How-to guide
How to Manage BPPV at Home
Quick answer: BPPV causes short spells of spinning when you move your head, such as rolling over in bed or looking up. It happens when tiny crystals in the inner ear come loose, and the Epley maneuver, a set of head and body positions, moves them back into place. The main risk is a fall during a spell, so sit or lie down until it passes. If your doctor has diagnosed or suspects BPPV and has told you which ear is affected, you can do the Epley at home, usually 2 to 3 times in a row. You do not need to sleep sitting up afterward. Call 911 for constant, severe dizziness or any sign of a stroke.
What is BPPV?
Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. Tiny calcium crystals in the inner ear come loose and drift into one of the balance canals. When you move your head, they shift and send a false signal that you are spinning. The spells are brief, usually under a minute, and they come with certain movements: rolling over in bed, lying down, tipping your head back or bending forward. BPPV does not affect your hearing. Read more in our article on BPPV and the Epley maneuver.
Before you start
- See a doctor first. The maneuver only works when it is done for the right ear and the right canal, and a doctor can usually tell both with a quick positioning test. The studies that showed home treatment works enrolled people whose BPPV had been diagnosed and who were taught the maneuver first (Radtke et al., 2004; Kim et al., 2023).
- Know which ear. Use the steps for the ear your doctor told you. The steps below are for the right ear; the left ear is the mirror image.
- Use a bed, with a pillow and enough room to lie back and roll onto your side.
- Have someone with you the first few times. The maneuver can set off a strong spell of spinning, and you may feel sick to your stomach for a moment.
Ask Us First If You Have
- Neck or back problems, or trouble lying back with your head tipped down
- Narrowed neck arteries (carotid disease)
- Trouble moving around in bed, or a high risk of falling
We may teach you a gentler version, or do the maneuver with you in the office.
Staying safe during a spell
The biggest risk with BPPV is a fall, not the spinning itself (AAO-HNS guideline, 2017).
- Sit or lie down as soon as the spinning starts, and stay still until it passes.
- Get up slowly. Sit on the edge of the bed for a moment before you stand.
- Use a night light and keep the path to the bathroom clear.
- Hold off on ladders, driving or anything risky while you are still having spells.
How do I do the Epley maneuver?
These steps are for right-ear BPPV. Sit on the bed with the pillow behind you, placed so that when you lie back it will be under your shoulders, not your head. Hold each position until any spinning stops, then about 30 seconds more.
Watch the steps
Shown for the right ear. The holds are shortened in the video: at home, hold each position until any spinning stops, then about 30 seconds more.
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Turn your head halfway to the right
Sitting up, turn your head 45 degrees to the right, toward the affected ear.
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Lie back quickly
Keep your head turned and lie back so your shoulders rest on the pillow and your head tips back slightly over its edge. Spinning now is expected. Hold.
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Turn your head to the left
Without lifting it, turn your head 90 degrees so it faces halfway to the left. Hold.
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Roll onto your left side
Roll your body onto your left side and turn your head with it, so your nose points down toward the floor at an angle. Hold.
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Sit up slowly
Sit up on your left side with your legs over the edge of the bed and your chin slightly down. Stay seated for a minute while any dizziness passes.
Left-ear BPPV: do the mirror image. Turn your head halfway to the left, lie back, turn your head to face halfway right, roll onto your right side looking toward the floor, and sit up on your right side.
Repeat the whole sequence 2 to 3 times in a row, or as we instructed. In studies, the Epley maneuver cleared BPPV in most people, often after one or two sessions (Hilton and Pinder, 2014).
What if I was taught the Semont maneuver?
If neck or shoulder problems make the Epley hard, we may teach you the Semont maneuver instead. It uses a quick swing from one side to the other rather than a slow roll, and it is harder to do correctly on your own (Radtke et al., 2004). Follow the steps we showed you:
- Sit in the middle of the bed with room to lie down on either side.
- Turn your head halfway away from the affected ear, and keep it turned the whole time.
- Lie down quickly on the side of the affected ear, so your face points slightly up. Hold about 1 minute.
- In one fast, continuous movement, swing up through sitting and down onto your other side, without changing your head angle. Your face now points toward the bed. Hold about 1 minute.
- Sit up slowly and stay seated for about 1 minute.
What happens after the maneuver?
- No special sleeping position. You do not need to sleep sitting up or avoid lying on one side afterward; the AAO-HNS guideline recommends against these limits (AAO-HNS guideline, 2017).
- Some unsteadiness is common for a short time after the spinning stops.
- Vertigo medicines do not fix BPPV. Pills such as meclizine may dull the nausea, but they do not move the crystals, and they can make you drowsy. The guideline recommends against using them routinely for BPPV.
- BPPV can come back, sometimes in the other ear. If spinning returns and the home maneuver does not help, call us so we can check which ear and canal are involved now.
Do and don’t
Do
- Use the steps for the ear your doctor told you
- Hold each position until the spinning stops, then about 30 seconds more
- Have someone with you the first few times
- Sit up slowly and stay seated a minute
- Call us if it is not better after a few days
Don’t
- Try the maneuver before a doctor has checked you
- Guess which ear is affected
- Stand up right after a spell or the maneuver
- Drive or climb while you are still having spells
- Rely on vertigo pills to fix it
When should I call?
Call our office if
- The spinning is not better after a few days of home maneuvers, or still bothers you after a month
- Your spells change: they last longer, come without head movement, or feel different
- BPPV comes back and the maneuver no longer works
- You have fallen, or are afraid of falling
- Your hearing changes, or you have ringing or fullness in one ear; sudden hearing loss needs to be seen as soon as possible, and definitely within two weeks
Get care right away
Go to the ER or call 911 for constant, severe dizziness (vertigo) that does not stop when you hold still, or dizziness with a severe headache, double vision, trouble speaking or walking, weakness, numbness or a drooping face.
Austin 512-339-4040 · Lakeway 512-682-4798 · Marble Falls 830-992-2830
Questions patients ask
Yes, if your doctor has diagnosed or suspects BPPV and has told you which ear is affected. The maneuver only works when it is done for the right ear and the right canal, and the studies showing home treatment works enrolled people who had been diagnosed and taught first.
A doctor can usually tell with a quick positioning test, watching your eyes as your head is tipped back. Spinning that is worse when you lie with one ear down is a clue, but it is easy to guess wrong, so use the side your doctor told you.
No. The AAO-HNS guideline recommends against limits on how you lie or sleep after the maneuver. Some unsteadiness for a short time afterward is common.
No. Vertigo pills such as meclizine may dull the nausea, but they do not move the loose crystals, and they can make you drowsy. The guideline recommends against using them routinely for BPPV.
Usually 2 to 3 times in a row, or as we instructed. If the spinning is not better after a few days of home maneuvers, call us.
It can, sometimes in the other ear. If spinning returns and the home maneuver does not help, call us so we can check which ear and canal are involved now.
This guide is for educational purposes only and does not replace an in-person evaluation. If your provider gave you different instructions, follow theirs.
Full guide and sources: capitalent.com/bppv-at-home.html
Sources
- Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngology–Head and Neck Surgery. 2017;156(3 Suppl):S1-S47. doi:10.1177/0194599816689667. PMID: 28248609
- Hilton MP, Pinder DK. The Epley (canalith repositioning) manoeuvre for benign paroxysmal positional vertigo. Cochrane Database of Systematic Reviews. 2014;(12):CD003162. doi:10.1002/14651858.CD003162.pub3. PMID: 25485940
- Radtke A, von Brevern M, Tiel-Wilck K, Mainz-Perchalla A, Neuhauser H, Lempert T. Self-treatment of benign paroxysmal positional vertigo: Semont maneuver vs Epley procedure. Neurology. 2004;63(1):150-152. doi:10.1212/01.wnl.0000130250.62842.c9. PMID: 15249626
- Kim HJ, Kim JS, Choi KD, et al. Effect of self-treatment of recurrent benign paroxysmal positional vertigo: a randomized clinical trial. JAMA Neurology. 2023;80(3):244-250. doi:10.1001/jamaneurol.2022.4944. PMID: 36648931