Epley maneuver at home: right ear, left ear, and who shouldn't

The Epley maneuver at home is a short series of head and body positions, held for about 20 to 30 seconds each, that guides loose crystals out of the back canal of one inner ear. It's safe and useful only after a clinician has examined you, found BPPV in the back (posterior) canal, and told you which ear. Use the right-ear steps for the right ear and the left-ear steps for the left ear, exactly as your clinician showed you. If nobody has told you the side and the canal yet, get that exam first.

What the Epley maneuver does, and why the side matters

Your inner ear has a small pouch that holds tiny calcium crystals. In BPPV, some of them come loose and drift into one of the three fluid-filled canals, where they don't belong. The Vestibular Disorders Association (VeDA) explains that when you move your head, the crystals move the fluid, and your brain gets a false message that you're spinning.

The Epley uses gravity to roll the crystals back out. The US ear, nose and throat doctors' society (AAO-HNS) says these maneuvers have high success rates, around 80%, though sometimes they need repeating a few times. Its 2017 guideline strongly recommends a repositioning procedure for BPPV in the back canal.

VeDA says the Epley works on only four of the twelve typical kinds of BPPV, and it urges caution with self-treatment. In the exam, called the Dix-Hallpike, a clinician lowers you onto your back with your head turned and watches your eyes for a particular twisting jerk. The ear facing down when it happens is the affected one. You can't watch your own eyes while you're lying back and spinning, so you can't reliably test yourself.

If you do the right-ear Epley on a left-ear problem, you're moving the ear that is fine.

How to do the Epley maneuver at home

The AAO-HNS says you can be taught to do these maneuvers yourself, with supervision. Ideally your clinician walks you through it once in the office. Set up first:

• A wide bed, with room behind you to lie back and room to roll onto your side.
• A pillow placed the way your clinician showed you, usually so your shoulders land on it and your head tips back a little when you lie down.
• A helper in the room, at least the first few times, to read the steps and keep time.
• The light on, a bucket within reach, and a timer you can see.

Cleveland Clinic says clinicians usually hold each position for about 20 to 30 seconds. If the spinning lasts longer than that, many clinics ask you to stay put until it stops. Use the hold time your clinician gave you.

Epley maneuver for the right ear

1. Sit on the bed with your legs out in front of you. Turn your head halfway toward your right shoulder, about 45 degrees.
2. Keep your head turned and lie back quickly, so your head tips back a little over the pillow. Hold.
3. Keep your head tipped back and turn it slowly to the left, until it points halfway toward your left shoulder. Hold.
4. Roll your whole body onto your left side. Your head turns with you, so your nose points down toward the bed. Hold.
5. Sit up slowly on the left side of the bed, chin tucked toward your left shoulder. Then bring your head forward.

Epley maneuver for the left ear

1. Sit on the bed with your legs out in front of you. Turn your head halfway toward your left shoulder, about 45 degrees.
2. Keep your head turned and lie back quickly, so your head tips back a little over the pillow. Hold.
3. Keep your head tipped back and turn it slowly to the right, until it points halfway toward your right shoulder. Hold.
4. Roll your whole body onto your right side. Your head turns with you, so your nose points down toward the bed. Hold.
5. Sit up slowly on the right side of the bed, chin tucked toward your right shoulder. Then bring your head forward.

Afterwards, sit on the edge of the bed for a minute or two before you stand, with a hand on something solid.

How many times a day

Home schedules differ between clinics. Cleveland Clinic says you may need to do it three times for the best result. Your clinician should tell you how many rounds, how many times a day and for how many days. Write those numbers down.

What you may feel, and the after-care

During the maneuver, the spinning is usually strongest when you first lie back. Cleveland Clinic lists nausea and intense vertigo as possible side effects, and vomiting as rare.

Afterwards, the AAO-HNS says some people feel clear right away. Others feel motion-sick and a little unsteady for a few hours or a few days. Feeling a bit sensitive to movement can last a few days to a few weeks. The guide on still being dizzy after the Epley covers that stage.

You don't need to sleep sitting up. The 2017 US guideline makes a strong recommendation against head or sleeping restrictions after the Epley for back-canal BPPV. Cleveland Clinic says there are no post-treatment instructions, though avoiding sudden head movements is sensible. If your clinic gave you short precautions anyway, follow them. The guide on sleeping with BPPV has more on nights.

Your balance may be off for a while, so the AAO-HNS advises taking care not to fall. Don't drive until the dizziness has gone.

When the Epley isn't working

Stop the round, sit up slowly and stay sitting if:

• the spinning hasn't faded after a minute or two
• you vomit, feel faint, or get neck pain
• you notice a change in your hearing, painful fullness in the ear, or new ringing

Then call your clinician. Cleveland Clinic also says to call if you've done the maneuver and still have symptoms, since your provider may test for other causes. The AAO-HNS lists the usual reasons it fails. You may need a few more sessions, you may have a different kind of BPPV, more than one canal or both ears may be involved, or the positions may be hard to get right alone. The 2017 guideline tells clinicians to reassess within a month. If you're not clearly better by then, go back.

If it settles and later returns, read when BPPV keeps coming back.

Who should not do the Epley at home

Don't do it at home unless your doctor or therapist has said it's OK for you if you have:

• a neck or back problem or injury, or a neck you can't turn or tip back
• a detached retina, or recent eye surgery
• a blood-vessel problem, a past stroke or a mini-stroke (TIA)
• a heart condition that isn't stable, fainting spells or seizures
• trouble breathing when you lie flat
• severe, disabling symptoms
• past falls, or a fear of falling
• trouble moving around, such as stiff joints or weakness
• no diagnosis yet, or a diagnosis that isn't BPPV
• any warning sign in the box below

Cleveland Clinic names neck and back injuries, retinal detachment and vascular disease. The AAO-HNS suggests a professional if your symptoms are severe, you're older and have fallen or fear falling, or you have trouble moving. VeDA adds that a clinician should check your nerves and neck before treating BPPV.

What to ask your clinician first

• "Can you watch me do it once, so you can check my positions?"
• "How many rounds in a row, how many times a day, and for how many days?"
• "Is there anything in my health that makes this unsafe for me at home?"
• "When should I come back if I'm not better?"

When to get help now

CDC says to call 9-1-1 for an ambulance rather than drive when stroke is possible. Mayo Clinic says to see a professional for any repeated, sudden, severe or long-lasting dizziness with no clear cause.

Questions people ask

Can you do the Epley maneuver by yourself?

Yes, once a clinician has diagnosed back-canal BPPV, told you the ear and shown you the moves. The AAO-HNS calls this self-repositioning and says it's taught with supervision. A helper in the room makes it safer.

How do I know which side to do the Epley on?

You don't work it out yourself. Your clinician finds it during the exam by watching your eyes, and the affected ear is the one facing down when the spinning starts. If they didn't tell you, call and ask before you start.

How many times should I do the Epley maneuver for the left ear or the right ear?

The same rules apply to both ears. Your clinician sets the number of rounds and days. Cleveland Clinic and the AAO-HNS both say it sometimes has to be repeated a few times.