BPPV Vertigo Exercises at Home: Epley Maneuver Guide

What is BPPV and why does it cause vertigo?

Your inner ear contains semicircular canals filled with fluid and lined with hair cells that detect head movement. In a separate chamber, small calcium carbonate crystals (otoconia) normally sit on a membrane that senses gravity.

In BPPV, some of these crystals dislodge and fall into one of the semicircular canals — most often the posterior canal. When you tilt your head in certain directions, the displaced crystals shift, causing false fluid movement the brain interprets as spinning.

The result is brief but intense rotational vertigo — typically lasting 10 to 30 seconds — triggered by rolling over in bed, looking up, bending forward, or other specific movements. Nausea often accompanies it. Importantly, BPPV does not cause constant dizziness; it is specifically positional.

How effective is the Epley maneuver?

The Epley maneuver (also called canalith repositioning) is the best-supported treatment for posterior canal BPPV, the most common form. Clinical practice guidelines from the American Academy of Otolaryngology — Head and Neck Surgery strongly recommend it as the primary intervention 1Ref 1Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017).Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).Canalith repositioning (Epley maneuver) as the primary recommended treatment for posterior canal BPPV; clinical diagnosis with Dix-Hallpike; imaging not routinely indicated2Ref 2Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017).Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.Summary recommendation for canalith repositioning and home instruction for BPPV.

A Cochrane review found the Epley maneuver is significantly more effective than sham maneuvers, with a large proportion of people achieving complete resolution of symptoms after one or two sessions 3Ref 3Hilton MP, Pinder DK (2014).The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo.Epley maneuver significantly more effective than sham for BPPV resolution. Clinical guidelines note that it is safe, effective, and can be performed in an office or taught for home use 2Ref 2Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017).Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update) Executive Summary.Summary recommendation for canalith repositioning and home instruction for BPPV.

How is the Epley maneuver performed?

The following describes the standard Epley for the right posterior canal — the side is mirrored if the left ear is affected. A clinician or trained specialist should confirm which ear and which canal are involved before you attempt this at home.

1. Start seated on a bed or exam table, turn your head 45 degrees to the right (toward the affected ear). 2. Lie back quickly with your head still turned and your head hanging slightly off the edge if possible. Hold for 30 seconds (or until the dizziness resolves). 3. Turn your head 90 degrees to the left (now facing 45 degrees to the left). Hold for 30 seconds. 4. Roll your body to the left so your whole body faces the floor. Hold for 30 seconds. 5. Sit up slowly on the left side.

You may feel vertigo during the maneuver — that is expected and means the crystals are moving. If you are unsure which ear is affected, or if the maneuver provokes intense prolonged dizziness (more than a minute), see a specialist before continuing at home.

Are there other exercises for BPPV?

Brandt-Daroff exercises are sometimes prescribed to habituate the balance system when repositioning has not fully resolved symptoms. They involve repetitive side-lying movements and are generally used as a complement to, not a replacement for, the Epley maneuver.

For horizontal canal BPPV (a less common variant), a different maneuver called the Barbecue roll (log roll) is used instead of the Epley. Correctly identifying the canal involved is essential — using the wrong maneuver will not help and may move crystals in the wrong direction.

Vestibular rehabilitation, led by a trained vestibular physical therapist, is recommended when symptoms persist or recur frequently 4Ref 4McDonnell MN, Hillier SL (2015).Vestibular Rehabilitation for Unilateral Peripheral Vestibular Dysfunction.Vestibular rehabilitation as effective for persistent symptoms of peripheral vestibular dysfunction.

Who should evaluate and treat BPPV?

An audiologist, ENT (otolaryngologist), vestibular physical therapist, or neurologist experienced in vestibular disorders can diagnose BPPV using a positional test called the Dix-Hallpike maneuver. The characteristic eye movement (nystagmus) it produces tells the clinician which canal is involved.

Clinical guidelines recommend against ordering imaging such as MRI or CT as a routine first step for suspected BPPV — the diagnosis is clinical 1Ref 1Bhattacharyya N, Gubbels SP, Schwartz SR, Edlow JA, El-Kashlan H, Fife T, et al. (2017).Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo (Update).Canalith repositioning (Epley maneuver) as the primary recommended treatment for posterior canal BPPV; clinical diagnosis with Dix-Hallpike; imaging not routinely indicated. Gale can help you think through your dizziness and determine whether BPPV is a likely explanation, then refer you to the right specialist for confirmation and treatment.