Giddy Book 2010

copyright © John Collins 2004 1

Chapter one

Giddy spells? There may be a cure for you!

Personal case history About ten years ago I approached my doctor to see if I could get an answer to a problem that had bothered me for more than twenty-five years. I had always suffered moments of nausea and giddiness when I looked upwards above my head or lay down flat on my back with my head resting on the floor, or often when I just put my head into a certain position. However as I entered my late forties I noticed an increase in the effects, and the nausea accompanying the giddiness took longer to settle. After another four or five years I also began to suffer the same feelings of giddiness as I lay down to sleep at night. One of the odd things about this experience was that it only showed itself when I lay on my right side – the side that I customarily slept on. If I adopted a sleeping position on my left side I had no attacks of giddiness and the room stayed reassuringly still. But as soon as I turned over – as we all do during the night – then the room spun round. I found that shutting my eyes helped to reduce the effect but it still left me with a feeling of nausea and I was eventually persuaded to attend the local surgery and discuss matters with my GP.(General practitioner or doctor) He examined me thoroughly and was able to reassure me that I was in perfect health and that there were no blood pressure problems often associated with such symptoms. He named the problem as Chronic Benign Positional Vertigo (CBVP) and told me that this was a common problem and that there was no cure, so I better get used to it. He said that often the symptoms would clear up of their own accord or reduce to an acceptable level. I left the surgery slightly disappointed but reasonably optimistic that things would improve in due course, although the fact that I already suffered for some thirty years should have warned me not to raise my expectations. In fact things did not improve, they got worse and I got more and more fed up with the problem. I returned to my GP only to have the same reaction as before, but an offer to prescribe some drugs that might reduce the effects. I tried them and they had no effect. Eventually I turned in desperation to the Internet to see if there was any hope of a cure. I discovered that there were thousands of people like myself and almost as many cures on offer. To cut a long story short I eventually found a remarkable cure and one which, to someone who has suffered this problem for so many years, seemed like a miracle. The cure works and it is based on sound medical and physical common sense. The disease is apparently caused, in some cases, by tiny particles within the inner ear becoming detached, sometimes due to a mild bump on the head. These particles roam freely within the inner ear causing conflicting signals to be sent to the balance mechanism. This gives rise to the familiar sensations of giddiness, room spinning and subsequent nausea. The treatment, ingeniously, removes the offending particles permanently, to another area within the inner ear which is without any of the balance


receptors, which receive the signals from such particles. So no more conflicting messages to the brain. I returned to my GP and told him what I had found and requested that he refer me to a clinic which was offering this treatment. He was sceptical of success but did as I requested and I made contact with a small department in a university, which was specialising in this particular cure. A meeting was arranged with the lady specialist at which my illness was diagnosed and confirmed as CBPV and I was told that I could be cured and all that was required was that I undergo a once-only series of exercises or manoeuvres! I knew she was right and believed her because I had read about the startling effects of the treatment and how it was carried out, yet it still seemed incredible that such a powerful cure was so simple. I was treated in the presence of number of medical students who were learning about this treatment. I was made to lie on a bed while my eyes were examined. Then I was requested to adopt a number of positions which were easy and simple to accomplish, but were carried out in a particular way and order. At the end of no more than five minutes I was declared cured! The doctor must have seen my look of scepticism and she suggested that I lie down as if in sleep; and then on my back; and then standing up with my eyes raised to the ceiling – absolutely amazing! No giddiness! No nausea! A few weeks later during a subsequent visit to my GP, he asked me if the treatment had helped and when I told him I was completely cured he said, “ you’re kidding! I can’t believe it worked!” He asked me all about it and was sufficiently impressed to promise to send more recommendations to the special unit at the university I mentioned earlier. I would like to have given this information out but have been advised that it is necessary for the unit to be contacted through doctor’s references. So – what causes it, why does the cure work and how can it help you? Turn to chapter two for a simple explanation of the causes of benign positional vertigo and then read on to where I will explain what to do to cure your self of it.


Chapter two

Benign Positional Vertigo - What is it?

Benign - Once recognized, as you will see, though the symptoms are unpleasant and worrying, they don’t necessarily mean anything serious, neither threatening to life nor limb. That is not to say that symptoms aren’t disturbing for those of us that have had them, or still do so, especially not knowing where they come from, but there is no cause for alarm Positional – it happens when you put your head in certain positions, typically in looking up, or when you lie down on your right or left side. It only lasts for seconds most of the time, but you get a terrible sense of spinning and the way the room whirls around is nauseating and disorienting. The name for this is Vertigo. My doctor included the word ‘chronic’ in my diagnosis but that just means ‘continual’ or ‘lasting a long time’. In the USA they say ‘paroxysmal’, and this means ‘ a sudden but passing attack’. So – scary words but quite mild and sensible in their meaning.

Sometimes a person will have an extended dizzy spell, but may not realize they have vertigo and other times they suffer mild dizziness that is often over very quickly. They may suffer it as they look up when painting the ceiling or while at the hairdresser or when they get in certain positions working on their car or gardening etc. Sometimes symptoms are at their worst in the morning and some people are not aware of it if the vertigo only occurs when they lie on one side – it might only manifest itself as a slight momentary dizziness which can be explained away as some symptom of over-indulgence of food or alcohol! Sometimes it appears whichever side they lie on.

Though vertigo is brief it is so uncomfortable that the resulting nausea can last for a long time after the initial symptoms have passed. Some people actually vomit due to the intensity of the nausea that afflicts them. In severe cases where the vertigo has been present for a long time, some sufferers begin to avoid certain activities which they feel may precipitate an attack. There are people who won’t drive and some who won’t even leave their house. They are worried that the dizziness will return while they are in control of a car or just walking in the street, and they are afraid that something serious may happen – some accident involving themselves or somebody else. This seemingly unpredictable aspect of vertigo can occasionally develop into agoraphobia, the fear of open spaces, and can literally change a person’s life and they will never leave the house again.

Often someone with this condition may not only have vertigo but will suffer some additional symptoms, which are generated by the initial vertigo. They may for instance, feel unsteady on their feet or retain the feelings of nausea for hours afterwards, suffer anxiety attacks, and blurred or erratic vision. Vertigo in the elderly may cause them to have falls because the condition can contribute to general unsteadiness of gait.

I found the following statics of frequency of CBPV


In the US: Incidence of CBPV is 64 cases per 100,000 population per year (conservative estimate).

Internationally: One study in Japan found an incidence of 11 cases per 100,000 population per year, but patients were counted only if examined by a subspecialist or at a referral centre.

Women are affected twice as often as men are.

Age: Onset can occur at any age, but most patients are older than 40 years. Several large studies show an average age of onset in the mid 50s. Vertigo in young patients is more likely to be caused by labyrinthitis (associated with hearing loss) or vestibular neuronitis (normal hearing).

The figures seem to suggest that BPV effects a tiny percentage of the population but I have also seen suggestions that the true figure may be larger and that this kind of vertigo may afflict up to 20 per cent of the population and the reasons for this are as follows. The figures point to onset of symptoms being at or around the age of 50, but I would suggest that these figures cloak the real facts. People, including myself, who have lived with CBPV for years don’t go to the doctor unless the symptoms worsen. They carry on and put up with it, so those people either never appear in any figures or only become a statistic in middle age when the symptoms worsen. My mother-in-law whom I also cured suffered with it for more than fifty years and never ever reported it to her doctor. It’s also worth pointing out that the figures are collated from those places where they record such problems, so if the figures aren’t collected they do not contribute to the statistics. If my doctor felt it unnecessary to report the disease then the same thing applies nationwide. To this doubt (that the figures reflect the real situation) we must also add that many doctors don’t recognise the symptoms and just brush the concerns away as mine did. It is therefore safe to assume that the problem is far more widespread than the figures suggest.

Furthermore, recent findings suggest that it becomes more common the older you get, and up to 50 percent of the elderly may suffer from it but for them the problem remains undiagnosed and the cure unknown.

So that’s what it is – but what causes it?


Chapter three

What causes it? - The inner ear and our balance mechanism

These particular symptoms all relate to the inner ear, where our sense of balance is based. The body is an amazing piece of equipment and the mechanisms within the inner ear demonstrate just how ingenious our balance mechanisms are.

Within each of the inner ears are three semi-circular canals filled with a viscous fluid. Each canal is oriented in a different direction and each is roughly at right angles to another and working in unison they are capable of detecting both the position and the slightest movement of the head in any particular direction. These semi-circular canals are named anterior, lateral, and posteri, which means above, side and rear, which indicates the direction of motion that they are sensitive to. A combination of their various signals enables the brain to detect movement of the head from side to side, up and down and forward and back.

The walls of the canals are lined with tiny hairs or cilia. These tiny strands wave to and fro within the fluid rather like sea anemones under the sea in the tropics, reacting to every current they are subjected to. On the ends of these hair-like threads are tiny crystals of calcium carbonate. Sometimes a minor bump on the head can cause one or more of these crystals to break off and become free to float around within one or more of the three canals within either or both of the inner ears. Sometimes no injury to the head can be remembered and one must assume that some crystals simply break off

during normal but raised levels of exercise.

These detached particles, sometimes called otoconia or canaliths or otoliths can be washed this way and that at random through the canals by certain motions of the head and, because they have become detached from their filaments or anchor chains if you like, they can touch the wrong nerve receptors within the semi-circular canals, which transmit the balance information to our brains. This leads to false and contradictory information being sent to the brain leading to the vertiginous feelings


we are discussing. The crystals can in some cases dissolve after a few weeks, hence the advice to wait and see. In my experience this can be a long time and there seems little reason to wait for them to dissolve when a few simple and beneficial exercises can resolve the problem.

So it’s all to do with the inner ear but how can you tell if you have this particular disease?


Chapter four

How can you tell if CBPV is what you are suffering from?

People are strongly advised to consult their Doctors first to ascertain precisely what they are suffering from. The reasons for this are clear and obvious. The treatment described in this book only works for particular causes of vertigo and the actual form that you are suffering from should be identified first. If the doctor informs you that you are suffering from chronic benign positional vertigo or paroxysmal benign positional vertigo and tells you that there is no cure then you can go ahead and take this treatment.

Having said that, if you prefer not to visit the doctor despite my warning, then there may be a way for you yourself, to discover what is causing your giddy symptoms and it is described as follows. Again it cannot be taken as being one hundred per cent accurate and I would still urge that professional medical advice be sought.

When someone has typical symptoms, it is quite simple to diagnose it, but you will need your partner or trusted member of the family or a good friend to help you. First of all you must sit down on the side of your bed with your head tilted back and to the side about 45 degrees. Ask your assistant to help you lie down with your head still in this position, so that the right ear is pointing downwards. You must keep your eyes open all the time during the bout of vertigo which will be induced. After a moment or so, when you begin to suffer an attack of vertigo and the room begins to spin, you will have nystagmus visible to your helper.

What on earth is Nystagmus? Well despite its fancy name it is merely a jerking movement of your eyes from side to side, easily visible to your assistant. During my own treatment the doctor who instructed me in the exercises told me that she can often locate the problem very precisely, identifying which semi-circular canal has been effected, just by noting the particular way in which the eyes jerk from side to side.

As a sufferer for many years it became obvious to me that the eyes are trying to follow the perceived motion of the room and that is why they flick from side to side. The movement exactly mimics what the room seems to be doing. But of course the room is not moving hence the feelings of nausea generated.

Of course the test to identify nystagmus may cause problems and I know that some people will be reluctant to voluntarily undergo tilting of the head, causing the very symptoms they are trying to avoid. I would try to encourage these people and tell them that after this short period of suffering there is a 95 per cent chance that they will be cured and they will never have to experience vertigo ever again.

I should also point out that the remaining 5 per cent may be attributable to incorrect diagnosis, since there seems little reason for the treatment not have a 100 per cent success rate. Alternatively the 5 per cent could also be blamed on incorrect or insufficient treatment.


Once nystagmus has been identified, and benign positional vertigo confirmed, the next step is to treat it. By means of a set of simple exercises carried out in the home (usually only once is necessary), the free-floating rock crystals within the semi-circular canals can be repositioned to occupy a place within the canals where there are no balance receptors. This simple solution seems almost too obvious and the most amazing thing is that so few medical people seem, as far as I’m aware, to know of this treatment nor the fact that they could obtain cures for all of their CBPV sufferers with a 95 per cent chance of success. This could be carried out within a surgery or by a suitably trained nurse.

What is this treatment and how do you apply it to yourself – or get someone to help you?


Chapter five

The cure

The treatment requires that we manipulate the position of our head through a series of positions in order to allow the detached crystals to float through the viscous liquid within the semicircular canals into regions where there are no balance receptors. Think of it as being a bit like those little amusement toys or mazes where you have to guide a tiny metal ball through a maze, by delicate changes of position of your hand.

The treatment was originally conceived by an American doctor called J.M.Epley and he termed in “The Epley canalith repositioning procedure”. The canaliths are the crystals which have become detached. There are three forms of this procedure described in this booklet. The first two can be carried out at home with the assistance of a friend, partner or relative. The third can be carried out at home by you on your own. However the last method is not so reliable and obviously as a sufferer it is more difficult to maintain sufficient objectivity to carry out the exercises exactly as described, nevertheless with a reasonable amount of self-control good results can be achieved.

The procedure is effective in about 95 per cent of cases, however the one the English clinic used varies slightly, and I am told that this is because they believe that their’s is an improvement on the original method. So I shall first go through the method used on me and carried out by the English clinic. After that I shall do the same with the Epley manoeuvre and finally I shall describe the do-it-yourself method where no assistants are available.

It is very important to remember that sufficient time must be allowed to elapse between one position and the next, and that movements themselves must be taken at a slow and steady rate, unless a more rapid movement is indicated.

The reason for this is that the crystals are suspended in a viscous liquid and they must be allowed time to settle through the liquid at each new position. The thickness of the liquid may vary from one person to another and it seems sensible to recommend that the slower you carry out the procedure the better.

Please refer to the diagrams as you read the following instructions. The first two methods described must be carried out with assistance. Please read through all of the methods before proceeding.

The English variation.

To begin you must adopt a sitting position on the middle of your bed, with your head facing the towards the top of the bed. To begin with aim to deal with the affected

side first, so if you feel giddy when lying on your left side, lie back and with your assistant’s help try to arrange your body so that your head hangs just clear of the edge of the foot of the bed. Your assistant will need to support your head in their hands. Allow your head to drop back slightly so that it is tilted a few degrees downwards and supported by your assistant. The


head should also be turned about 45 degrees to the your left, which is the side, in this case, which is generating the vertigo.

This is unpleasant but the beneficial results are really effective. You must keep your eyes open to allow the appearance and disappearance of nystagmus to be observed by your assistants. Allow at least 30 seconds to pass after nystagmus is

no longer observed.

Now turn the head to the right about 45 degrees, and hold it there. The nystagmus will return briefly, but hold the position until all signs of nystagmus have passed, and at least thirty seconds even if there is no nystagmus. Remember you must keep your eyes open

so that your assistant can watch for nystagmus.

Then roll the body over towards the same side as the head is already at, by rotating the knees, from their upright position to a lying down position, but be sure to maintain the position of the head to that same side. You should now be lying on your side –

the side that is not effected by vertigo –with your head also lying on the same side but looking slightly toward the floor.

After another 30 seconds or so, slowly and carefully raise yourself, sideways, into a sitting position, with the help of your assistants. You must maintain the position of the

head relative to the body. In other words, as you raise yourself up into a sitting position keep your head in line with your body as it slowly rises. Keep your head tilted slightly forward but not to the side and at this point take a breather and try not to let

the feelings of nausea overwhelm you.

This is the half way point to full recovery! You will need to repeat the series of manoeuvres, starting with your head inclined to the opposite side that you began with, once you are lying down. Exactly the same routine as the first set of positions must be carried out but towards the side which does not usually cause vertigo. This is because the detached crystals may be in more than one

semi-circular canal and will have to be manipulated into their own non-receptive area.

There is no reason why you should not test the cure to see if it has worked immediately upon completion of the exercises, however be aware that the feelings of nausea generated by the exercises may last for several minutes to a few hours afterwards. It is advisable to sit quietly for few minutes once you have finished to allow things to settle down. Once the nausea has subsided is probably a better time to test yourself! Try lying down as if to sleep on the side which normally causes problems. If all has gone according to plan and you have carried out the instructions accurately, all signs of vertigo should be gone.

Sometimes traces of a milder form of vertigo remain and this is because a few crystals have remained within the balance receptor area and another attempt needs


to be made to move them to the safe area again. This maybe because not all of the crystals moved when the head was held in a particular position. This can be attributed to more than one cause, for instance; the exercise was carried out too quickly or because some crystals stuck in a position or the fluid in your ear is slightly thicker or more viscous. It is advisable to wait for a day or two before repeating the exercises.

Self treatment in your own home

There are two versions of this set of exercises and they both will work if you can do it right, but without assistance it takes some effort to maintain an objective viewpoint when you are in the middle of a bout of vertigo!

Begin by sitting upright on your sofa or settee.

Next move into a position where you are lying on your side, with your head looking upwards at an angle of about 45 degrees, or tilted about half way between horizontal and vertical. You can imagine that you are looking at the head of someone who is standing in front of you about six feet away. Stay in the side-lying position for 30 seconds, or until the dizziness subsides if this is longer, then return to the sitting position. Stay there for 30 seconds, and then go to the

opposite side and follow the same routine. It is important to take your time with these manoeuvres to give the crystals time to float downwards within the viscous liquid in the semi-circular canals, to their new position.

You will notice that these do-it-yourself exercises are designed to deal with balance problems in both ears so that there is no need to reverse the procedure for problems associated with a particular side.

The originators of this method make the following recommendations, but in my experience one or two sets of exercises is sufficient. However to follow their advice - these exercises should be carried out daily for two weeks, three times per day, or for three weeks, twice per day. This adds up to 52 sets in total. In most persons, complete relief from symptoms is obtained after 30 sets, or about 10 days. They say that in approximately 30 percent of patients, vertigo may recur within one year. If it does recur, you may wish to do one 10-minute exercise daily until it has gone.


The chief difference between the two exercises is the requirement in the English method for the head to be tilted slight backwards and downwards at certain times.

Variation on the above which I have found more beneficial.

Adopt the same sitting position. Secondly lie down as in position two, but keep your head looking straight forward, not upwards at 45 degrees – yet! Now, after any nystagmus has settled, look up at 45 degrees as in the second position. Wait for sixty seconds.

Now, as you then raise yourself back into a sitting position keep your head at the same 45 degree angle, so that when you are sitting upright your head is still looking to one side, now bring it back to a forward and slightly tilted downward position and wait for sixty seconds before proceeding to position three.

Repeat the actions as for position two in this variation. Wait for sixty seconds and return to the upright position, repeating the same actions as you did in position three of this variation.

A final case history When I returned home, having had the treatment, my mother-in-law asked me how I had got on. Now, she had good reason to ask because she had suffered similar symptoms for most of her adult life. Her chief problem was that her favoured side for sleeping on was impossible to use because she said that whenever she lay on her right side the room would begin to spin and she could not bear it. Consequently she tried to sleep on her left side with varying degrees of success. She was sceptical of my so-called “cure” and would not be persuaded to try the exercise regime no matter how hard I tried. She often suffered dizzy spells when carrying out everyday chores, bending and stretching, while doing housework. The symptoms increasingly restricted what she could do in the home and they eventually led to her avoiding taking extended trips into town in case she should undergo a bout of vertigo. Even when she visited us or other members of the family, she would worry constantly that the dizziness might return at any moment and she would not relax until she was back safely in her own home. The trouble was that she could not bear to do anything that might bring on an attack and so she began to avoid anything which might induce it. She knew that I had had a seemingly miraculous cure but was doubtful that she could possibly benefit as I had, from the same exercises. To cut a long story short I persuaded her that I would attempt to replicate the exercises with her that had been taught to me, with the aid of her daughter and with her husband to assist.

We made her sit on her bed and lay back with her head to one side as I had been taught. Then, I checked her eyes to see if they were jerking from side to side, as


mine would do. This was the nystagmus. They were jerking as described and I was pleased to announce that I was certain that the cause of her affliction was precisely the same as mine. We followed the prescribed routine of exercises and I pronounced her cured. She muttered some inaudible comment which I took to represent extreme scepticism. I suggested that she sit up and then lie down as if in sleep – but on her left side. She complied, albeit unwillingly. There was a moment’s silence and then she said jubilantly “thank God, it’s worked. The room isn’t going round!” She then began to cry and said that she had suffered from this problem for years and years and suddenly it was gone – just like that! It has never returned.

Let me know how you get on by emailing me.

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Giddy Book 2010