How to Do the Epley Maneuver for Vertigo
Perform the Epley maneuver step-by-step to reposition dislodged inner ear crystals, stopping vertigo and nystagmus caused by posterior canal BPPV.
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🧰 Required Tools & Equipment
- ✓ Bed or treatment table
- ✓ Firm pillow
- ✓ Digital timer or phone stopwatch
📦 Materials & Supplies
- ✓ Comfortable clothing
- ✓ Glass of water
⚠️ Safety Checkpoints & Warnings
- • Do not perform this maneuver if you have severe cervical spine instability, acute neck trauma, or vascular neck issues.
- • Expect dizziness or spinning during position changes; do not sit up prematurely while dizzy.
- • Ensure the area beside the bed is clear of objects in case you lose balance when sitting up.
📋 Step-by-Step Guide (6 Steps)
Set Up Bed and Initial Seated Position
Sit upright on the bed with legs extended straight in front of you. Place a firm pillow behind you so that when you lie back, it will support your upper back and shoulders while allowing your head to recline back slightly.
- • Person seated upright with legs flat on bed.
- • Pillow aligned roughly one torso-length behind hips.
- • Placing pillow under the head instead of beneath the shoulders.
- • Sitting too close to the headboard, restricting head extension.
Rotate Head 45 Degrees Toward Affected Side
Turn your head 45 degrees toward the ear causing the vertigo symptoms. Keep your torso square and upright while turning only your neck.
- • Head rotated exactly halfway between center and the shoulder of the affected side.
- • Torso remaining upright and facing forward.
- • Turning head a full 90 degrees to look directly over shoulder.
- • Twisting the torso along with the neck.
Lie Back Rapidly into Extension
Quickly lie back onto the bed while maintaining the 45-degree head turn. Your shoulders should rest on the pillow with your head tilted backward approximately 20 to 30 degrees off the pillow onto the mattress. Hold this position for 30 to 60 seconds until all spinning stops.
- • Shoulders resting flat on the pillow.
- • Head tilted back 20-30 degrees over the pillow edge with face still angled 45 degrees.
- • Losing the 45-degree head angle during the descent.
- • Sitting up immediately when dizziness starts.
Rotate Head 90 Degrees to Opposite Side
Without lifting your head off the bed, rotate your head 90 degrees toward the unaffected side. Your head should now be turned 45 degrees away from the original side, maintaining extension. Hold for 30 to 60 seconds until dizziness resolves.
- • Head turned 45 degrees toward the opposite shoulder.
- • Head remains extended back against the mattress without lifting chin.
- • Lifting chin to chest while rotating.
- • Over-rotating head too fast.
Roll Body onto Side and Turn Face Downward
Roll your entire body onto your unaffected side while simultaneously turning your head another 45 degrees downward so your nose points toward the floor or mattress edge. Hold this position for 30 to 60 seconds.
- • Torso fully on its side with hips stacked.
- • Face angled 45 degrees downward facing the mattress or floor.
- • Leaving hips flat while only twisting the neck.
- • Looking forward horizontally instead of downward.
Slowly Return to Seated Position
Swing your legs off the side of the bed and use your arms to push your torso upright in one smooth motion. Keep your chin tucked slightly toward your chest as you sit up, avoiding sudden backward head tilts.
- • Feet dangling or planted near the floor.
- • Spine upright with chin slightly tucked down.
- • Throwing head back when sitting up.
- • Standing up immediately from the bed.
Credit: inspired by an original tutorial by Dr. Jon Saunders — watch the original on YouTube.
Don’t have everything?
- No Firm pillow? Rolled bath towel placed under shoulder blades
- No Digital timer or phone stopwatch? Counting out 60 slow breaths per position