Summary
Waking up with sudden dizziness (vertigo) is usually caused by calcium crystals in the inner ear moving out of place (BPPV — benign paroxysmal positional vertigo). The Epley manoeuvre is a head-positioning technique that uses gravity to return these crystals to the right place and can also be done at home. In most patients it brings marked relief in a single session.
What is BPPV?
Our balance centre is in the inner ear. Imagine narrow, fluid-filled bony canals that sense our movements, and a shared chamber into which their ends open. In that chamber there are tiny marbles stuck to the wall, and they sense gravity and acceleration. Sometimes the marbles come loose and slip into the canals. When that happens, the nerve endings in the canals pass this unusual signal from the marbles (the ear crystals) to the brain. We feel the sensation of movement that “is not really happening” — caused by marbles that have slipped where they should not be — as dizziness.
How is the Epley manoeuvre performed?
The Epley manoeuvre is a “gravity journey” that lets the crystals leave the semicircular canals of the ear and return to where they belong. Before you start, place a pillow on the bed so that it will be under your shoulders when you lie back.
- Preparation: Sit on the bed and turn your head 45 degrees towards the affected side (to the right, for example, if your right ear is affected).
- Lying back: Without changing the position of your head, lie back quickly so that your shoulders are on the pillow. Your head should tilt back slightly over the pillow (about 30 degrees down). Stay in this position until the dizziness passes, or for about 30–60 seconds.
- Turning the head: Without lifting your head, slowly turn it 90 degrees to the other side (to the left). Your head should now be facing your left shoulder. Wait 30–60 seconds here too.
- Turning the body: Keeping your head in the same position, roll your whole body onto your left side. Your nose should now be pointing towards the floor. Again wait 30–60 seconds.
- Sitting up: Slowly tilt your head forward (chin close to your chest) and move to a sitting position on the edge of the bed.
Which side should I start from?
The Epley manoeuvre is performed in a different direction depending on which ear is causing the dizziness. To identify the correct side, your doctor performs a specific test during the examination (the Dix–Hallpike test) and shows you which side to start from.
If you have not yet been examined by a doctor, deciding on the side and trying the manoeuvre by yourself is not recommended — a manoeuvre done on the wrong side does not help and can cause unnecessary discomfort. There may, however, be a clue you notice in daily life: the dizziness is usually felt more strongly when you lie on that side or turn in that direction — sharing this with your doctor can speed up the diagnosis.
The steps in this article are intended as a reminder for patients whose doctor has already established which ear is affected.
What to be careful about after the manoeuvre
For 2 days after the manoeuvre, avoiding sudden head movements and not letting the head tilt backwards (keeping the head raised on 2–3 pillows when lying down) is important for the manoeuvre to succeed.
When should you see a doctor?
If any of the following applies, you must see an ENT specialist before trying the manoeuvre at home:
- The dizziness is accompanied by severe headache or blurred or double vision
- There is slurred speech, or weakness in the face or on one side of the body
- The dizziness lasts more than a few days or keeps getting worse
- There is confusion, or loss of balance that creates a risk of falling
These symptoms may point to a neurological cause other than BPPV and need urgent assessment.
Frequently asked questions
How long does the Epley manoeuvre take?
The manoeuvre itself is usually completed within a few minutes, but you need to wait in each position for the stated time (usually 60 seconds).
How many times should the Epley manoeuvre be repeated?
The manoeuvre can be done once in a session. If symptoms continue, a repeat under medical supervision — or sometimes other, more specific manoeuvres — can be planned.
Is it normal to feel dizzy or nauseous during the manoeuvre?
Yes. A temporary increase in dizziness is expected while the crystals move within the canal. It can be a sign that the manoeuvre is working.
How long do I need to be careful after the manoeuvre?
For 2 days afterwards, take care to avoid sudden head movements and not to tip your head back.
Who should not try this manoeuvre at home?
People with neck or spine problems, those with serious cardiovascular disease, anyone with the symptoms listed under “When should you see a doctor?”, and patients whose doctor has not yet identified the affected side should consult a doctor before trying the manoeuvre at home.
Does BPPV come back?
BPPV can recur in some patients. In cases that recur often, an ENT examination is recommended to look for an underlying cause.