Vertigo is a sensation of movement when we are not in fact moving. It can happen to any of us and is relatively common in the general population. It may also occur with noise in the ears (this is called tinnitus).
For balance, we use our vestibular system in the inner ears, our eyes, our sensations of touch and of course, our brain. For brief spells of dizziness, steady breathing and stillness can be sufficient to regain balance. Sometimes, a sudden spin of vertigo can feel like a sneeze inside our head that comes and goes without much warning. This is a temporary sensation of dizziness – the ears, eyes, touch sensors and brain need a moment to recalibrate information. It passes and resolves. In a yoga class this can happen if a student moves too quickly from an inversion to standing, or from an intense posture in which they have laboured breathing and rajasic efforts. Satva, effortless effort, is the antidote.
However, there are also vertigo conditions that result in prolonged spinning sensations from 10 seconds to hours. This usually occurs when there is an inner ear condition creating error signals to our eye muscles. This can be seen in rapid little flicking movements of the eyes, known as nystagmus. Vertigo may be consistently triggered by positions such as lying down to the side, looking up (Trikonanasana is a great trigger for this one), or bending downwards. These are symptoms of positional dizziness, also known as BPPV (benign paroxysmal positional vertigo).
If your students complain of frequent vertigo and begin to avoid looking upwards, lying flat or doing certain yoga postures, it might be worth encouraging them to be tested for BPPV. It is treated quickly without pain and without drugs.
I have seen many clinic patients with BPPV who have quit yoga as the head movements in class trigger their symptoms! This is why encouraging treatment is really essential – it can be treated and they can get back to class! If it occurs in class, allow the student to find a stable position (usually sitting upright) and minimise head movements until they have had it diagnosed and resolved. The longer we delay treatment, the more difficult it can be to resolve.
BPPV treatments are very effective in majority of cases. It is caused by dislodged calcium particles in the inner ear that need to be repositioned from the semicircular canals (rotation detectors) of the vestibular organs to where they belong inside the otoliths (these detect acceleration and linear movements). Treatment is quite simple, gentle and requires very specific head positions as described in the “Epley manoeuvre”. There are a number of other treatments also available if the Epley is unsuccessful. Over-treating the BPPV can cause the crystals to again dislodge. So it is recommended to take it easy on the day of treatment and sleep with a bigger pillow so the head is kept slightly elevated (as though for pranayama). I usually encourage patients to review the treatment after one week and to repeat as required, to ensure that the BPPV has resolved.
WHO can help treat BPPV?
Ask around to find a local who specialises in BPPV- not everyone has this training.
This may be a vestibular audiologist, physiotherapist, ENT surgeon, neurologist or GP to perform the BPPV diagnosis and manoeuvre. (I also can do this over the phone or on Skype for patients who live remotely or can’t find a local specialist.)
Remote support details can be found here: www.seekingbalance.com.au
As luck would have it, I have had BPPV twice! It made me feel queasy, drunken and vague. I could get by with daily tasks but I felt a loss of confidence and general uneasiness with head movements. All symptoms resolved once the calcium crystals were treated. And thankfully, I could then return to daily activities and yoga practice the following day with steadiness, balance and confidence.
The first step to recovery of vertigo is understanding what the triggers are therefore, what condition you may have. Then we can support the body to repair via neuroplasticity and compensation processes. We can all find balance
Further details: http://www.seekingbalance.com.au/benign-paroxysmalpositional-vertigo-bppv/
Joanna Remenyi is a Vestibular Audiologist with Seeking Balance Australia and a
Certified Iyengar Yoga Teacher with Geelong City Yoga.
