The sensation of the room spinning, known as vertigo, is commonly caused by Benign Paroxysmal Positional Vertigo (BPPV). BPPV occurs when tiny calcium carbonate crystals, called otoconia, become dislodged from their normal position in the inner ear and migrate into one of the semicircular canals. These misplaced crystals disrupt the fluid movement, sending incorrect signals to the brain about head movement. The Epley Maneuver is a specific, non-invasive physical therapy technique designed to guide these otoconia back into the utricle, resolving the vertigo symptoms.
Preparing for the Maneuver
Before attempting the Epley Maneuver at home, it is important to confirm that BPPV is the cause of the vertigo, as the maneuver is only effective for this specific condition. A healthcare provider typically uses the Dix-Hallpike test to diagnose BPPV and, crucially, to identify the affected ear. Performing the maneuver on the wrong side can potentially worsen symptoms by moving the crystals into an incorrect canal or deeper into the affected canal.
Once the affected side is identified, preparation involves ensuring a safe environment. Use a bed or firm surface where you can lie back quickly, positioning a pillow to support your shoulders and allow your head to tilt backward over the edge. Because the maneuver can initially provoke intense vertigo, nausea, or vomiting, it is highly recommended to have another person present, especially for the first attempt. People with neck or back problems, a detached retina, or certain vascular conditions should consult a doctor before proceeding, as the forceful head movements may not be appropriate.
Guidelines for Initial Application and Repetition
When performed by a healthcare professional, the maneuver may be repeated two to three times during a single session until the vertigo symptoms or involuntary eye movements (nystagmus) extinguish. A single professional treatment session is often effective, with success rates ranging from 70% to over 90%.
For self-treatment at home, the common recommendation is to perform one full cycle of the Epley Maneuver per day. Some guidelines suggest performing up to three repetitions, or “cycles,” per session, once daily, often at night before sleep. Performing the maneuver at night is preferred, as any residual dizziness can resolve while sleeping. Avoid repeating the maneuver multiple times per hour, as this may be overly irritating to the inner ear.
Each position should be held for a minimum of 30 seconds, or until any sensation of vertigo has completely passed, whichever is longer. This holding time allows the otoconia to settle in the correct location before moving to the next position. Consistent daily application is the standard approach until symptoms have fully resolved.
Recognizing Success and When to Stop
The Epley Maneuver is considered successful when the vertigo symptoms cease entirely, particularly during movements that previously triggered the spinning sensation, such as rolling over in bed or looking up. After a successful maneuver, a person may experience a brief period of residual unsteadiness or mild dizziness for a few days or weeks, but the intense positional vertigo should be gone.
Stop performing the maneuver once you have been free of positional vertigo for 24 to 48 hours. Continuing the procedure unnecessarily can cause minor irritation or potentially dislodge the crystals again. Some professionals recommend avoiding positions that cause extreme head extension or flexion, such as sleeping on the affected side, although the necessity of strict post-maneuver restrictions is debated. To test the resolution of BPPV, cautiously attempt the movement that originally caused the vertigo, ensuring you are in a safe position.
When the Maneuver Fails or Vertigo Returns
Self-treatment should be discontinued, and professional consultation should be sought if certain red flags appear or if the condition persists. These warning signs include a significant worsening of vertigo symptoms, the appearance of new symptoms like severe headache, hearing loss, or weakness. If the vertigo persists after one week of consistent daily application, it indicates that the self-treatment is not working.
Failure can occur if the maneuver was performed incorrectly, if the BPPV is located in a different semicircular canal (such as the horizontal or anterior canal), or if the diagnosis is incorrect. In these cases, a vestibular physical therapist or ENT specialist can reconfirm the diagnosis, check for proper technique, and potentially administer an alternative treatment. Examples include the Semont maneuver or the “BBQ Roll,” which are effective for other canal types.