Following a treatment maneuver for BPPV many practitioners recommend staying upright for 48 hours. This recommendation makes some empiric sense. The idea behind it is to allow the particles, disturbed like snow in a snow globe, to settle before exposing the opening of the posterior canal by lying down.
In the attached image you can see the particles and the opening to the canal, at the top. However, these precautions were never proven. In fact, a number of researchers have demonstrated that restrictions do not improve the results of the Epley canalith repositioning maneuver. We think that this is because the disturbed particles, like snow flakes, don’t cause problems until they form clumps. Unfortunately, there is no way to keep the flakes from finding their way back into the posterior canal everytime you “shake the snow globe” by lying down. Eventually clumps will form again. This is why BPPV is recurrent.
Many people who do try to complete the post maneuver precautions find that they loose two nights of sleep and get a sore neck. I am not sure it is worth it when there is no evidence for it and plenty against. Below are three of the published articles on how and why the post maneuver precuations are of limited value.
Simoceli L, Bittar RS, Greters ME. Posture restrictions do not interfere in the results of canalith repositioning maneuver. Braz J Otorhinolaryngol. 2005 Jan-Feb;71(1):55-9. Epub 2006 Jan 2.[PubMed]
- Nuti D, Nati C, Passali D. Treatment of benign paroxysmal positional vertigo: no need for postmaneuver restrictions. Otolaryngol Head Neck Surg 2000;122:440-4. [PubMed]
- Massoud EA, Ireland DJ. Post-treatment instructions in the nonsurgical management of benign paroxysmal positional vertigo. J Otolaryngol 1996;25:121-5. [PubMed]