The Epley maneuver, also known as the Canalith Repositioning Procedure (CRP), is a highly effective treatment for Benign Paroxysmal Positional Vertigo (BPPV). BPPV causes brief episodes of dizziness or spinning sensations due to the displacement of tiny calcium carbonate crystals (canaliths) within the inner ear’s fluid-filled canals. The maneuver uses a sequence of precise head and body movements to guide these loose crystals back into the utricle, where they can be harmlessly reabsorbed. Following specific care instructions immediately afterward significantly enhances the success of the treatment. These precautions allow the newly repositioned particles time to settle and adhere to the inner ear tissue, preventing them from floating back into the semicircular canals.
Immediate Post-Maneuver Positioning
Immediately following the Epley maneuver, patients should avoid lying down flat for the next few hours, typically one to four hours. This initial upright position allows the relocated inner ear crystals a chance to stabilize before gravity or movement can dislodge them again. The procedure itself can sometimes cause brief dizziness or lightheadedness, known as “quick spins” or liberation vertigo. Because this temporary residual dizziness occurs as debris moves through the canals, patients must wait at least ten minutes after the maneuver before leaving the office.
Patients should not attempt to drive themselves home immediately after the procedure. If any residual dizziness or a sense of being “off-balance” persists, arranging for a ride home is a necessary safety precaution. Throughout these first hours, maintaining a relatively vertical head position is advised, avoiding any significant forward or backward tilting of the chin. Some practitioners may suggest using a soft neck collar to help limit unconscious head movements.
Restrictions on Head and Body Movement
For the first 24 to 48 hours after the procedure, patients must exercise caution with activities that involve rapid or extreme changes in head position. Do not engage in activities that cause the head to drop below the level of the heart, such as bending over to tie shoes or pick up dropped objects. Instead of bending at the waist, patients should squat or bend at the knees to keep the head relatively level.
Looking sharply upward or extending the neck backward should also be avoided. This means temporarily skipping tasks like reaching for items on a high shelf or washing hair over a sink. Activities requiring significant head movement, such as going to the hairdresser or the dentist, should be postponed for at least two days. When performing tasks like shaving or applying eye drops, individuals should bend their bodies forward to keep the head vertical, rather than tilting the head back.
Strenuous exercise, running, and contact sports are prohibited for the initial 48-hour period. This restriction includes avoiding swimming and activities like sit-ups that involve forceful head movements. Sudden or quick head turns, even minor ones, should be replaced with slower, deliberate movements where the entire body turns as a unit.
Sleeping Precautions for the First Few Nights
Specific sleeping adjustments are necessary for the first one to two nights following the maneuver to prevent the loose crystals from migrating back into the sensitive canals. Patients should not sleep on the side that was treated. To help reinforce this, some people place a pillow or physical barrier behind them to prevent rolling over during sleep.
It is recommended to avoid lying flat. The head should be kept elevated at an angle of approximately 45 degrees, which can be achieved by propping up the head of the bed or using several pillows (two to four) to create a semi-recumbent position. Sleeping in a recliner chair is also an effective way to maintain this elevation.
Patients should be mindful of not rolling over suddenly while asleep, as this movement could undo the effects of the procedure. The goal of these precautions is to use gravity to help the crystals settle while the inner ear adjusts. After the first two nights, patients can gradually return to their normal sleeping patterns, though many are advised to continue avoiding the affected side for up to a week.