The Epley maneuver, also known as the Canalith Repositioning Procedure, is a sequence of head movements used to treat Benign Paroxysmal Positional Vertigo (BPPV). This non-invasive therapy is one of the most common and effective treatments for BPPV, a condition characterized by brief, intense episodes of a spinning sensation triggered by changes in head position. While often performed by a healthcare professional, a modified version can be safely and effectively done at home. The procedure works by physically moving misplaced particles within the inner ear to resolve BPPV symptoms.
The Cause of Vertigo and How the Maneuver Works
The vertigo treated by the Epley maneuver originates in the inner ear’s vestibular system, which maintains balance and spatial orientation. Inside the utricle are tiny calcium carbonate crystals, known as otoconia or canaliths, normally embedded in a gel-like membrane. These crystals help the brain sense gravity and linear movement.
Benign Paroxysmal Positional Vertigo occurs when these otoconia become dislodged from the utricle and migrate into one of the three semicircular canals, most commonly the posterior canal. When the head moves, these misplaced particles cause the fluid inside the canal to slosh more than normal. This sends confusing signals to the brain that the body is spinning, even after the head movement has stopped, causing sudden, brief episodes of vertigo.
The Epley maneuver uses gravity and a precise sequence of head and body positions to guide the displaced otoconia out of the semicircular canal and back into the utricle. Once returned, the crystals no longer interfere with the fluid dynamics of the balance canals. The crystals can then dissolve or be reabsorbed by the body, stopping the inappropriate signals and relieving vertigo symptoms.
Performing the Epley Maneuver Safely at Home
Before attempting this maneuver, you must know which ear is affected, as the steps are specific to the side experiencing the vertigo. The maneuver is performed on a bed, starting in a seated position with a pillow placed to rest under your shoulders when you lie down. This ensures your head is positioned correctly in an extended, or slightly hanging, position.
Begin by sitting upright and turning your head 45 degrees toward the affected side. Quickly lie back, keeping your head turned, so your shoulders are supported by the pillow and your head is reclined. Maintain this position for at least 30 seconds, or until any sensation of dizziness subsides.
Next, rotate your head 90 degrees to the opposite side without raising it, so you are looking 45 degrees away from the affected ear. Hold this position for 30 seconds to one minute, or until the dizziness stops. Then, turn your entire body and head another 90 degrees in the same direction, rolling onto your side so you are looking down at the floor.
Hold this final lying position for 30 seconds to one minute. To finish, slowly sit up while keeping your head turned and your chin tucked toward your chest, then return to a neutral, upright position. Repeat the entire sequence up to three times a day until you are free of positional vertigo for 24 hours.
Essential Safety Checks and Post-Maneuver Care
While the Epley maneuver is safe, consult a healthcare professional before self-treating, especially if you have existing health conditions. The procedure is not recommended for individuals with neck or back injuries, a detached retina, or vascular issues that may be aggravated by rapid neck movements. A medical evaluation can confirm BPPV is the correct diagnosis and that the maneuver is appropriate for you.
Immediately after performing the maneuver, some individuals may experience temporary, intense dizziness or nausea. Wait about ten minutes after the procedure before moving around significantly, and avoid driving right away. If symptoms persist or worsen after several attempts, professional medical attention is necessary to rule out other causes of dizziness.
For at least one night following the procedure, sleep with your head elevated, such as by using two pillows or sleeping in a recliner, to maintain an angle of about 45 degrees. For the next few days, avoid positions that cause your head to tilt far back or forward, and avoid sleeping on the affected side. These precautions help ensure the newly repositioned crystals remain settled in the utricle and maximize the chances of a successful outcome.