The Epley maneuver is a common, non-invasive procedure used to treat Benign Paroxysmal Positional Vertigo (BPPV). BPPV occurs when tiny calcium carbonate crystals (otoconia) become dislodged from the utricle and migrate into the semicircular canals of the inner ear. The Epley maneuver, also known as the Canalith Repositioning Procedure, uses specific head movements to guide these crystals back into the utricle, resolving vertigo. Post-maneuver care is important to ensure the crystals settle correctly and prevent immediate recurrence.
Immediate Post-Maneuver Precautions
For the first 24 to 48 hours after the procedure, the primary goal is to maintain a head position that encourages the otoconia to settle and adhere to the gelatinous membrane in the utricle. Immediately following the maneuver, it is often recommended to remain seated upright for about 10 minutes to allow any brief bursts of vertigo, known as “quick spins,” to pass before leaving the clinic. Avoid driving yourself home, as residual dizziness may impair your ability to operate a vehicle safely.
For the first night, sleep in a semi-recumbent position, meaning the head is elevated halfway between flat and upright (about 45 degrees). This can be achieved using a recliner or two or more pillows to prop the upper body. Also, avoid sleeping on the affected ear for several nights, as this position risks the crystals falling back into the canal.
Head movement must be restricted, especially sudden or quick turns, bending, or extreme positions that move the head far up or down. Avoid activities such as bending over to tie shoes or pick up objects from the floor, and refrain from exercises like sit-ups or “crawl” swimming for at least one week. Be cautious in situations that require head extension, such as at the dentist’s office or while having hair washed at a salon sink, as these positions can disrupt the newly settled crystals.
Managing Expected Residual Symptoms
Even after a successful Epley maneuver, it is common to experience what is known as residual dizziness, which is distinctly different from the intense spinning vertigo of BPPV. This lingering sensation does not indicate the maneuver has failed, but rather that the brain is adapting to the corrected signals from the inner ear. Symptoms often include a generalized sense of imbalance, lightheadedness, or mild unsteadiness when walking or turning the head.
This temporary discomfort may manifest as a feeling of “fogginess” or being slightly “off-kilter.” The brain takes time to recalibrate and trust the corrected input after processing faulty signals during active BPPV. Coping strategies involve moving slowly and deliberately, especially when changing positions, to give the vestibular system time to adjust.
While dealing with residual symptoms, it is helpful to ensure adequate rest and hydration, as fatigue can exacerbate feelings of unsteadiness. Engaging in gentle, non-vertigo-provoking activities can help the brain re-learn balance faster. If the residual symptoms are severe or cause anxiety, your healthcare provider may recommend specific vestibular rehabilitation exercises to accelerate the brain’s adaptation process.
Timeline for Recovery and Relapse Indicators
Most people experience significant relief from the acute spinning vertigo immediately or within a few days of the Epley maneuver. Full resolution of symptoms, including the residual dizziness, typically occurs within one to four weeks. While some post-maneuver precautions may be lifted after the initial 48 hours, most clinicians suggest avoiding provoking head positions for a full week to minimize the risk of recurrence.
A successful recovery is defined by the complete and sustained absence of the original spinning vertigo that was triggered by specific positional changes. Patients are generally cleared to return to all normal activities, including more strenuous exercise, once they have been completely symptom-free for a specified period. The long-term recurrence rate for BPPV is about 30% within three years, meaning the condition can return.
If the original, severe, spinning vertigo returns, especially with the same positional triggers, it indicates a relapse or an unsuccessful maneuver. Contact your treating physician or therapist if the intense vertigo returns, or if milder residual symptoms persist for more than a few weeks without improvement. Re-evaluation is important because the crystals may have moved into a different canal, requiring a modified treatment.