It’s happened again. You come out of the shower and rub your hair, and you feel tipsy and you get a headache. It’s okay if you do it for a minute or two, or if you don’t rub with too much pressure. But the more you rub your hair and head, the worse is the headache.
What You Will Find In This Guide
- Epley Maneuver For BPPV
- BPPV Diagnosis
- Before & After Instructions
- Side Effects
- How To Determine Which Side
- Can Epley Maneuver Affect Tinnitus?
- How Often To Perform The Epley Maneuver
You similarly can’t take the chance of suddenly getting up from a seated position, especially if you have been seated for a long time. You suddenly feel dizzy, lose your balance and if you are not careful, you may even fall down. There can be many reasons for all this happening, like anemia or hypertension but most often than not, it’s usually because of a vertigo attack.
Yes, everyone seems to know and hear about vertigo, and quite a few people suffer from it. You hear episodes of people losing their balance upon suddenly getting up and even tripping over because of a loss of balance and dizziness.
But did you know that there are so many types of vertigo, and this type where you lose balance because of a sudden change of position is called Benign Paroxysmal Positional Vertigo (BPPV)?
BPPV tends to attack women twice as often than men. It generally attacks those in the 40s and 50s where there’s lifetime prevalence in about 2.4% of victims, which may increase to as high as 10% by the age of 80 years.
And while you may have always thought that medication and rest were the best treatments for the problem, you’ll be surprised to know that BPPV is best treated by an exercise called the Epley maneuver.
What Is The Epley Maneuver For Vertigo?
As mentioned above, it’s an exercise you can do at home for relief from the dizziness of BPPV. It’s also called canalith repositioning and is named after Dr. John Epley. It involves a series of head movements that are used to treat posterior semicircular canal benign paroxysmal positional vertigo.
The first paper he produced on the maneuver was called Canalith Repositioning Procedure. He had listed that the maneuver successfully treated 30 patients where 3 of them had some other problems besides BPPV triggering vertigo. Another 9 of them did have another attack some time later but who responded well to repeated treatments Epley maneuvers.
However, studies over the past two decades have proven that the maneuver is indeed much better at treating BPPV than other repositioning treatments like Sermont maneuver and Brandt-Daroff exercises.
Research has also proven that the Epley maneuver is better than anti-vertigo drug treatment. Besides, people treated with the Epley maneuver were more than 37 times likely to recover from BPPV than other maneuvers.
Epley Maneuver For BPPV
The maneuver is based on the canalithiasis theory that involves rotating the posterior semicircular canal backwards, nearer to its planar orientation. It uses the help of gravitational forces to direct canaliths out of the posterior canal to the utricle so that it doesn’t interfere with the semicircular canal dynamics.
It was originally performed using sedation and mechanical skull vibrations but the latest maneuver doesn’t need it. Besides, the modified version is much more effective and easier to perform than the original technique.
It helps because BPPV is in the first place triggered by the dislodging and moving around of calcium crystals called canaliths in the inner ear. It’s when they reach the semicircular canals that you feel as if the world is spinning or moving. The maneuver helps dislodge and remove the canaliths from the semicircular canal.
This is why the Epley maneuver is best used for treating patients with BPPV, and where some head movements trigger vertigo. While some people experience immediate relief after the exercise, other do complain of mild symptoms for a few weeks. But it’s safe enough for anyone suffering from vertigo to give it a try.
Importance of a BPPV Diagnosis
Your doctor will perform a diagnosis to find out and ensure that the Epley maneuver is the best treatment for your vertigo case. The diagnosis starts with your doctor asking questions about your general health, and symptoms. They will then look for telltale nystagmus eye movements.
Your doctor may then ask you to lie down on your back on a table, while keeping your head tilted backwards and off it. This is done to find out if you can control your eye movements or not.
Your doctor will also check to see if there are any symptoms of dizziness when your eyes or head turn in one direction, and if you get dizzy while doing it. If required, your doctor may also perform a test with infrared goggles.
There are two types of BPPV. It’s important for your doctor to distinguish between the two because they require different treatment.
In case of canalithiasis, the crystals are loose and move freely in the semicircular canal fluid. In this case, all you need is less than 60 seconds to stop the crystals movement upon changing the head position that triggered vertigo in the first place. The vertigo and nystagmus usually stop when the crystals stop moving.
In case of cupulotithiasis, the crystals remain stuck on the nerve bundles which sense fluid movement. In this case, the vertigo and nystagmus symptoms continue will the head has moved out of the position that had triggered the vertigo attack.
Epley Maneuver Instructions
Epley maneuver steps are really easy that you can even do it at home. The instructions given are for Epley maneuver left side, meant to give relief from people suffering from a problem on the left side.
You can perform the same steps, but by turning your head in the opposite direction, if your vertigo is on the right side for Epley maneuver right side.
- You can do the exercise sitting on a bed while extending your legs flat in front of you. It’s essential that you are close to the bed edge because you’ll have to sit up on the edge of the bed upon completing the exercise.
- Make sure there’s enough space for you to lie down. Also place a pillow on the bed so that your mid back is supported while you lie down while your head is kept lightly tilted backwards.
- Now turn your head about 45 degrees to the left and slowly lie down while keeping your head turned to the left. You may experience some vertigo symptoms like spinning. Don’t worry because it’s common and happens to most people. It anyway lasts only for about 30-60 seconds.
- Wait for about half a minute, or until the spinning stops. And then slowly turn your head 90 degrees to the right till it lies about 45 degrees to your right side.
- You may once again feel dizzy. Don’t worry. Relax and Wait here for another half minute to a minute till the spinning subsides. Then roll to your right side with your head turned and facing downwards.
- This may cause slight vertigo in some people so don’t worry if it happens to you. Just remain on the side for as long as the spinning subsides and then slowly return to your seated position. This completes the Epley maneuver. It’s better to remain seated for a few minutes to ensure you don’t feel any dizziness while getting up.
Epley Maneuver Instructions Before The Procedure
There are a few things you need to remember before doing the Epley maneuver. You need to tell your physician if you suffer from any high blood pressure, have a history of detached retina or if you have neck or back problems.
Your doctor will give you some instructions on what you should and shouldn’t do before the appointment. These instructions include
- Not eating at least 4 hours before the appointment
- Dressing comfortably
- Taking medications to prevent nausea or vertigo symptoms like promethazine before the appointment as a preventive measure
The main difference between performing the Epley maneuver in the presence of your physician is that they will be on hand to treat you if anything amiss happens.
And they will hold your head while you perform the maneuver and tilt backwards. You can also hold your doctor’s arm for support if you get a vertigo attack while performing the exercise.
In case you start feeling dizzy while leaning backwards, your doctor will hold your head till the vertigo stops and then help turn your head to the appropriate direction. Your doctor will also help you back to your seated position.
Epley Maneuver Instructions After The Procedure
You may need to use a soft cervical collar to maintain proper head position after performing the maneuver. Your physician will also give some instructions to follow after the procedure which include:
- Waiting for at least 10 minutes before leaving the clinic
- Not driving home alone and bringing someone along
- Avoiding exercises involving head movement
- Sleeping with your head propped to a 45 degree angle for two nights
- Staying as upright as possible for a week.
- Use multiple or at least two pillows while sleeping
- Avoid sleeping on the affected side
- avoid low back exercises and abdominal crunches or sit ups
- Avoid crawling swimming movements
Some Helpful Tips To Perform Epley Maneuver For Vertigo
- It is generally better and safer if you have your doctor show you how to perform the epley maneuver for the first time. This is to ensure you are doing it correctly and won’t worsen the condition.
- While many people will experience immediate relief, others may have to redo it. If you tend to get some dizziness or vertigo after performing the maneuver, then you could always do it just before turning in for the night. This way you can sleep and take some rest while the dizziness and vertigo settle or resides.
- Do remember that this exercise is most effective for BPPV sufferers and may not bet that effective at treating other forms of vertigo.
- It’s better if someone is nearby while you exercise. This is to keep you safe while you perform the maneuver as it may sometimes trigger vertigo symptoms like spinning and dizziness.
- It is always better to perform the Epley maneuver in your physician’s office the first time around, and then you can do it at home.
Epley Maneuver Side Effects
There has also been some research conducted about the safety of the maneuver, where it was proven that it’s indeed quite safe. In fact, most of the studies proved that there weren’t many adverse side effects of treating BPPV using the Epley maneuver.
There are some patients who cannot tolerate the maneuver because of neck and back problems however it doesn’t compensate the maneuver’s safety but is more like a contraindication for it.
Nausea is the most adverse effect of the maneuver which affects between 15-30% of the patients. Most important, the safety of Epley maneuver seems to be the same, no matter if it’s performed by a medical professional or by the patient.
The maneuver is however contraindicated in people suffering from:
- Neck or back disease or injury
- Vascular conditions
- Renal detachment
- Down’s syndrome
- Advanced rheumatoid arthritis
- Paget’s disease
- Extreme obesity
- Severe low back dysfunction
- Severe kyphoscoliosis
Epley Maneuver How To Determine Which Side
It’s possible to find out which ear is affected by first sitting on your bed. Let your head hang over the edge while lying down. Now turn your head to the right and quickly lie down.
If you feel dizzy after a while, then it means the right side is affected. In case you don’t feel dizzy, just sit up, wait for a while and repeat the same thing with your left side. If you feel dizzy now, then it means your left side is affected.
How Come I’m Still Feeling Dizzy?
If you are still feeling dizzy after performing the Epley maneuver, then it’s better to visit your healthcare provider. They will not only check to ensure you are performing the maneuver properly or not, or if you should try something different or if you need some nausea or motion sickness medicine.
And as the maneuver only treats BPPV dizziness, your doctor may also check to ensure there is no other cause for the dizziness like migraine, anemia or ear infection.
How Long Should I Perform The Epley Maneuver?
There is no fixed rule for this because it depends on how your body responds to it. While most will get immediate relief with one day of treatment, some respond to it within a week and others after doing it thrice a day till there are no positional vertigo effects for 24 hours.
There are also some people who may initially benefit from the maneuver but later experience recurring symptoms. However, they usually get relief upon performing the Epley maneuver when symptoms return.
However, if you don’t get any relief after a week of Epley maneuver, especially if you do it alone, it may because you are suffering from some other form of vertigo. This is when it’s better to consult a neurologist or otolaryngologist (ENT specialist) for treatment.
Can Epley Maneuver Affect Tinnitus?
No because BPPV is triggered by the moving canaliths in the inner ear and the Epley maneuver repositions these canaliths to reduce or eradicate vertigo. However, tinnitus is a buzzing, roaring or ringing sensation you experience in the ears. The sensation may be pulsing or steady and can be just an annoyance or really disturb your normal life.
While tinnitus also arises from the inner ear, it’s often a consequence of some damage incurred to the tiny hair on the auditory cells. These damaged cells may send signals to the brain to produce a sound only you can hear. Tinnitus may be triggered by age, exposure to some loud noise or other hearing problems.
So, while the Epley maneuver will not worsen tinnitus, it doesn’t help it much too. Instead, a hearing aid may help if the tinnitus affects your hearing. Some behavioral therapies like stress reduction, hearing restraining for tinnitus and biofeedback may also help.
How Often To Perform The Epley Maneuver
Your healthcare provider is the best person to advice about this. They usually tell you to do it thrice a day, till you don’t experience any vertigo symptoms for at least 24 hours.
This may take a single session in some people, three sessions in a day for others and even a few weeks of performing the Epley maneuver. It differs between individuals, but you just stop once the symptoms disappear.
The spinning and dizziness in BPPV can get so bad in some people that you find it so difficult to move in bed, get up, stand up from a seated position or even walk around normally.
It’s when the deposits reach some place, they don’t belong in that they interfere with the vestibular system’s nerves. This in turn makes it difficult for your brain to interpret your head position, which in turn causes the spinning sensation.
The Epley maneuver is a great therapy you can safely perform at home for vertigo and BPPV relief. However, while the Epley maneuver can help treat your BPPV it’s your physical therapist or health care provider who determines what is best for your vertigo case.