Dizziness When Lying Down: 7 Main Causes

Dizziness when lying down is a symptom that can be caused by conditions like labyrinthitis, benign paroxysmal positional vertigo, migraine, or Ménière’s disease. It may happen when getting into bed, turning over, or lying flat.

Depending on the cause, dizziness when lying down may occur with other symptoms, such as hearing loss, nausea, vomiting, memory problems, or sensitivity to light. These symptoms can help the doctor identify what may be causing the dizziness.

If dizziness when lying down is frequent or does not go away, it is recommended to see a primary care provider. Treatment depends on the underlying cause and may include medications, physical therapy, dietary changes, or, in some cases, surgery.

Main causes

The main causes of dizziness when lying down are:

1. Labyrinthitis

Labyrinthitis is inflammation that affects the inner ear, which helps control hearing and balance. It can cause symptoms such as dizziness when lying down or in another position, vertigo, hearing loss, nausea, or general discomfort.

What to do: Treatment recommended by an otolaryngologist (ENT specialist) may include medications such as meclizine or dimenhydrinate, which can help relieve symptoms like dizziness, vertigo, nausea, or vomiting. Vestibular rehabilitation therapy may also be recommended to help improve balance and reduce dizziness.

In addition, avoiding alcohol, quitting smoking, and identifying symptom triggers may help reduce episodes of dizziness.

2. Vestibular neuritis

Vestibular neuritis is an inner ear disorder that can cause symptoms such as dizziness when lying down, sudden and intense vertigo, loss of balance, nausea, and vomiting.

What to do: Treatment usually involves controlling symptoms with medications such as meclizine, promethazine, benzodiazepines, or steroids, which should be prescribed by an ENT. Antivirals may be considered in some cases, depending on the suspected cause.

3. Benign paroxysmal positional vertigo (BPPV)

Benign paroxysmal positional vertigo (BPPV) is an inner ear disorder that causes symptoms such as a spinning sensation, loss of balance, and dizziness when lying down, getting up, turning over in bed, or quickly looking up, for example.

What to do: Treatment should be guided by an ENT or primary care provider.

According to the American Academy of Otolaryngology-Head and Neck Surgery Foundation, canalith repositioning procedures, such as the Epley maneuver, are recommended for posterior canal BPPV. This maneuver uses specific movements to reposition calcium carbonate crystals inside the inner ear.

In some cases, the doctor may also prescribe medications to relieve vertigo, such as meclizine, or medications to help with nausea and vomiting, such as ondansetron or metoclopramide.

4. Migraine

Migraine is a chronic neurological condition that can cause dizziness, including when lying down. It can also cause other symptoms, such as moderate to severe headache, nausea, vomiting, tingling in the body, and sensitivity to light.

What to do: Treatment may be managed by a neurologist, who may recommend anti-inflammatory medications, pain relievers, triptans, or antiemetics. The doctor may also recommend rest and acupuncture.

5. Pregnancy

During pregnancy, pressure from the uterus on blood vessels can cause dizziness when lying down, especially when lying on the back. This happens because the weight of the baby on the vena cava can make it harder for blood to return from the legs to the heart, leading to dizziness.

What to do: According to the American College of Obstetricians and Gynecologists (ACOG), lying on the back during the second and third trimesters can compress a major blood vessel and cause dizziness. To help prevent this, it is recommended to lie on your side or place a pillow under your legs, as this can make it easier for blood to return to the heart.

In addition, avoiding standing for long periods, wearing loose and comfortable clothing, and avoiding hot showers can also help with circulation and prevent dizziness during pregnancy.

However, if dizziness does not improve with these measures, it is important to see your OB-GYN or midwife for a full evaluation.

6. Ménière’s disease

Ménière’s disease is a rare condition that affects the inner ear. It causes excess fluid to build up inside the ear canals, leading to dizziness when lying down or in any other position, as well as frequent vertigo, hearing loss, and ringing in the ears.

What to do: Treatment recommended by an ENT specialist may include medications to reduce nausea, dizziness, and vertigo, such as meclizine, metoclopramide, or lorazepam.

The doctor may also recommend dietary changes, such as reducing salt intake and avoiding caffeine, chocolate, and alcohol.

7. Head injuries

Head injuries, such as a concussion, skull fracture, or traumatic brain injury (TBI), can happen due to car accidents, sports or recreational activities, or falls. They can cause symptoms such as dizziness when lying down or in another position, vomiting, severe headache, and memory loss.

What to do: In mild cases, treatment may involve pain medication and wound care, such as stitches and/or dressings. In some cases, the person may need to be monitored for 4 to 6 hours before going home.

In moderate or severe cases, surgery may be needed to relieve pressure in the head and control bleeding. In these cases, admission to the intensive care unit (ICU) for a few days is usually necessary.

When to see a doctor

It is recommended to see a doctor when dizziness when lying down is persistent or occurs with other symptoms, such as:

• Difficulty speaking

• Hearing loss

• Fever

• Vision loss or double vision

• Chest pain

• Tingling or numbness

It is also important to see a primary care provider in cases of fainting, or if the person has a high risk or history of stroke.