BPPV: The Overlooked Cause of Dizziness That Is Often Misdiagnosed—and Easily Treated

By Daniel Soule
Owner & Director, HormoneSynergy®

Dizziness is one of the most unsettling symptoms a person can experience. It can feel disorienting, destabilizing, and frightening—especially when it appears suddenly or lingers without explanation. For many people, persistent dizziness immediately raises fears of stroke, brain tumors, heart disease, or serious neurological decline.

What I’ve learned—both personally and through our work at HormoneSynergy®—is that one of the most common causes of vertigo is also one of the most frequently missed:

"Benign Paroxysmal Positional Vertigo (BPPV)"

We have worked with many patients whose lives were disrupted for weeks, months, or even years by symptoms that were misattributed to sinus infections, anxiety, inner ear inflammation, migraines, or neurological disease—when the real cause was BPPV.

What Is BPPV?

BPPV is not a neurological disease—it’s a mechanical problem of the inner ear.

Inside the vestibular system are tiny calcium carbonate crystals (called otoconia) that help the brain understand head position and movement. In BPPV, these crystals become dislodged and drift into one of the semicircular canals, where they send incorrect signals to the brain during normal head movements.

This can cause:

• Sudden spinning sensations (vertigo)

• Dizziness triggered by specific head positions

• Symptoms when rolling over in bed, looking up, or bending down

• Nausea, imbalance, or a persistent “off” or floating sensation

Despite how dramatic it feels, BPPV is not a stroke, not a brain disorder, and not degenerative.

And when it’s recognized, it is often highly treatable.

Why BPPV Is So Often Missed

What surprised me most is how often BPPV is overlooked—even within conventional healthcare settings.

Dizziness is frequently managed with:

• Imaging

• Medications

• Steroids

• Anti-nausea drugs

• Reassurance without resolution

What’s often missing is a basic vestibular assessment and awareness of the most effective treatment for BPPV: the Epley Maneuver.

Many healthcare practitioners receive limited training in vestibular disorders, which means:

• Patients are given medications that suppress symptoms rather than fix the problem

• Steroids are prescribed unnecessarily

• Anxiety is blamed when answers aren’t obvious

• Patients are told “everything looks normal” while their symptoms persist

When the underlying issue is mechanical, medication alone cannot correct it.

When It Became Personal

This gap in understanding became deeply personal for me in more than one way.

After working under his RV one day, my father suffered from persistent vertigo and dizziness and was treated for months with medications and steroids. During that time, BPPV was never clearly identified, and the Epley Maneuver was never offered. We persisted to have BPPV evaluated and finally, after months of ineffective treatments, medication and fear, he was sent to a knowledable phsyical therapist and his symptoms were over in less than 15 minutes.

I also experienced it myself.

One night, I got out of bed in the middle of the night and was suddenly hit with intense spinning. The room felt like it flipped sideways, my balance was gone, and for a brief moment, it was genuinely frightening. If you’ve experienced vertigo, you know how instantly alarming it can be. The nausea lasted for days.

Kath (Dr. Retzler) recognized the pattern immediately. Once the Epley Maneuver was performed, the resolution was clear and rapid.

Both experiences reinforced the same lesson: when BPPV is recognized, it can often be resolved quickly—but when it’s missed, people can suffer far longer than necessary and its often mistaken for a true medical emergency. One of our patients was transported by ambulance to a hospital that never investigated BPPV. When they shared their story with Dr. Retzler, she put them through the Epley Maneuver, taught them how to do it on their own, and in 10 minutes their symptoms were resolved. 

How We Address BPPV at HormoneSynergy®

At HormoneSynergy®, we see BPPV as an example of how attention, experience, and practical knowledge matter.

When BPPV is identified, treatment is often non-pharmaceutical and straightforward. The cornerstone of care is the Epley Maneuver—a precise series of guided head and body movements designed to return displaced crystals to their correct position in the inner ear.

Depending on the individual, we:

• Perform the Epley Maneuver or related repositioning techniques

• Reassess symptoms immediately after treatment

• Repeat the maneuver when necessary

• Provide guidance on positioning and prevention

• Support balance, vestibular integration, and nervous system recovery

Many people experience significant relief within one or two sessions—sometimes right away.

It’s a powerful reminder that effective care doesn’t always mean more tests or more medication. Sometimes it means knowing what to look for and how to act.

Why This Matters for Longevity and Quality of Life

From a longevity perspective, chronic dizziness isn’t a minor issue:

• It increases fall risk

• It reduces mobility and confidence

• It accelerates physical deconditioning

• It erodes independence, particularly as people age

BPPV is a common, often unrecognized contributor to falls. Left untreated, it can quietly undermine healthspan and day-to-day quality of life.

At its core, longevity medicine isn’t about chasing interventions—it’s about preserving function, stability, and independence for as long as possible.

The Takeaway

If dizziness or vertigo is triggered by head movement, BPPV should be considered early, and the Epley Maneuver should be part of the discussion—not a last resort.

When healthcare providers understand the mechanics of the vestibular system, people are spared months of unnecessary medication, fear, and frustration.

This is why patient-centered, integrative care matters—and why asking the right questions can make all the difference.

If something doesn’t feel right, it deserves a thoughtful evaluation—not dismissal, guesswork, or prolonged trial-and-error treatment.

Medical Disclaimer:

This content is provided for educational purposes only and is not intended to diagnose, treat, or replace individualized medical care. Vertigo and dizziness can have multiple causes, and symptoms that are severe, persistent, or worsening should be evaluated by a qualified healthcare professional. Always consult your physician or licensed healthcare provider before making changes to your medical care.