Vertigo or light-headedness?
- Vertigo: a feeling that you or the room are spinning; usually from the inner ear.
- Light-headedness: feeling faint, woozy or about to pass out; often blood pressure or blood sugar related.
- Unsteadiness: feeling off-balance when walking.
Telling these apart helps find the cause. See sinus dizziness.
BPPV: spinning when you roll over
Benign paroxysmal positional vertigo is the most common cause of vertigo. Small calcium crystals in the inner ear become dislodged and move into one of the semicircular canals. When the head moves into certain positions, such as rolling over in bed or lying back, the crystals move and cause intense spinning for 10 to 60 seconds, sometimes with nausea.
BPPV is more common after age 50, after head injuries and after periods of bed rest. It is diagnosed with a positional test and treated with repositioning manoeuvres, which work in most people within one to three sessions.
Blood pressure drop on standing
When you stand up, blood pools in the legs and blood pressure briefly falls. Normally the body compensates within seconds. If it does not, you feel light-headed, see spots or feel faint. This is called orthostatic or postural hypotension and is more common in the morning, in older adults, with dehydration, after alcohol and with medicines for blood pressure, prostate problems or depression.
Other causes of morning dizziness
- Dehydration: not drinking enough, hot bedrooms, alcohol or illness.
- Low blood sugar: in people taking insulin or some diabetes medicines.
- Medicines: sleeping tablets, antihistamines, blood pressure medicines and others.
- Sleep apnoea: morning headaches, tiredness and dizziness; see morning headaches.
- Vestibular neuritis: severe vertigo lasting days, often after a viral illness.
- Ménière’s disease: attacks of vertigo with hearing loss, tinnitus and ear fullness.
- Vestibular migraine: dizziness with or without headache.
- Anxiety: morning anxiety can cause light-headedness; see morning anxiety.
What you can do
- Sit on the edge of the bed for a minute before standing.
- Move your ankles and legs before getting up.
- Drink a glass of water when you wake up and keep hydrated during the day.
- Limit alcohol, especially in the evening.
- Get up slowly and hold on to something stable.
- If you have BPPV, move your head slowly and sleep slightly propped up until treated.
Repositioning manoeuvres for BPPV
The Epley manoeuvre moves the crystals out of the affected canal through a series of head and body positions. It is best done first by a trained clinician who confirms the affected side. Some people are then taught to repeat it at home. Brief dizziness during the manoeuvre is expected.
How dizziness is assessed
A doctor or ENT specialist asks about the type of dizziness, triggers and duration, checks blood pressure lying and standing, examines the ears and eye movements and may perform positional tests. Hearing tests, blood tests and, occasionally, scans are used depending on the findings. See ear pressure relief.
Dizziness and falls in older adults
Morning dizziness increases the risk of falls, especially when getting up at night to use the toilet. Using a night light, keeping a clear path to the bathroom, sitting before standing and having medicines reviewed reduce the risk. Balance exercises improve stability.
Keeping a dizziness diary
Writing down when the dizziness happens, what you were doing, how long it lasts, whether the room spins or you feel faint, and any other symptoms such as hearing changes, headache or palpitations helps your doctor find the cause. Recording blood pressure lying and standing at home, if you have a monitor, can also help.
When to seek urgent help
- Dizziness with weakness or numbness on one side, slurred speech or a drooping face: call emergency services.
- Sudden severe headache, double vision or difficulty walking.
- Chest pain, palpitations or fainting.
- Sudden hearing loss.
- Repeated falls or dizziness that does not settle.
Key points to remember
- Brief spinning when rolling over in bed is often BPPV, which is very treatable.
- Light-headedness on standing is often a blood pressure drop.
- Sit before standing, stay hydrated and review medicines.
- Dizziness with stroke signs, chest pain or fainting is an emergency.
Questions about waking up dizzy
These answers are general information and do not replace an examination or individual medical advice.
Why do I feel dizzy when I roll over in bed?
BPPV is the most common cause, from crystals moving in the inner ear.
Why am I dizzy when I get out of bed?
A drop in blood pressure on standing is common, especially with dehydration or some medicines.
Can dehydration cause dizziness in the morning?
Yes. Drinking water in the evening and on waking helps.
How long does BPPV last?
Episodes last seconds, but the condition can persist for weeks unless treated with repositioning.
Can sleep apnoea cause morning dizziness?
It can contribute, along with morning headaches and tiredness.
Can anxiety cause dizziness when waking?
Yes, morning anxiety can cause light-headedness.
When should I worry about waking up dizzy?
If it comes with weakness, speech problems, chest pain, fainting or hearing loss.
Can low blood sugar cause dizziness in the morning?
Yes, especially in people taking insulin or some diabetes medicines.
Sources
This guide is for general information and does not replace medical advice. How a problem is diagnosed and treated depends on your examination and medical history. If you think you have an emergency, contact your local emergency services.