Short answer
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Tiny calcium carbonate crystals (otoconia) come loose from the utricle and drift into one of the semicircular canals. When you lie down, roll over or look up, they move and trigger brief, intense spinning, usually lasting under a minute. A canalith repositioning maneuver moves them back out, often within one to three visits1.
Answered by Dr. Manan Patel, PT, DPT, TPS, Certified Vestibular Specialist and Therapeutic Pain Specialist. Updated October 18, 2026.
Why does the room spin when I roll over in bed?
Rolling over moves the loose crystals through the canal, and the spinning starts a few seconds later, peaks and fades within about a minute2. Other common triggers are lying back, getting up in the morning, looking up at a high shelf and bending down. Nausea and a lingering off-balance feeling between spells are common. Constant spinning that does not change with position, or vertigo with neurological symptoms, is not typical BPPV and needs prompt medical evaluation.
Why do inner ear crystals come loose?
Often there is no clear reason, but BPPV becomes more common with age and is linked to head injury, inner ear conditions such as vestibular neuritis or Ménière's disease, long periods lying flat, migraine and low vitamin D1. Because it can come back, we also teach you the early signs to watch for.
How is BPPV diagnosed and treated?
We perform the Dix-Hallpike and supine roll tests while recording your eyes with infrared video goggles. The direction of the nystagmus shows which ear and which canal is affected, and whether the crystals are floating or stuck to the cupula. Then we choose the matching maneuver: Epley or Semont for the posterior canal, BBQ roll or Gufoni for the horizontal canal, or a deep head-hanging maneuver for the anterior canal. A Cochrane review confirms the Epley maneuver is a safe, effective treatment for posterior canal BPPV3.
How soon can I get BPPV treatment in Alpharetta or Cumming?
Urgent appointments are available within 48 hours at our Cumming and Alpharetta clinics, and treatment usually starts at the first visit. Patients come from Johns Creek, Milton, Roswell, Suwanee and Sugar Hill. The BPPV guideline advises against routine anti-vertigo medicines, because repositioning treats the cause1.
Where can I get help in Alpharetta, Cumming and nearby?
Dr. Manan Patel, PT, DPT, TPS and our team of physical therapists see patients from Alpharetta, Johns Creek, Milton, Roswell, Cumming, Suwanee, Sugar Hill, Buford, Duluth and Forsyth County at two North Atlanta clinics. Every visit is 60 minutes, one-on-one, and urgent appointments are available within 48 hours. We are in-network with Traditional Medicare, BCBS / Anthem and Tricare, and offer a $129 rate per visit for self-pay and out-of-network plans. Not sure where to start? Take the free symptom self-check, or visit our Alpharetta clinic or Cumming clinic page.
Cumming clinic
Off GA-400 Exit 13 on Peachtree Parkway
Cumming, GA 30041
Alpharetta clinic
Inside Georgia Brain & Spine Physical Therapy
Alpharetta, GA 30022
Related care
Related questions
- Why do I still feel wobbly after my BPPV crystals were cleared?Residual dizziness, a lingering floating, foggy or unsteady feeling after the spinning has stopped, is common after…2 min read · Patient question
- Horizontal vs. posterior canal BPPV: why doesn't the Epley maneuver work for everyone?The Epley maneuver is designed for posterior canal BPPV, the most common type. Horizontal (lateral) canal BPPV, the…2 min read · Patient question
- Why are infrared video Frenzel goggles essential for an accurate BPPV diagnosis?In normal room light, your eyes can suppress nystagmus, the involuntary eye movement that reveals an inner ear…2 min read · Patient question
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References
- Bhattacharyya N, et al. Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update). Otolaryngology–Head and Neck Surgery. 2017.
- von Brevern M, et al. Benign paroxysmal positional vertigo: Diagnostic criteria. Journal of Vestibular Research. 2015.
- Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. 2014.
This answer is general education, not a diagnosis or a substitute for an examination. If you have new or worsening symptoms, contact your doctor. Call 911 for sudden severe dizziness with trouble speaking, weakness, numbness, double vision or a severe headache.
