Summary
Waking up with sudden dizziness (vertigo) is usually caused by dislodged calcium crystals in the inner ear (BPPV – Benign Paroxysmal Positional Vertigo). The Epley maneuver is a head positioning technique that can be done at home, returning these crystals to their correct position with the help of gravity. It provides significant relief in most patients within a single session.
What is Benign Paroxysmal Positional Vertigo (BPPV)?
The balance center in our inner ear is located. Imagine narrow, fluid-filled bone canals that sense our movements, and a common chamber where their ends open. In the common chamber, there are marbles stuck to the wall, and these sense gravity and acceleration. Sometimes, the marbles can break loose and get into the canals. In this case, the nerve endings in the canals transmit the unusual stimulus from these marbles (ear crystals) to the brain. We perceive the feeling of dizziness as a sensation of movement that isn't actually happening, caused by the marbles that have moved to the wrong place.
How to perform the Epley Maneuver
The Epley maneuver is a “gravity” journey that allows crystals to exit the semicircular canals in the ear and return to their proper place. Before starting the procedure, place a pillow on the bed so that it will be under your shoulders when you lie down.
- Preparation:Sit on the bed and lean your head to the affected side (for example, to the right if your right ear is affected) 45 degrees Translate.
- Lying downLie quickly on your back with your shoulders on the pillow, without changing the position of your head. Your head should hang slightly back off the bed (about 30 degrees down). Stay in this position until the dizziness passes or for approximately 30-60 seconds
- Head TurnWithout lifting your head, slowly to the other side (left) 90 degrees Your head should now be looking towards your left shoulder. Here too 30-60 seconds
- Body TwistKeeping your head in the same position, turn onto your left side with your entire body. Your nose should now be pointing at the floor. Again 30-60 seconds
- Correction:Slowly lower your head forward (with your chin close to your chest) and transition to a seated position on the edge of the bed.
Which side should I start the maneuver from?
The Epley maneuver is applied in the opposite direction of the ear causing dizziness. To determine the correct side, your doctor will perform a special test (Dix-Hallpike test) during the examination and show you which side to start with.
If you haven't had a doctor's examination yet, it is not recommended that you self-diagnose and attempt maneuvers on your own — because a maneuver performed on the wrong side may not be beneficial and could lead to unnecessary discomfort. Instead, it might be a clue you notice in your daily life: Dizziness is usually felt more intensely when you lie down on that side or turn in that direction. Sharing this information with your doctor can speed up the diagnosis.
The steps in this article are intended as a reminder/review guide for patients who have already had their affected ear identified by their doctor.
Post-Maneuver Precautions
After the maneuver, it is important to avoid sudden head movements and to prevent the head from drooping backward for 2 days (keep the head elevated with 2-3 pillows while lying down) for the success of the maneuver.
When should you go to the doctor?
If any of the following conditions are present, you must consult an ENT specialist before attempting any maneuvers at home:
- If dizziness is accompanied by a severe headache, blurred/double vision
- Slurred speech, weakness in the face or one side of the body
- If dizziness lasts more than a few days or is getting worse
- If there is clouded consciousness or loss of balance that poses a fall risk
These symptoms may indicate a neurological cause other than BPPV and require urgent evaluation.
Frequently Asked Questions
The Epley maneuver takes about 10-15 minutes.
The maneuver itself usually takes a few minutes; however, you must hold each position for the specified duration (usually 60 seconds).
How many times should the Epley maneuver be repeated?
A maneuver can be applied once per session. If symptoms persist, reapplication under a doctor's supervision or sometimes more specialized maneuvers can be planned.
Is it normal to feel dizzy/nauseous during a maneuver?
Yes, a temporary increase in dizziness as crystals move within the canal is to be expected. This can be a sign that the maneuver is effective.
How long should I be careful after the maneuver?
After the maneuver 2 days You need to be careful to avoid sudden head movements and to not throw your head back.
Who should not try this maneuver at home?
Individuals with neck or spine problems, serious cardiovascular disease, or symptoms listed in the “When to see a doctor” section, and those not previously directed by a doctor, must consult a physician before attempting any maneuvers at home.
Does crystal play repeat?
BPPV can recur in some patients. In cases of frequent recurrence, an ENT examination is recommended to investigate an underlying cause.