The Epley maneuver is a simple sequence of head movements you can do on your bed to treat the most common type of vertigo. It works by guiding tiny displaced calcium crystals out of the semicircular canals in your inner ear, where they don’t belong, back to a part of the ear where they cause no trouble. The whole process takes about five minutes, and clinical data shows it resolves vertigo in roughly 63% to 85% of people on the first attempt.
Figure Out Which Ear Is the Problem
Before you start, you need to know which ear contains the displaced crystals. The maneuver is performed differently depending on whether your right or left ear is affected, and doing it on the wrong side won’t help.
The standard clinical test for this is called the Dix-Hallpike maneuver. A provider turns your head 45 degrees to one side, then quickly guides you from sitting to lying back with your head hanging slightly below the surface of the table. If your eyes start making small, involuntary jerking movements (called nystagmus) and you feel a surge of dizziness, the crystals are in whichever ear is pointing toward the floor during the test. So if the vertigo hits when your right ear faces down, your right ear is the affected one.
Most people arriving at this article already have a diagnosis from a provider. If you haven’t had one, pay attention to which direction triggers your vertigo in daily life. Rolling over in bed onto one particular side, or tilting your head back in one direction, usually points to the affected ear. That said, getting a proper Dix-Hallpike test first is the most reliable way to confirm the side and rule out other causes of dizziness.
What You Need Before Starting
You need a bed or firm surface long enough to lie flat on, and two pillows. Place one pillow where your shoulders will land when you lie back. This is important: the pillow goes under your shoulders, not your head. When you recline, your head should drop past the pillow and rest on the mattress itself, creating a natural backward tilt of about 20 to 30 degrees at your neck. A dense pillow roughly 10 centimeters (about 4 inches) thick works well for this. The second pillow can go nearby in case you need extra comfort.
Have someone nearby if possible, especially the first time. The maneuver will temporarily trigger vertigo and possibly nausea as the crystals move through the canal. That’s actually a sign it’s working, but it can be disorienting.
Step-by-Step for the Right Ear
Use these steps if your right ear is the affected side.
- Step 1: Sit upright on your bed with your legs stretched out in front of you. Turn your head 45 degrees to the right, roughly halfway between looking straight ahead and looking over your right shoulder.
- Step 2: Keeping your head turned, quickly lie back so your shoulders land on the pillow and your head reclines past it, touching the bed. Your head should still be rotated 45 degrees to the right. Hold this position for 30 seconds. You will likely feel dizzy here.
- Step 3: Without lifting your head, turn it 90 degrees to the left. Your head will now be angled 45 degrees to the left. Stay still for 30 seconds.
- Step 4: Turn your head and your body another 90 degrees to the left, rolling so you’re almost face-down into the bed. Wait 30 seconds.
After the final 30 seconds, slowly sit up on the side of the bed. Stay seated for a minute or two before standing.
Step-by-Step for the Left Ear
Use these steps if your left ear is the affected side. The sequence mirrors the right-ear version.
- Step 1: Sit upright on your bed with your legs out. Turn your head 45 degrees to the left.
- Step 2: Keeping your head turned, quickly lie back so your shoulders are on the pillow and your head reclines onto the bed. Hold for 30 seconds.
- Step 3: Without lifting your head, turn it 90 degrees to the right. You’ll now be looking 45 degrees to the right. Hold for 30 seconds.
- Step 4: Turn your head and body another 90 degrees to the right, rolling into the bed. Hold for 30 seconds.
Sit up slowly on the side of the bed and wait before standing.
Why the Timing Matters
Each 30-second hold gives the crystals time to settle into their new position under gravity before you move to the next step. Rushing through the positions can leave crystals behind in the canal, which means the vertigo won’t fully resolve. If the dizziness at any step is still intense at 30 seconds, wait until it calms before moving on. The 30 seconds is a minimum, not a maximum.
How Many Times to Repeat It
You can repeat the full sequence up to three times in a single session. If your vertigo resolves after the first round, you don’t need to do it again. Clinical data shows that patients who aren’t fully better after one attempt often succeed on the second or third try. In studies of the standard Epley maneuver, about 63% of patients improved after one attempt, and 86% after up to three attempts.
If vertigo persists after a few days of daily sessions, the issue may not be posterior canal BPPV, or the wrong ear may have been targeted. That’s a good signal to get reassessed.
What to Expect During and After
The maneuver will trigger a brief but sometimes intense wave of vertigo, especially during step 2 when you first lie back. Some people also feel nausea. This is normal and means the crystals are moving. The dizziness during each position typically peaks and then fades within 30 seconds.
Afterward, you may feel mildly off-balance or “foggy” for a few hours or even a couple of days. This residual unsteadiness is common and doesn’t mean the maneuver failed. It usually clears on its own.
Post-Maneuver Restrictions
The original description of the Epley maneuver recommended sleeping with your head elevated at 45 degrees for 48 hours, avoiding sudden head movements, and not sleeping on the affected ear for up to a week. These precautions were meant to keep the crystals from drifting back into the canals.
More recent research, however, has found that posture restrictions after the maneuver don’t actually change outcomes. A randomized study comparing patients given strict post-maneuver instructions to patients given no restrictions at all found no difference in symptom resolution between the two groups. So while sleeping propped up on two pillows won’t hurt, skipping it likely won’t set you back either.
The Half-Somersault Alternative
If you have neck pain, stiffness, or difficulty lying flat, the half-somersault maneuver (sometimes called the Foster maneuver) is an alternative. Instead of lying back, you start on your hands and knees, tuck your head toward the floor, then rotate it toward the affected ear before sitting up. It targets the same canal as the Epley.
The tradeoff is speed versus comfort. In a comparative study, the Epley resolved vertigo in 61% of patients after one attempt, while the half-somersault resolved it in 35% on the first try, with more patients needing three or four repetitions to get relief. But the half-somersault caused significantly less dizziness and nausea during the procedure, and patients reported feeling better psychologically afterward. For people who find the Epley too intense or physically difficult, it’s a reasonable option that works with more repetitions.
That said, the half-somersault still requires getting on the floor and tucking forward, so it’s not necessarily easier for people with knee or back injuries.