Dizziness in bed? Otoliths could be the cause

Last update on Mar, 23, 2022

What is paroxysmal positional vertigo (BBPV)?

Benign paroxysmal positional vertigo (BBPV) is a common syndrome that occurs with short-lived vertigo and is the classic vertigo that occurs when the patient moves his/her head, for example while turning over in bed. It can also be defined as canalolithiasis or cupololithiasis, based on the displacement site of the otoliths, and is due to an alteration in the function of the balance organ. The patient who suffers from it feels like on a carousel: this syndrome occurs:

  • during sleep,
  • while turning over in bed,
  • while looking up to reach an object with eyes,
  • when a person bend his/her head, for example to tie a pair of shoes.

All this happens due to a displacement of these otoliths inside the wrong placements of the ear, from where they send signals to the brain about the position of the head in space. Despite the fear and anxiety that is generated by the onset of symptoms, the syndrome is not to be considered a serious disease. It is in fact called "benign" as it can be solved in most cases.

What are otoliths?

Otoliths are also known as "earstones". To understand otoliths it is important to know that the inner ear is composed of two main organs: labyrinth and cochlea. Cochlea helps us in hearing sounds, and labyrinth is responsible for the senses of hearing and equilibrium, it is composed of three channels that are helpful in perceiving the rotational acceleration of the head and two organs (utricle and saccule) which are helpful for the perception of gravity.

These two organs contain otoliths, which are, crystals immersed in a liquid in the inner ear. Through their movements, the otoliths are able to stimulate receptor cells to communicate to the brain the change in the position of the head within the space.

Cause of dizziness in bed: displacement

It is precisely because of the displacement of the otoliths that the ailments associated with dizziness and that annoying feeling of being on a carousel occurs: the otoliths should be in their natural place, they move towards the semicircular canals and stimulate the receptors connected to the acceleration of the head, thus giving a wrong sensation of rotation of the surroundings. The displacement of otoliths can happen for various causes such as:

  • ear infections,
  • head trauma,
  • excessive abrupt movements of the head,
  • severe stress.

The idiopathic paroxysmal positional vertigo diagnosis is given when the cause of the displacement of the otoliths is not recognizable; and also on the contrary, like following accidents resulting in head trauma, it is possible to identify the cause of the displacement of the crystals or calcium carbonates from their natural location.

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Can otoliths return to their place on their own? How long does it take to heal?

Our body often has a tendency to heal automatically but it all depends on the intensity of the syndrome and associated disorders. In any case, the patient is strongly advised to undergo the liberating maneuvers performed exclusively by an experienced otolaryngologist to restore the otoliths to their original place, solve the problem as quickly as possible and minimize the associated ailments.

When to contact a specialist to treat dizziness in bed?

It is important that the patient contacts the specialist quickly whenever he or she notices the beginning of more or less intense dizziness, triggered by certain head movements (upwards, downwards or horizontally).

Manoeuvres for repositioning otoliths

The manoeuvres performed by specialized operators help the patient to eliminate or mitigate the annoying sensation generated by dizziness; the practices must be carried out by specialized operators only. Among the most common, the Epley and Semont manoeuvers aim to reposition the otoliths within their natural place which is the inner ear.

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