If you are attending goPhysio because of dizziness or suspected benign paroxysmal positional vertigo (BPPV), it is helpful to know what to expect before, during and after your appointment.
The Epley manoeuvre is a specialist treatment for BPPV. It can be highly effective, but the assessment and treatment may temporarily reproduce your dizziness. This guidance explains how to prepare, whether you should drive, how you may feel afterwards and what precautions to take.
What is BPPV?
Benign paroxysmal positional vertigo, usually shortened to BPPV, is a common inner-ear condition. It causes brief episodes of spinning or vertigo when your head moves into particular positions. Common triggers include:
- Rolling over in bed
- Lying down or sitting up
- Looking upwards
- Bending forwards
- Turning your head quickly
BPPV happens when tiny calcium particles in the inner ear move into one of the semicircular canals responsible for detecting movement. When you change the position of your head, these particles move and send confusing signals to your brain, creating the sensation that you or your surroundings are spinning.
You can find out more about BPPV and our Dizzy Clinic.
What is the Epley manoeuvre?
The Epley manoeuvre is a sequence of supported head and body movements. It uses gravity to guide the displaced particles out of the affected semicircular canal and back to an area of the inner ear where they should no longer cause vertigo.
Although many people refer to their appointment as “having an Epley”, your appointment will always begin with an assessment. Not every type of dizziness is caused by BPPV, and an Epley manoeuvre will only be performed if your assessment confirms that it is appropriate and safe for you. Other types of BPPV may require a different repositioning manoeuvre.
Before your appointment
Positional testing and treatment deliberately move your head into positions that may reproduce your familiar dizziness. During or immediately after the assessment or treatment, you may experience:
- A brief but sometimes intense spinning sensation
- Nausea and, occasionally, vomiting
- Light-headedness
- Temporary imbalance or unsteadiness
- A “floaty” or disorientated feeling
You do not need to fast before your appointment. Wear comfortable clothing that allows you to move freely.
Please tell your clinician before testing or treatment if you:
- Have a significant neck or back problem
- Have recently injured your neck or had neck or back surgery
- Have rheumatoid arthritis or severely restricted neck movement
- Have a significant vascular or heart condition
- Have recently experienced a stroke or transient ischaemic attack (TIA)
- Have recently experienced a retinal problem or had eye surgery
- Are pregnant
- Have difficulty lying flat, turning or rolling
- Have any other health condition that may affect the assessment
This does not necessarily mean that you cannot be treated. Your clinician may need to modify the assessment, use a different technique or recommend a medical review.
Can I drive to my appointment?
If you are currently dizzy, unsteady or do not feel completely safe to drive, you should not drive to your appointment.
The positional assessment and treatment may temporarily increase your symptoms. We therefore recommend arranging for someone to bring you and take you home, or planning alternative transport.
If you do drive to the clinic, please tell your clinician at the beginning of your appointment. If you remain dizzy or unsteady afterwards, you may need to arrange collection or leave your vehicle and return for it later.
What happens during the appointment?
Your clinician will ask about your symptoms, medical history and the movements or activities that trigger your dizziness.
They may then perform positional tests to establish whether BPPV is present and identify which part of the inner ear is affected. These tests may temporarily bring on your familiar spinning sensation. Your clinician will support you throughout and observe your eye movements, which provide important information about the cause of your symptoms.
If BPPV is confirmed and treatment is appropriate, your clinician may perform the Epley or another repositioning manoeuvre.
You will be guided and supported through each position. You can ask questions or ask to stop at any time.
How might I feel after an Epley manoeuvre?
Some people experience an immediate improvement. Others continue to feel mildly dizzy, tired, “floaty” or slightly unsteady for several hours or occasionally a few days while their balance system readjusts.
It is also possible for your familiar positional symptoms to continue after the first treatment. This does not necessarily mean that anything has gone wrong. Some people need more than one treatment, and occasionally a different canal or the other ear needs to be assessed.
BPPV can also return weeks, months or years after successful treatment.
Can I drive after an Epley manoeuvre?
There is no universal rule requiring everyone to avoid driving for 24 or 48 hours after an Epley manoeuvre. Whether you can drive safely depends on your symptoms and how you respond to the assessment and treatment.
You must not drive while you feel:
- Dizzy or light-headed
- Nauseous
- Unsteady or off balance
- Visually disorientated
- Unable to concentrate normally
- Unable to turn your head comfortably to check mirrors and junctions
Only drive once your symptoms have completely settled and you feel fully able to control the vehicle safely.
If you drove to your appointment, we may ask you to remain in the clinic while your immediate symptoms settle. Waiting for a particular length of time does not automatically mean that you are safe to drive. If you remain symptomatic, please arrange alternative transport and collect your vehicle later.
You are responsible for ensuring that you are medically fit to drive. The DVLA states that sudden, disabling or recurrent dizziness may need to be reported. You can read the current DVLA guidance about dizziness, vertigo and driving. Speak to your GP or clinician if you are uncertain how this applies to you.
What positions should I avoid after treatment?
Evidence about positional restrictions following an Epley manoeuvre is mixed.
A major clinical guideline advises against imposing restrictions routinely. However, a Cochrane review found a small potential improvement in treatment success when short-term restrictions were added, and current ENT UK patient guidance continues to recommend some precautions.
To follow our standard goPhysio aftercare guidance:
- Remain upright for the rest of the day where practical.
- Avoid sleeping on the treated side for the next few days.
- Avoid deliberately repeating movements that provoke strong dizziness immediately after treatment.
- Resume gentle, normal everyday movement once your immediate symptoms have settled.
Remaining upright does not mean that you need to stand all day. You can sit normally and rest in a supported upright position.
You do not usually need to:
- Keep your head completely still
- Wear a neck brace or cervical collar
- Sleep sitting fully upright
- Avoid all head movement
- Stop normal gentle activity for several days
Your clinician may adjust this advice depending on the type of BPPV treated and your individual response. Please follow the specific guidance given during your appointment.
Can I sleep normally after an Epley manoeuvre?
You can sleep after your treatment, but we recommend avoiding the treated side for the next few days where practical.
You do not routinely need to sleep sitting upright. Choose a comfortable position that follows the advice given by your clinician and allows you to get in and out of bed safely.
Move slowly when lying down, rolling over or getting out of bed, particularly if you still feel slightly unsteady.
Returning to normal activity
Once your immediate dizziness has settled, gentle everyday movement is usually helpful. It allows your balance system to begin readjusting and helps rebuild confidence in normal movement.
If you remain unsteady:
- Stand up slowly
- Pause before starting to walk
- Use a handrail on stairs
- Keep a light on when getting up during the night
- Avoid ladders and working at height
- Avoid operating machinery
- Ask for help if you feel at risk of falling
- Avoid driving until your symptoms have completely settled
Be particularly careful in the bathroom, on stairs and when walking over uneven ground.
Do I need to repeat the Epley manoeuvre at home?
Do not begin repeating the Epley manoeuvre at home unless your clinician has confirmed:
- That your symptoms are caused by BPPV
- Which ear and canal are affected
- Which manoeuvre is appropriate
- That it is safe for you to perform independently
- How often you should repeat it
Performing the wrong manoeuvre or treating the wrong side may not help and could make your symptoms more difficult to assess.
If home treatment is appropriate, your clinician will show you what to do and provide clear instructions.
When should I contact goPhysio?
Please contact us if:
- Your symptoms are not beginning to improve
- Your dizziness becomes more frequent or severe
- Your symptoms feel different from your previous brief positional vertigo
- You remain significantly unsteady
- You experience new symptoms
- You are unsure whether to repeat a manoeuvre at home
- Your BPPV returns
- You have any concerns following treatment
You may need another assessment, a different repositioning manoeuvre or referral for further medical investigation.
When should I seek urgent medical help?
BPPV normally causes brief episodes of vertigo triggered by particular head movements. Seek urgent medical help if your symptoms are severe, persistent or different from this pattern.
Call 999 or go to A&E if vertigo occurs with:
- Double vision or loss of vision
- Sudden hearing loss
- Difficulty speaking
- Facial drooping
- Weakness, numbness or tingling in an arm or leg
- New severe difficulty walking or coordinating your movements
- Collapse or loss of consciousness
Contact NHS 111 urgently if you experience vertigo with a severe headache, repeated vomiting, a high temperature or rapidly worsening symptoms.
Do not drive yourself to A&E. The NHS vertigo guidance provides further information about when to seek urgent help.
Specialist BPPV treatment in Chandler’s Ford
Our experienced physiotherapists assess and treat BPPV at goPhysio in Chandler’s Ford. No GP referral is required, although some symptoms may need medical assessment before treatment.
An Epley manoeuvre can be highly effective, but your treatment will always be based on a thorough assessment of your symptoms and individual circumstances.
Find out more about our Dizzy Clinic, contact the goPhysio team or book an appointment.
Clinical sources
This guidance has been informed by: