The ceiling swung, and I blamed my age

THE 30-SECOND VERSION

The commonest cause of dizziness in older adults is loose crystals in the inner ear. It is treatable, often in a visit or two. And it is badly underdiagnosed.

FEEL-GOOD FRIDAY

The crystals nobody tells you about

We close balance week with the most fixable thing I have come across in a long while.

One morning in the spring I rolled over to shut off the alarm clock and the ceiling swung sideways. It lasted perhaps twenty seconds, long enough to make me grip the mattress, and then it stopped as suddenly as it started. I lay still for a minute, got up carefully, and said nothing to Carol.

What I told myself was that I am sixty-seven and this is what happens. That is what most of us tell ourselves, and it is one of the most expensive assumptions going.

Because on Tuesday I told you the inner ear was the one balance input you cannot do much about at home. That was true as far as it went. But there is one inner ear problem that is remarkably common, routinely missed, and very often fixed in a couple of appointments. Let me tell you about it.

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Brief spinning when you roll over in bed or tip your head back. What is the commonest cause?

Tap your guess. A ready-to-send reply opens. Just press send and we’ll tell you if you got it right.

Loose crystals in the inner ear

Low blood pressure

Simply getting older

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THE MYTH

Dizziness is not simply getting older

Deep in your inner ear sit tiny crystals of calcium. They have a proper job there, helping you sense gravity and movement. Over the years they can come loose, and a few of them drift into the fluid-filled tubes next door, the ones that detect turning.

Now they are in the wrong room, sloshing about. Every time you tip your head, roll over in bed, or look up at a high shelf, they shift and the tube reports a violent spin that is not happening. Your eyes say the room is still. Your ear insists it is turning. The result is the ceiling swinging sideways while you grip the mattress.

Doctors call it benign paroxysmal positional vertigo, which is a mouthful meaning harmless, brief, and brought on by position. It is the single most common cause of vertigo, and it becomes more common with age. In one population study of 75-year-olds, one in ten had it.

Here is the figure that stopped me. Among people referred to specialist falls clinics, 39 in 100 were found to have it. Nearly four in ten. These are people who had been falling, often for a long time, with a treatable cause sitting in their ear.

Why it gets missed

Two reasons, and the second is the important one. First, we blame our age and never mention it, as I did. Second, and this genuinely surprised me, older people often do not get the dramatic spinning at all. They feel vague unsteadiness instead. Of those found to have it in falls clinics, around a quarter had not reported any dizziness when asked. So you can have this and never once describe yourself as dizzy.

And it is fixed by moving your head

No drugs, no surgery. A clinician guides your head through a specific sequence of positions to roll the crystals back where they belong. It takes a few minutes. Reported success rates run from roughly 80% upward, often after one or two goes. There are few things in this whole newsletter where the fix is that quick.

What I would ask for

International falls guidelines now say that every adult over sixty with balance trouble should be tested for this, whether or not they complain of dizziness. That gives you something concrete to say at your next appointment. Not a vague worry, but a specific request: please test me for positional vertigo.

Where the week lands

On Monday we trained the sideways step. On Tuesday we saw that balance runs on three inputs and that losing two at once is the danger. On Wednesday a popular supplement turned out not to earn its place. And today, the one input I said you could not adjust at home turns out to have a common fault that somebody can often put right in an afternoon. Worth asking about.

⚠ NOT ALL DIZZINESS IS THIS

Get tested, and do not try the manoeuvre alone

The repositioning depends on which ear and which tube, so it needs proper testing first. And some dizziness is something else entirely:

● Dizziness with a sudden severe headache, double vision, slurred speech, weakness or numbness on one side, or trouble walking. Call emergency services. These can be signs of a stroke.

● Dizziness that is constant rather than brief, or comes with hearing loss, ringing, chest pain, or fainting.

● Dizziness that began after a new medication. Blood pressure, heart conditions and medicines all cause it too.

When in doubt, get it checked. PainFree adds to your doctor’s care. It never replaces it.

THIS WEEK’S QUICK WINS

Three ways to carry balance week forward

💬 Say the words out loud

If you get brief spinning when you roll over, look up, or lie back, tell your doctor and ask to be tested for positional vertigo. Those are the words. Vague unsteadiness counts too, and so does a fall.

One sentence • At your next appointment

📝 Note when it happens

Write down what you were doing each time, and how long it lasted. Seconds while turning over points one way. Minutes or hours, or dizziness while sitting still, points somewhere else. That note is genuinely useful to whoever sees you.

A few lines • Position and duration

🦵 Keep the side steps going anyway

Whatever your ears are up to, Monday’s side stepping and a night light on the landing are still the best-supported things you can do yourself. A minute at the counter, most days.

1 minute • The part you control

RESEARCH BRIEF

Common, missed, and treatable

A review in the journal Age and Ageing lays out the figures. In a population study of 75-year-olds, 10% had positional vertigo. In a general geriatrics clinic it was 9%. Among people referred to falls clinics it reached 39%, and around a quarter of those had not reported any dizziness at all when asked. The review calls it an underdiagnosed problem that reduces quality of life and raises the risk of falling. Treatment is a repositioning manoeuvre, with reported success commonly above 80%, though older adults may need a second attempt more often than younger ones. Two honest notes. Some unsteadiness can linger for a week or two after successful treatment. And it does come back for some people, with recurrence estimated at roughly 15 to 20% a year.

39%

of people referred to falls clinics were found to have it

1 in 10

75-year-olds had it in a population study

80%+

commonly reported success from repositioning the crystals

A cause of falling that is found by a test taking minutes and often fixed by moving somebody’s head. It deserves to be better known than it is.

WORTH KNOWING

1 in 4

Of the people found to have this at falls clinics, roughly one in four had never mentioned feeling dizzy. In older adults it often shows up as plain unsteadiness rather than the room spinning. Which is why the guidelines now say to test for it on the basis of balance trouble alone, not on whether somebody uses the word dizzy.

From a review in Age and Ageing.

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