

Next, guide the crystals out of the affected area

Once BPPV is identified, the therapist uses a series of head and body movements to guide the crystals out of the area where they are causing symptoms.

 

 

What if the spinning returns?

Schedule an assessment. Even if the feeling is familiar, a new episode may involve a different part of the inner ear—or have a different cause.

Tell your clinician which movements bring on the spinning, how long it lasts, and whether this episode feels different from the last one. Until you can move safely, avoid driving, climbing ladders, or playing sports while dizzy or unsteady.

Get emergency help if vertigo comes with new weakness, facial drooping, trouble speaking, double vision, a severe headache, or an inability to walk safely. Spinning that is new, continuous, or very different from your usual symptoms also needs prompt medical assessment.

Help for BPPV and vertigo in Mendota Heights

You do not have to simply put up with repeated spinning or avoid movement because you are worried it will happen again.

Superior Physical Therapy offers vestibular rehabilitation for dizziness, vertigo, and balance concerns inside The Heights Racquet & Social Club in Mendota Heights, serving the Twin Cities.

To arrange an assessment, call 651-212-5223 or visit our contact page for scheduling information.

About the author

Keely Behning, PT, SCS, ATC owns Superior Physical Therapy and brings more than two decades of orthopedic and sports medicine experience.

Keely also completed specialized vestibular rehabilitation training at Emory University, taught by leading experts in dizziness and balance disorders. This course required participants to demonstrate their knowledge and clinical skills to pass. As of 2025, fewer than 2% of physical therapists nationwide had completed this training.