Poor sleep quality worsens vertigo in patients with benign paroxysmal positional vertigo: Study

A recent study published in the Nature and Science of Sleep found that poor sleep quality significantly increases the severity of vertigo in individuals suffering from benign paroxysmal positional vertigo (BPPV), with anxiety and depression playing an important mediating role.

Based on baseline data from a large cohort of 1,056 BPPV patients in Northwest China, this study highlights the complex interplay between sleep disturbances and vertigo severity. Using the Pittsburgh Sleep Quality Index (PSQI) for sleep, the Dizziness Handicap Inventory (DHI) for vertigo severity, and various psychological assessment scales like the Hospital Anxiety and Depression Scale (HADS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS), this study conducted detailed statistical modeling to understand the associations.

The study found patients who reported poor sleep were more than twice as likely to experience severe vertigo symptoms when compared to the individuals with adequate sleep (Odds Ratio: 2.024; 95% CI: 1.571–2.608). Moreover, there was a clear dose-response relationship; as PSQI scores rose above 7, which indicates worsened sleep quality and increased vertigo symptoms in parallel.

The mediation analyses revealed that psychological distress significantly influenced the link between sleep and vertigo. Anxiety accounted for 28.5% of the mediating effect, depression for 38%, and the HADS scale as a combined psychological index explained 37.7% of the association. This means that sleep quality does not just affect vertigo directly, it does so largely through its impact on the mental health of patients.

This research explained that the PSQI total scores showed statistically significant correlations with all three subscales of the DHI (physical, emotional, and functional), which suggests that sleep disturbance affects every aspect of the vertigo experience. The study authors highlight that treating sleep problems and providing psychological support could play a central role in improving outcomes for BPPV patients. Conventional treatment for BPPV often focuses on physical maneuvers and balance therapy, but this new evidence suggests a more holistic approach could be more effective.

Integrated care strategies that include cognitive behavioral therapy for insomnia (CBT-I), relaxation training, and screening for anxiety and depression could help reduce both vertigo and its psychological burden. Overall, this study is among the first to robustly quantify the mediating role of mental health in the sleep–vertigo connection in BPPV. The results illuminate the importance of multidisciplinary intervention, combining sleep hygiene practices and psychological care in the routine management of BPPV.

Reference:

Xing, J., Xu, X., Shan, H., Wu, J., Liu, P., Shi, W., Ren, P., Liu, J., Huang, Y., & Mi, B. (2025). Association between sleep and vertigo severity in benign paroxysmal positional vertigo: Mediating role of psychological factors. Nature and Science of Sleep, 17, 1477–1490. https://doi.org/10.2147/nss.s529355