Vertigo While Sleeping: Symptoms, Causes, and Treatment

Vertigo while sleeping can make something as simple as rolling over in bed feel like the room is spinning out of control. This nighttime dizziness can interrupt rest, cause anxiety about going to bed, and increase the risk of falls when getting up in the dark.

While vertigo itself is a symptom rather than a condition, it may be linked to issues in the inner ear, nervous system, or circulation. Understanding the possible causes can help you and your doctor determine the best way to manage vertigo and protect your sleep.

Why You Have Dizziness When Lying Down

Dizziness when lying down is often related to how your inner ear and balance system respond to changes in head position. Conditions like benign paroxysmal positional vertigo (BPPV) can cause sudden spinning sensations when you roll over or tilt your head, while issues such as fluid buildup in the inner ear, low blood pressure, or circulation problems can also play a role.

Benign Paroxysmal Positional Vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of dizziness when lying down.

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It occurs when tiny calcium crystals in the inner ear shift out of place and disrupt the balance signals sent to the brain.

This miscommunication can trigger sudden, brief episodes of spinning or tilting sensations, especially when you roll over in bed, lie down, or tilt your head. While BPPV is not life-threatening, it can be very uncomfortable and may increase the risk of falls if left untreated.

Vertigo vs. Lightheadedness

Even though people may use the term dizziness to describe both vertigo and lightheadedness, the two issues are different. A sense of spinning makes vertigo distinct from being lightheaded, which involves feeling like you are going to pass out or faint. Lightheadedness is more likely to occur when quickly getting out of bed than when lying down. 

Symptoms of Vertigo

Vertigo is a sensation of movement that occurs when a person is not actually moving. People with vertigo may feel like they are spinning, leaning, or swaying. They may also perceive that their surroundings are moving or spinning around them. These sensations can cause a feeling of dizziness and imbalance. 

In some cases, vertigo can be accompanied by
other symptoms

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, including: 

• Light or sound sensitivity
• Headache
• Nausea and vomiting
• Difficulty swallowing or speaking
• Double vision
• Racing heartbeat
• Sweating
• Shortness of breath

With time, the brain can compensate for vertigo, so symptoms are not constant. Instead, they typically go away or change within days or weeks.

“Vertigo can be a very concerning symptom to the patient, but it often has reversible or self limiting causes. It is best to seek prompt attention, especially if it’s interrupting sleep.”

Abhinav Singh, MD, MPH, FAASM

Sleep Medicine Physician,
MD

Causes of Vertigo

Vertigo is a symptom that can be caused by a wide number of issues that affect the vestibular system, which is how the body maintains balance. Vertigo is more common in
older adults

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, who are more likely to have health issues that contribute to dizziness. Other potential risk factors for vertigo include head trauma, a history of migraines, and use of certain medications. 

Causes of vertigo are categorized as either peripheral or central disorders. Peripheral disorders involve the inner ear, while central disorders affect the brain. 

Peripheral disorders cause vertigo because the inner ear plays a crucial role in maintaining balance. It’s estimated that around 80% of cases of vertigo are peripheral. Three specific kinds of peripheral disorders are most likely to cause vertigo. 

• Benign paroxysmal positional vertigo (BPPV): This common peripheral disorder happens when loose calcium fragments in the inner ear disrupt the body’s perception of motion. BPPV may result from head injuries or other disorders that affect the inner ear, but in many cases, there is
  no evident cause
  

  
  
  
  
  
  

  
  

  
  
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  . Vertigo from BPPV often occurs when a person changes their head position, such as when they get in or out of bed. Episodes of vertigo from BPPV usually last for less than a minute. 

• Vestibular neuritis: This condition is caused by inflammation of a nerve in the ear. People with vestibular neuritis experience intense vertigo that may get worse with
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  . They may also have other symptoms like nausea and vomiting. The worst symptoms of vestibular neuritis usually only last a few days and then resolve gradually, but some dizziness may linger for months. 

• Meniere’s disease: Fluid buildup in the inner ear can lead to
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  . Risk factors for Meniere’s disease include ear infections, head injuries, allergies, alcohol use, and taking certain medications. The duration of episodes of vertigo from Meniere’s disease are quite variable, with the potential to last anywhere from 20 minutes to 24 hours. Hearing loss or abnormal sounds and sensations in the ears may occur alongside dizziness. Though it can become chronic, Meniere’s disease can usually be effectively treated or may even go away naturally. 

Vertigo caused by central disorders that affect the brain
account for 20%

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of vertigo cases. Central nervous system disorders that can cause vertigo include certain migraines, stroke, tumors, and multiple sclerosis. 

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How Doctors Treat Vertigo

In general, medical professionals employ
three different strategies

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to treat vertigo. 

• Alleviation of symptoms: Sensations of vertigo can be treated with medication, although this is generally only useful for longer-lasting or frequently recurring episodes. Symptoms may also be alleviated by avoiding rapid head movements, bright lights, and other exacerbating factors.
• Treatment of underlying condition: When vertigo has a clear cause, treating the underlying condition may bring relief. Fortunately, this type of treatment can be beneficial for several of the most common types of vertigo. 
• Rehabilitation exercises: Doctors may recommend rehabilitation exercises that help the brain adapt to overcome vertigo. With some types of vertigo, starting these exercises earlier may make them more effective.

How to Sleep With Vertigo

Some research has found that, at least in certain people, vertigo has the potential to
disturb sleep

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. The impact on sleep may be more likely if episodes of vertigo persist over an
extended period of time

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. Similarly,
some sleep disorders

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have been associated with a higher prevalence of BPPV and other forms of vertigo. While more research into vertigo and sleep is necessary, evidence suggests that there may be a bidirectional relationship between them.

If you experience vertigo when lying down or sleeping, the best things you can do involve avoiding certain positions and movements that may initiate or exacerbate dizziness. 

• Keep movements slow: As much as possible, minimize head acceleration when lying down or getting out of bed. Try to move slowly and deliberately rather than rapidly or suddenly. 
• Elevate the head: Sleeping with the head elevated by
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  may be effective at reducing benign paroxysmal positional vertigo. Pillows can be used to prop up the upper back, neck, and head to achieve this angle of elevation.

• Sleep with the unaffected ear facing down: Vertigo caused by inner ear conditions such as BPPV may affect only one ear. Episodes of vertigo are more likely when the affected ear is
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  . For that reason, it may be helpful to keep the affected ear out of this position when lying in bed. 

• Avoid exacerbating activities: Things like reading and watching TV in bed may worsen vertigo, so it may help to eliminate these from bedtime routines. Exposure to bright lights may also exacerbate dizziness. 

When to See a Doctor

Although vertigo can be disorienting and bothersome, some of the most common causes of vertigo are relatively harmless. However, other causes can be serious health issues. You should get prompt medical attention if you experience vertigo with certain additional symptoms, including: 

• Fever of 100.4 degrees Fahrenheit or higher
• Severe headache
• Difficulty hearing or talking
• Vision problems including double vision
• Tingling sensations
• Difficulty walking without help
• Persistent vomiting
• Fainting
• Chest pain

Additionally, if you have a history of stroke, are at a high risk for stroke, or are 60 years old or older, you should seek immediate medical attention if you have an episode of vertigo that continues for multiple minutes or longer. 

If you have occasional episodes of vertigo, you should make an appointment with your doctor who can evaluate your symptoms to determine its most likely cause. 

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