Part of Dizziness and BPPV
Can BPPV make you tired? Vertigo, tiredness and brain fog
Warning signs, and when to get help
Can BPPV make you tired?
Yes. Tiredness during a bout of positional vertigo is a documented feature of it, not a sign that you are making heavy weather of a minor problem.
Before the study, the limit that goes with the answer. Tiredness is the easiest symptom in medicine to explain away, and an ear that has been spinning hands you a ready explanation for it. Tiredness that is new, that you cannot account for, or that has been building over weeks is a question for your doctor in its own right, and the section further down on what else it can be is the one to read if you read only one.
One study has measured it, and only its summary is available to read, so what follows is what that summary states and nothing past it. Pollak and Stryjer asked 172 adults who were being treated for idiopathic BPPV at one center in 2011 and 2012 about fatigue over the previous week, using the Fatigue Severity Scale. Forty of them, 23.2 percent, reported fatigue, at a level the authors called moderate (Pollak and Stryjer, 2015).
Two of their findings carry more weight than the percentage. The fatigue scores did not track anxiety or depression in that group, which means the tiredness was not simply low mood under another name. And the scores did not vary with the type of BPPV, whether it had come back, how long each spell of vertigo lasted, the person's sex or their other health conditions. The authors also reported that fatigue was more of a feature in the younger patients than the older ones, which is the reverse of what most people expect.
What none of that explains is the mechanism. Nobody has shown what produces the tiredness, and this page is not going to fill that gap with a guess dressed up as physiology.
One line of orientation before the rest. BPPV is short-lived spinning set off by a change of head position, and what it is, how it is diagnosed and how it is treated all sit on the main page for dizziness and BPPV. That page is also where the treatment lives, because a repositioning maneuver depends on which ear and which canal are involved, and this site publishes no steps for one.
Why does vertigo make you tired when the spells are short?
A spell is brief, and the main page sets out how brief, from its own source. The day you build around it is not.
Think about what the last week has actually cost you. Bracing before you roll over. Getting out of bed in stages rather than in one movement. Turning your head as though it were on a hinge that might break. Then the stretch after a bad spell, when you sit on the edge of the mattress sweating and swallowing and waiting for the room to stop, which outlasts the spinning that caused it and takes far more out of you.
Add the watching. Once a particular movement has thrown you across a room, part of your attention stays permanently on the next one, and attention spent that way is not available for anything else. Shoulders and neck hold tighter than they need to. Rooms you used to walk through get planned.
None of that has been measured in a study we could read, and we are not going to pretend otherwise. It is simply what people describe, in almost the same words, week after week.
If your nights are the problem rather than your days, that is a subject of its own, and sleeping position with BPPV takes it further than this page does.
Two explanations circulate online and neither belongs here. One is that the tiredness is your brain working hard to compensate. The other is that it is a sign of recovery. Neither appears in anything we read for this page. They might turn out to be true, and telling an exhausted person that their exhaustion is a progress report is a poor thing to do on a hunch.
What people mean by brain fog with vertigo
Usually three things at once: words arriving slower than they should, losing the thread halfway through a sentence, and screens or spreadsheets becoming unreasonably hard work. Some people also describe walking into a room and losing the reason they went.
Here is where the evidence runs out. No source we read has measured memory, attention or any other part of thinking in people with BPPV, so you will not find a sentence here telling you that vertigo impairs your cognition. Brain fog is a description people give, not a result anybody has produced.
What is easy to account for is less alarming than the term sounds. Broken sleep, the effort of staying upright, nausea and a running background check on your own balance will flatten anybody's concentration, and none of it says anything about your brain being damaged.
There are other routes to the same complaint, and they get mistaken for each other. The NHS lists poor memory and brain fog among the symptoms of menopause and perimenopause, and vertigo in the menopause deals with that overlap. Separately, dizziness and unsteadiness that have run on for months, most days, with no spinning, have their own named diagnosis, which a clinician makes after an assessment rather than from a page (Staab and colleagues, 2017). Which of your symptoms belongs to which story is not something to settle on your own.
Fog with no explanation, like tiredness with no explanation, is a reason to see your doctor rather than to keep reading about ears.
Does being this tired mean the vertigo is not getting better?
Not on its own, and the study above is the reason for saying so. Fatigue scores in that group did not depend on the type of BPPV, on whether it had come back or on how long the spells lasted (Pollak and Stryjer, 2015). A symptom that does not track any of those is a poor progress meter.
What does deserve a second look is a change in the pattern rather than a change in how tired you are. Spinning that has turned into dizziness present all the time, treatment that has not worked, or new symptoms joining the old ones are all reasons to go back rather than to wait. The guideline behind the main page advises clinicians to check again for BPPV that has not cleared and for other inner ear or brain causes when treatment has not worked, and dizziness and BPPV sets out what that reassessment involves.
Some cases of dizziness are not BPPV at all, and a handful of other inner ear and migraine-related diagnoses explain a good share of them. Those belong on the page about what else vertigo can be, which is the only place on this site that describes them, so you are not reading four partial accounts of the same condition.
Tiredness and dizziness together: what else it can be
This is the part of the page that matters most, because the ear is a tidy explanation and a tidy explanation is how a treatable problem gets left alone for six months.
The NHS lists several causes of dizziness that have nothing to do with the balance organs, and the overlap with tiredness is obvious once you see them written down. Iron deficiency anemia is on that list. So is low blood sugar because of diabetes, along with dehydration, heat exhaustion, an ear infection, migraine, motion sickness, and stress or anxiety. Where dizziness has no obvious cause, the same page pairs the pattern with the likely reason: dizziness on standing or sitting up suddenly with a sudden drop in blood pressure, feeling off balance with hearing loss or ringing in the ears with an inner ear problem, spinning and sickness after a cold or flu with labyrinthitis, and dizziness that started after a new prescription with a side effect of the medicine.
Read that list again with your tiredness in mind. Anemia, blood sugar, blood pressure and a medicine review are settled by a blood test, a cuff and a conversation, usually inside one appointment. None of them is settled by vestibular exercises.
So here is the one instruction this page exists to give, and it now has its own line in the warning list below. New tiredness, tiredness you cannot account for, or tiredness that has been getting worse over weeks or months is its own medical question. Book an appointment with your doctor about the tiredness itself. The line below sets out what else to mention, including the symptoms that change the answer. Do that whether or not anyone has explained your dizziness, and never stop or change a prescribed medicine on your own.
One boundary, since the internet will offer it to you as the answer within about two clicks. Anxiety is on the NHS list of causes of dizziness, and in the study on this page fatigue did not correlate with anxiety or depression at all. So being tired with BPPV is not evidence that you are anxious, and vertigo, stress and anxiety handles that question properly rather than using it to tidy this one away.
Why a search for BPPV fatigue brings up something else
If you have searched for this already you will have hit a wall of papers that seem to be about your symptom and are not.
In the research literature, BPPV fatigue is a technical term for something quite different: the positional nystagmus and the dizziness decreasing with each repetition when a clinician repeats the provoking test, an effect thought to come from lumps of otoconial debris breaking into smaller parts (Imai and colleagues, 2023). It describes what happens to the eye movement and the spinning on repeated testing in a clinic. It says nothing whatever about how tired anybody feels.
That is worth knowing for a practical reason. If you tell a clinician you have fatigue, there is a small chance they hear the technical meaning. Say exhausted, wiped out, or that you are sleeping in the afternoons, and the ambiguity disappears.
What helps, and where exercise fits
Start these exercises only after a doctor or vestibular physio has found the cause of your dizziness. New dizziness, or dizziness that has changed, needs checking first.
With that settled, the honest list of what helps is short. Getting the diagnosis made and the right treatment done is the first thing, because an untreated positional vertigo keeps generating the spells that are costing you the day. For unsteadiness that lingers afterward there is a graded program of gaze, balance and walking work, which the APTA guideline describes as gaze stability and habituation training (Hall and colleagues, 2022). The staged version of it, with the doses and the stop rules, sits on dizziness and BPPV rather than here, and your own physio sets what you do and how much.
Beyond that, some things are worth doing for the tiredness itself. Put the demanding parts of your day where your head is at its steadiest, which for most people is not first thing. Turn the light on before you get up in the night, and sit on the edge of the bed for a few seconds before you stand. Sit down straight away when you feel dizzy. Do not drive, climb ladders or use machinery while you feel dizzy (NHS dizziness), and that applies to the swimmy, tired part of the day as much as to a spell. A walking stick is reasonable if you are at risk of falling, and the wider plan for that is on balance and falls prevention.
Tell whoever is treating you that you are exhausted. It belongs in the history, and the fact that nobody has explained it yet is not a reason to leave it out. Other pages in this area are grouped under balance and dizziness if you want to see what else is here.
When tiredness with dizziness needs checking
Call emergency services straight away for any sign of a stroke, even if it goes away: sudden dizziness with unsteadiness or falling over, a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack).
Every line in the warning list at the end of this page carries its own time frame, and they are not interchangeable. Some mean emergency services now. Some mean advice today. The last one means an appointment within a few days so that the cause of your spinning gets confirmed and treated, which is the step most readers of a page like this have not taken yet.
Two of those lines exist because of the exact mistake a page about tiredness invites. Dizziness that is there all the time for a day or more, rather than in short spells when you move your head, is not behaving like BPPV, and it carries a same-day route for that reason. A racing, pounding or irregular heartbeat with dizziness or faintness carries an emergency route, because that combination is easy to file under being run down.
And the tiredness itself, if it is new, persistent or unexplained, goes to your doctor on its own ticket. Not because your vertigo is dangerous, but because tiredness is not an ear symptom, and the ear is not where that question gets answered.
Related exercise programs
Warning signs
Get emergency help now
- Emergency: call emergency services straight away for any sign of a stroke, even if it goes away: sudden dizziness with unsteadiness or falling over, a face that droops on one side, an arm you cannot lift or keep up, slurred or muddled speech, weakness or numbness on one side of your body or face, sudden blurred vision, double vision or loss of sight, trouble swallowing, a sudden severe headache, or a sudden fall where your legs give way but you do not black out (a drop attack).
- Emergency: vertigo or dizziness together with new hearing loss, double vision or loss of vision, trouble speaking, or weakness, numbness or tingling in an arm or leg. Call emergency services or go to an emergency department straight away.
- Emergency: dizziness with a new, severe headache, or a sudden, severe headache that feels unlike anything you have had before. Call emergency services straight away.
- Emergency: a new headache or neck pain, or both, that does not feel like ordinary neck pain. If this is your first bout, judge it by how it behaves rather than by how it compares. Either of the next two is enough on its own. One, it came on suddenly, in a single moment, even if it is not severe and even if it has eased since. Sudden onset counts on its own. Two, nothing you do changes it much: no position or rest makes a real difference, and after the first day or two it has not started to settle. It counts even if you have none of the other emergency signs above, and it matters more if it started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated. Go to an emergency department straight away, or call emergency services if you cannot get there safely, and do not drive yourself. Do not start these exercises, and do not have any hands-on treatment to your neck, until your neck has been checked. A tear in an artery in the neck can start as pain alone, often on one side, with nothing else to find. If you can find a position that eases it, follow the same day warning sign for this below instead.
- If chest pain, pressure or tightness does not ease quickly when you rest, spreads to your arm, neck, jaw, stomach or back, or comes with sweating, feeling sick, feeling light-headed or being short of breath, call emergency services straight away, as this can be a heart attack. If it eases quickly and none of these happen, get medical advice the same day, and do not exercise again until you have been checked.
- Emergency: a racing, pounding, fluttering or irregular heartbeat that does not settle when you rest, or that comes with dizziness, feeling faint or fainting, chest pain or shortness of breath. Call emergency services straight away. If it has already stopped, get medical advice the same day.
- Emergency: you have just fallen and cannot get up, or you think you may have hurt your head, neck, back or hip. Stay where you are, keep warm and call emergency services, or get someone to call for you. If you got up and walked without trouble and only notice pain later, use the same-day lines in this list instead.
- Emergency: you fell and cannot remember the fall or how it happened. Go to an emergency department straight away, and do not drive yourself. You may have blacked out or hit your head without knowing it.
Get help today
- Same day: a new headache or neck pain, or both, that does not feel like ordinary neck pain, that started after a neck injury or strain, even a minor one, a bout of heavy coughing, or having your neck manipulated, but that does ease when you change position or rest. Get checked the same day before you start these exercises or have any hands-on treatment to your neck. If nothing you do changes it much any more, or it has not started to settle after a day or two, follow the emergency warning sign for this above.
- Same day: you blacked out or fainted, even for a moment. Get medical advice the same day. Call emergency services instead if the person is not breathing, cannot be woken within 1 minute, has not fully recovered or has trouble speaking or moving, has chest pain or a pounding, fluttering or irregular heartbeat, fainted while exercising or lying down, is shaking or jerking, or was badly hurt.
- Same day: dizziness, lightheadedness, blurred vision or feeling faint when you stand up that is new for you, does not pass within a minute or two, keeps happening, or has made you fall. Sit or lie down, and get medical advice the same day. This can be a drop in blood pressure on standing (postural hypotension), a type of low blood pressure, which the NHS lists among the causes of falls, and your doctor can check it. Tell them about your medicines, because some can cause it. If it does not settle within a few minutes of sitting or lying still, call emergency services. If you faint, use the fainting line above.
- Same day: sudden new dizziness, or feeling faint or unsteady, without any of the stroke signs above. Stop, sit down and get medical advice the same day. If you faint, it does not settle within a few minutes of sitting still, or you cannot stand or walk steadily, call emergency services.
- Same day: dizziness or spinning that has been there all the time for a day or more, rather than coming in short spells when you move your head, without any of the emergency signs above. Get medical advice the same day. If you cannot stand or walk steadily, call emergency services.
- Same day: vertigo with being sick or feeling very sick, a very high temperature, or feeling hot, cold or shivery, without any of the emergency signs above. Get medical advice the same day.
- Same day: you are more short of breath than usual, or short of breath while you are resting or lying down, without any of the emergency signs above. Get medical advice the same day. Call emergency services if you have severe difficulty breathing, are gasping, choking or cannot get your words out, or your lips or skin turn very pale, blue or gray. Breathlessness is not a symptom of the inner ear: the NHS names heart failure and lung conditions among the causes, and it is easy to put down to being run down.
- Same day: after a fall, you are in pain, have hurt yourself or feel unwell, or you were on the floor for an hour or more, without any of the emergency signs above. Get medical advice the same day, even if you managed to get up.
Book an appointment
- Within a few days: short spells of spinning when you lie down, roll over in bed or look up, or dizziness that keeps coming back, without any of the signs above. See your GP or a physio within a few days so the cause can be confirmed and treated.
- Within a few days: you have had a fall, even if you were not hurt, or you keep tripping, stumbling or feeling that your legs might give way. Book an appointment with your doctor within a few days and ask about a falls assessment. Tell them about every fall, even the ones where you were not hurt.
- Routine: you have been tired for a few weeks and you are not sure why, your tiredness is getting in the way of your daily life, or you are tired along with other symptoms such as losing weight without meaning to or a change in your mood. Book an appointment with your doctor about the tiredness itself, say how long it has been there and what else has changed, and let them decide what to test. Tiredness is not a symptom of the inner ear: the NHS names sleep apnea, iron deficiency anemia, diabetes, an overactive thyroid and ME or chronic fatigue syndrome among the conditions behind it, and a blood test settles several of them. Tell your doctor as well if anyone has said you gasp, snort or choke in your sleep. If the tiredness comes with chest pain, feeling faint, or being short of breath while you are resting, use the emergency and same day lines above instead.
Common questions
Does vertigo make you tired?
For a fair number of people, yes. The clearest measurement of it comes from a study of 172 adults being treated for idiopathic BPPV at one center in 2011 and 2012, who were asked about fatigue in the previous week on the Fatigue Severity Scale. Forty of them, 23.2 percent, reported it, at what the authors called a moderate level (Pollak and Stryjer, 2015). Only the summary of that paper is readable, so that figure and its population are the whole of what this page takes from it. Two details in it are worth knowing. The fatigue scores did not track anxiety or depression, and they did not depend on the type of BPPV, whether it had come back, how long each spell of vertigo lasted, the person's sex or their other health conditions. Nothing in that study explains the mechanism, and nothing we read anywhere else does either.
Can vertigo cause extreme fatigue?
The study above measured moderate fatigue, not extreme, so exhaustion beyond that is not something this page can attribute to the ear. That is the useful part of the answer rather than a dodge. Tiredness has plenty of causes that have nothing to do with balance, and the NHS lists iron deficiency anemia and low blood sugar because of diabetes among the causes of dizziness alone, both of which a blood test settles. Dehydration and a new prescription medicine are on the same list. So tiredness that is out of proportion to your spells, that has been there for weeks, or that is getting worse month by month is a reason to see your doctor and have it looked into, not a reason to wait for your balance to improve. Never stop or change a prescribed medicine on your own.
Does vertigo cause brain fog?
Plenty of people describe fog with their dizziness, and no source we read has measured thinking in people with BPPV, so this page does not tell you that vertigo impairs memory or attention. What people usually describe is slower words, losing the thread of a conversation, and screens becoming hard work. Broken nights, the effort of holding yourself steady and the time spent watching for the next spell will all do that to anybody's concentration. Two other things are worth separating out. The NHS lists poor memory and brain fog among the symptoms of menopause and perimenopause, which is a different route to the same complaint, and dizziness that has run for months with fog and unsteadiness most days has its own defined diagnosis that a clinician makes after an assessment (Staab and colleagues, 2017). Fog on its own, with no explanation, is worth taking to your doctor rather than filing under your ear.
Should I worry that vertigo and fatigue mean something serious?
Most tiredness turns out to have an ordinary cause, and most is not a reason to be frightened. That is not the same as a reason to leave it unexplained, which is the mistake this page is most likely to encourage. Two routes matter here and they are different from each other. Sudden dizziness with any sign of a stroke, dizziness with a new severe headache, a racing or irregular heartbeat, fainting, or dizziness that has been constant for a day or more, all appear on the warning list at the end of this page, and each line there carries its own time frame, from calling emergency services to an appointment within a few days. Separately from all of that, tiredness that is new, persistent or unexplained is its own medical question. Book an appointment with your doctor, say how long it has been going on, and let them decide what to test.
References
- Pollak L, Stryjer R. Fatigue during an episode of benign paroxysmal positional vertigo. European Archives of Oto-Rhino-Laryngology. 2015;272(9):2129-2133. https://doi.org/10.1007/s00405-014-3041-3
- Imai T, Uno A, Yamato A, et al. Comparison of the efficacy of the Epley maneuver and repeated Dix-Hallpike tests for eliminating positional nystagmus: a multicenter randomized study. Frontiers in Neurology. 2023;14:1095041. https://doi.org/10.3389/fneur.2023.1095041
- Staab JP, Eckhardt-Henn A, Horii A, et al. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): consensus document of the committee for the Classification of Vestibular Disorders of the Barany Society. Journal of Vestibular Research. 2017;27(4):191-208. https://doi.org/10.3233/VES-170622
- Hall CD, Herdman SJ, Whitney SL, et al. Vestibular rehabilitation for peripheral vestibular hypofunction: an updated clinical practice guideline from the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. Journal of Neurologic Physical Therapy. 2022;46(2):118-177. https://doi.org/10.1097/NPT.0000000000000382
- NHS. Dizziness. https://www.nhs.uk/symptoms/dizziness/
- NHS. Vertigo. https://www.nhs.uk/conditions/vertigo/
- NHS. Menopause and perimenopause symptoms. https://www.nhs.uk/conditions/menopause-and-perimenopause/symptoms/
- NHS. Symptoms of a stroke. https://www.nhs.uk/conditions/stroke/symptoms/
- NHS. Heart palpitations. https://www.nhs.uk/conditions/heart-palpitations/
- NHS. Fainting. https://www.nhs.uk/symptoms/fainting/
- NHS. Chest pain. https://www.nhs.uk/symptoms/chest-pain/
- Rushton A, Carlesso LC, Flynn T, et al. International framework for examination of the cervical region for potential of vascular pathologies of the neck prior to musculoskeletal intervention: International IFOMPT Cervical Framework. Journal of Orthopaedic and Sports Physical Therapy. 2023;53(1):7-22. https://doi.org/10.2519/jospt.2022.11147
- NHS. Falls. Page last reviewed 06 March 2025. https://www.nhs.uk/conditions/falls/
- NHS. Low blood pressure (hypotension). https://www.nhs.uk/conditions/low-blood-pressure-hypotension/
- NHS. Shortness of breath. Page last reviewed 30 January 2024. https://www.nhs.uk/symptoms/shortness-of-breath/
Written and checked by the PocketPhysio editorial team. Last updated 2026-10-18.
This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.