Dizziness When Lying Down
Feeling dizzy when you lie down can be a scary and disorienting experience. Thankfully, most cases of dizziness that occur when you are lying down or rolling over in bed are not related to a dangerous medical condition. Physical therapists can usually help you overcome dizziness associated with lying down or turning your head. Their approaches can also teach you how to manage dizziness spells.
Dizziness that occurs only when you are lying down is commonly related to an inner ear condition. To understand why it happens, it’s helpful to understand how your inner ear helps you keep your balance. The ear is composed of three parts: The outer ear, which includes your ear lobe and ear canal; the middle ear, which is composed of bones of hearing and the Eustachian tube, which controls ear pressure; and the inner ear, which is composed of the hearing center and includes the cochlea and the vestibular system. The inner ear’s vestibular system allows your brain to monitor your body’s position in space and determine if you’re moving or not.
The Vestibular System
There are two parts to the vestibular system:
PeripheralThe peripheral vestibular system is a network of fluid-filled canals and a small organ in the middle called the otolith that are responsible for detecting movement and sending information about how your body is moving to the brain.
Inside each inner ear are tiny organs called otoliths that are covered by the sticky gelatinous membrane, which embeds microscopic calcium crystals that move when your head moves. As these crystals move, they bend tiny hair cells that provide information about the speed and direction of your motion. As long as the crystals remain firmly embedded on the membranes, they will provide accurate information about your movement.
However, when they become detached from the membrane, they get trapped in the canals surrounding the otolith organs like a trap in a sink, and when they move in the canals they cause your brain to think you’re moving even when you are stationary, leading to the phenomenon we call vertigo. To make matters worse, the loose crystals often accumulate in these canals leading to persistent, debilitating vertigo.
CentralThe central vestibular system is the part of your brain that receives information from the peripheral vestibular system. When the canals and otoliths in your peripheral vestibular system sense movement, they relay data about how you are moving to the brain. This information is integrated with other incoming information from the visual and somatosensory (joints, muscle, and skin sensation) systems to coordinate your movements, allowing you to move purposefully and accurately.
Damage or dysfunction in the peripheral and/or central vestibular system leads to symptoms of dizziness. Dizziness that occurs when you lie down or roll over is usually caused by the calcium crystals moving in the canals of the peripheral vestibular system.
Types of Dizziness
When we feel any kind of imbalance or vertigo, we often simply say we are experiencing dizziness. Like pain, there are many forms of it. Some patients might say burning, tingling, aching, or radiating pain. Dizziness is the same and is a non-specific term that can mean many things. Dizziness also has a subjective and objective component. There are five types of dizziness, and understanding which type(s) you have can help you understand why you are feeling dizzy:
VertigoThis is a sensation of spinning or a rotational sensation when you are standing or moving. There are two types of vertigo – subjective and objective vertigo. Subjective vertigo is when you feel the motion inside. Objective vertigo is when you see it. The most common form of subjective and objective vertigo is Benign Paroxysmal Positional Vertigo (BPPV).
DisequilibriumThis is a feeling of imbalanced when you are standing or walking.
Dysequilibrium can be subjective and objective. Subjectively, the patient will feel the sensation internally as tilting or a feeling of intermittent imbalance. Objective, this is seen as staggering, intermittent tripping, and even falling in worst cases.
Presyncope/LightheadednessIf you feel faint or like you’re about to pass out, you’re likely experiencing presyncope (syncope is an actual loss of consciousness). Presyncope is often related to a condition called orthostatic hypotension, which occurs when your blood pressure is too low to get enough oxygenated blood to the brain.
LightheadednessWith lightheadedness, you feel like you’re floating or like your head isn’t attached to your body, and it’s not related to walking or moving. Both presyncope and lightheadedness are common subjective complaints that can be objectively measured with blood pressure, heart rate, or CO2 monitoring.
Motions SicknessThis is a form of dizziness where you may feel nauseated or sick to your stomach. Subjectively, these symptoms are felt when patients move or change positions of their head or body and with increased movement. If the symptoms get severe enough, the patient may vomit or demonstrate severe nausea symptoms
Behavioral DizzinessThis form of dizziness is the most complex as there are many forms of behavioral dizziness. The subjective and objective description can be measured with specific outcome questionnaires like the Dizziness Handicap Inventory (DHI) or the Activities Specific Balance Confidence Scale (ABC). Briefly, on one end of the spectrum there are functional neurological symptoms. This is when patient have underlying vestibular dysfunction, but it is magnified by their behavior. On the other end of the spectrum is malingering or functional overlay. These dizziness symptoms are due to patients exaggerating for secondary gain or monetary reasons.
Dizziness When Lying Down Before Bed
If you get dizzy only when you lie down for bed, your peripheral vestibular system is the likely culprit. Benign Paroxysmal Positional Vertigo (BPPV) occurs when the crystals in your inner ear become detached from the otolithic membrane that normally holds them in place. These loose crystals can inappropriately activate the canals of the inner ear that provide the brain with information about the speed and direction.
Dizziness symptoms related to BPPV occurs when you lie down or roll over in bed, and will often stop after 15 to 20 seconds once the crystals stop moving in the canals of the inner ear.
When you’re lying down, detached crystals will settle in your inner ear canal. When you move your head, they become suspended in the inner ear fluid, where they can activate the parts of your inner ear that transmit information to your brain. The result is a mismatch between the information your brain is getting from your vestibular system and from your other sensory systems (vision, touch), and you will feel dizzy while your brain tries to make sense of the discrepancy.
To understand how this works, visualize a snow globe. When it’s been sitting on a shelf, the snowflakes settle to the bottom. But when you pick up the globe and roll it over, the snow swirls through the liquid before slowly settling back down. Similarly, if you have detached crystals in your fluid-filled inner ear canals, every time you move your head they will swirl around in the fluid, randomly bouncing off of the walls of your inner ear canals and delivering inaccurate information about your motion to your brain.
Some people will only feel dizzy when they turn to either the right or the left. There can be many reasons, but some simple ones can be they only have debris loose in one ear. The challenge is, in some cases of BPPV, the debris can cause the patient to have dizziness symptoms on both sides, so we have to be cautious when determining the side based on symptoms alone.
Unfortunately, aging is a major cause of BPPV. As we age, our otolithic membranes degrade and the crystals they held in place are able to detach and move freely in your inner ear fluid. Head trauma can also dislodge crystals.
Dizziness that Feels Like the Room Is Spinning
Vertigo is a unique type of dizziness because it includes a rotational or spinning sensation. While dizziness is related to the tiny inner ear organs (the otoliths), vertigo is caused by changes in the inner ear fluid itself. BPPV is a major cause of vertigo when you’re lying down, because when the tiny crystals that are normally held in place by the otolithic membrane become free floating, they can move into the inner ear canals and displace fluid. This leads to inaccurate reporting from the inner ear to the brain about how you are moving.
One common cause of vertigo is alcohol. If you’ve ever over-imbibed and felt like the room was spinning, it was because the alcohol you consumed changed the volume and viscosity (thickness) of your inner ear fluid, resulting in a mismatch between your actual movements (perhaps just lying still on the floor) and what your inner ear fluid tells your brain about your movement.
Dizziness When Your Eyes Are Closed
If you only experience dizziness when you have your eyes are closed and you’re lying still, there may be something other than BPPV to blame. Vestibular Neuritis is a relatively common disorder that is thought to be caused by inflammation in a nerve called the vestibulocochlear nerve (also known as the eighth cranial nerve). The vestibulocochlear nerve is what transmits information from the peripheral vestibular system in the inner ear to the central vestibular system in the brain. If this nerve is inflamed, normal information transfer is disrupted, and your brain gets incorrect information about your body’s position.
When your eyes are open, your brain uses information from your visual system to help you understand your position in space. Even if your vestibulocochlear nerve is inflamed, your brain will get accurate information from your visual system. It can override inaccurate information from your vestibular system with accurate information from your visual system. However, when you close your eyes, your brain no longer gets accurate information from your visual system, and it relies on information from the vestibular system. If your vestibulocochlear nerve is inflamed, it is constantly sending out incorrect information, leading your brain to think you are moving when you’re not.
Treatment for vestibular neuritis may include a medication to reduce inflammation, but a physical therapy-based balance rehabilitation program can be very effective in helping you manage dizziness when your eyes are closed.
When to See a Doctor
Dizziness and vertigo are usually not related to a medical emergency, but if they are accompanied by any of these other symptoms you should call your doctor immediately:
- Double vision
- Paralysis of arms or legs
- Numbness in face or limbs
- Severe headache
- Slurred speech
- Ongoing vomiting
If you have fallen as a result of being dizzy, you may want to see your doctor to rule out a head injury or other injuries sustained during the fall.
Dizziness and Vertigo Treatment
Physical therapy is a highly effective treatment option for people who are experiencing dizziness and vertigo. BPPV is often related to displaced crystals in the inner ear, and there are particle-repositioning exercises that can help get them back where they belong. Vestibular neuritis also responds well to Physical Therapy techniques.
At FYZICAL, our providers use holistic therapeutic techniques to help you manage dizziness and vertigo. Using a medication-free and surgery-free approach, our experts can help you develop a tailored regimen that can help you get your balance back and get a better night’s sleep.
FYZICAL offers free assessments that can help you understand why you’re feeling dizzy or have a sense of vertigo, and help you explore ways to re-balance yourself. Find a FYZICAL location near you and make an appointment with one of our locations today.
To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.