The Epley maneuver worked – why do I still feel dizzy?

A person with BPPV who was treated in Greece asked: “After the treatment maneuver I felt much better. However, I now feel,…off balance? Why? How long with this last? Should I keep trying the Epley treatment?”

This is a common question and has an interesting, if theoretical, answer. It seems that some people can tell when they have BPPV just by the way they feel, even if they don’t experience vertigo at that moment. They just feel off, like something isn’t right. It is almost as if they can feel the particles sitting in the posterior semi-circular canal. This feeling goes away after they get used to the particles being in the canal. These people still experience spinning vertigo when they lay down or move in such a way as to stimulate BPPV. Interestingly, when they undergo treatment for BPPV with the maneuver and the particles are suddenly gone they again feel odd. Some describe a sense of being off balance, or even lightheadedness. It seems as if they miss the particles after having become used to them. Again this feeling goes away after about 1-2 weeks and you return to normal. There is no need to continue repeating the treatment maneuver at this point unless you are still experiencing spinning vertigo.

This whole sequence of events can be prevented by rapidly undergoing treatment before your brain has had a chance to become accustomed to the presence of the particles in the ear canals.

As always it is important to consult your own physician about your specific symptoms, especially if they change or do not fit with your usual experience or expectations.

46 Responses

  1. Clearwater Clinical

    Short answer – YES.

    Long answer. Sadly BPPV is a chronic disease. Meaning many people get recurrent episodes of BPPV for the rest of their lives. With that said, don’t be too discourage as many people don’t get these and even in the cases that do, most people find that they get shorter duration and less severe over time. I have had 4 episodes and the first was by far the worst, the rest we just one day events. The small episodes of spinning you experience might just have been some of the last few crystals finding their way out. The off balance sensation is very normal and usually goes away after a bit.

    Good luck.

  2. Clearwater Clinical

    Thanks for the update. I am glad you have come to a conclusion. I must admit to some surprise as I have not encountered others who wanted to keep their BPPV to avoid 1-2 weeks of off balance symptoms. However, it is important that everyone be comfortable with their own decisions. I have been through 4 bouts of BPPV and the post maneuver symptoms myself and would, in general, say that it was a good trade off. Let us know how you make out. Bouts of BPPV do usually go away anyway after weeks to months – that’s why they call is benign! Take care.

  3. Lily

    My doctor has suggested I have the Epley treatment,I have suffered from Vertigo attacks on and off for at least 20 years which I manage with Stemitil tablets 3 times daily, I’m concerned by the descriptions of side effects of Epley and having read this site I feel that the spinning and off balance sensation experienced by people who have had Epley has put me off having treatment. I need to be able to drive and function normally ,I feel I might be unable to cope with the side effects,I have decided to abstain from Epley treatment. Thanks for this very helpful site.

  4. Sandra

    I am wondering if you can help me. About two months ago I started to feel somewhat off balance. Then, I awoke one night and felt very dizzy. I was so disoriented, I couldn’t even read the Advil bottle.

    After that, I would have these dizzy attacks while I was at work. I would be on the phone, leaning my head to the right and get the spins. I also noticed when I looked down (to the right) to the write something on a piece of paper I would also get the spins. But as soon as I put my head straight, the spinning subsided. During this time, I never actually realized vertigo during head change in bed like most definitions of BPPV explain.

    As time went on, the episodes of positional vertigo got closer to together so I ended up going to the hospital.

    They told me I had BPPV. I had a CT scan done and there was nothing noted and everything was normal. They send me home with an Epley worksheet and so I did the Epley every day. I realized that when I went down to my right, I would spin and the spinning would last about 10-15 seconds. Then it would stop and I would flip over.

    Finally, the actual spinning stopped when I performed the Epley , except one huge attack I had after doing the Epley where I felt I was on a rollercoaster. The ER doctor (the next time I went) said that was a good sign of particles moving out of place.

    But since then (3 weeks ago), I have had a general off balance feeling, unsteadiness. Today, I have also had another positional attack of vertigo. I ran home to do the Epley to see if the spinning sensation came back but there was no more spinning.

    Are these little positional vertigo episodes normal even after successful repositioning, and also, how long does the off balance feeling last?

  5. Clearwater Clinical

    Thanks – sure sounds like some post maneuver symptoms – the good news is they generally go away with time. Keep us posted.

  6. Jay

    I did the Eppley Manuever and I think it works because I haven’t experienced the spinning, but I’ve been burping a storm for the past 3 days and still feel nauseated especially when I move my head down or up. Something inside me still fears spinning…maybe post Manuever symptoms along with a bit of anxiety?

  7. Clearwater Clinical

    No – ear pressure is not associated with BPPV. However, many other diseases do cause BPPV, furthermore any kind of stress worsens your experience of BPPV. For example Meniere’s Disease is associated with ear pressure, ringing and hours of vertigo. Also the common cold can cause certain types of dizziness lasting weeks which will also have ear pressure. It could also be a coincidence. If you are having problems bring it up with your GP.

  8. Clearwater Clinical

    That’s tough to answer. What I would say is that if you do feel vertigo during the maneuver that is a good thing. So if you don’t feel anything then there is something not right about that maneuver.

  9. XueHong


    I was diagnosed with having BPPV. When I do the Epley maneuver I get very dizzy. When I do the half somersault I feel nothing. Why is that?

  10. Pat

    Thank you for your response to my earlier post. Having some residual symptons going on after eply maneuver but seem to be getting better. Just started having ear pressure in ears with slight earach in one. Little bit of ringing. Been taking allergy meds for a while along with nose spray. Even took Sudafed thinking it was sinus conjestion. My eyes are extremely dry. Doesn’t seem to help. Does ear pressure go along with Bppv. I have never had problems with pressure in ears before. Thank you for your responses
    They are greatly appreciated.

  11. Clearwater Clinical

    Thanks for all the details. It seems like you have a complicated history and are doing the right thing by seeking professional advice from your own physicians. With that said you might want to look into a few things.
    1) BPPV is not associated with a whooshing in the ears. This can be Meniere’s Disease or other things entirely. You may want to bring this up
    2) A rocking sensation, especially after a turbulent flight (or boat ride for that matter) could be Mal De Debarquement Syndrome. This is a rocking sensation which happens when you are still, but goes away on boats, cars etc. You can read more about it here DizzyFIX Blog MDDS Link – or here:” UK MDDS Link.
    3) There are a number of other things from Depression to MS that can cause odd symptoms which don’t really fit in any category. Step 1 is determining if it is related to the ear, step 2 is treating the cause (depression or other).

    Hope some of that helps.

  12. Clearwater Clinical

    If you are no longer getting the “spinning” sensation when you lie down and turn then what remains is usually just the “off balance” feeling, which is made worse by sudden head motion, and which fades with time. Just try to be safe and keep doing normal activities and you body will (often) return to normal.

  13. Pat

    I had epley maneuver done 3 weeks ago. Some of the positions that made me dizzy are gradually going away. But still get lightheaded and off balance when looking down and head turning. Will this eventually go away?

  14. Holly

    I’m not sure if you’re still reading these comments, but I’ll give it a shot every hopefully get a response. My dizziness began spontaneously and after a few days post a particularly turbulent trans-Atlantic flight. The sensation is most pronounced on the right side but overall, I feel like I’m constantly on a rocking boat, even if I’m sitting still. I tried the Epley after waiting it out a week, and it seemed to work, but I didn’t realise I had to not make drastic movements right after, so I cleaned the whole house. The next day, the spins were back with a vengeance, with sound of running/whooshing water in my right ear. I went to see an ENT by week 3 and she doubt think I have BPPV because she didn’t note nystagmus on doing the Dix-Hallpike, even though the dizziness is severe on right side and almost absent on left. She refused to do the Epley.

    Saw another ENT today who put goggles on me, attached to a machine, and did the D-H and saw no nystagmus, either, but postulated that because I’ve done Epley on my own and am moving into week 5 of symptoms, my eyes may have compensated. He said based on my dizziness response on the right side being so obviously positional and severe, he’d do the Epley, after which he put me in a neck brace and said I must stay upright for 36 hours, including in bed.

    With the neck brace and limited mobility, my dizziness is less, however, if I remotely lay down slightly less than fully inclined, I feel the unfortunate “rocking side to side” sensation on the right side. If I walk very gently with the neck brace on, the dizziness is mild but if I speed up to normal gait, I feel the side to side rocking. I also feel a pulling sensation under my right ear lobe, similar to when you have a full ear feeling on a flight from air pressure, but then it pops and feels better, except mine doesn’t pop. My hearing is fine so far, but I get eye twitches along with the spinning. I’ve tried decongestants and they seem you work better at a higher dosage, but not always. Meclizine sort of works and Dramamine just makes me tired. Antihistamine seem to keep it a bit more manageable, but not if I lay to the right. If I tilt my head to the right while sitting, the spins are out of control. If I tilt my head to the left while sitting, almost bearable.

    The only time the spinning is gone by 98% is while I’m driving. The minute I stop the car, it comes back, esp as I try to exit the car or walk. That rocking sensation, as if moving from side to side, like being drunk or on a turbulent boat. In close quarters, such as with shops with many aisles, I bump into everything, can’t seem to walk in a straight line.

    If I walk really fast or lift my arms above my head while walking, the dizziness is controlled by 80%. Doctors are at a loss, though the first ENT thought I may have MdDS, which is scary as it’s uncurable. Her reasoning was that the dizziness came on after my flight, except truth is it was not right after the flight but 2-3 days later. She said the lack of spins while driving is what makes her think this is MdDs. Second ENT disagreed with MdDs, though he wants to do an MRI to check for vestibular artery issues. Basically, no one knows what this is for sure, because of lack of hallmark nystagmus during D-H maneuver, though the dizziness is highly pronounced with movement and laying to the right side, not the left.

    I’m at a loss what is going on and have been pouring over your website and responses in comments, but still wanted to see if you have input on the additional info I’ve included here.

    Thank you.

  15. Clearwater Clinical

    Congrats – glad the maneuver worked. Usually that post maneuver feeling lasts a few days to a few weeks. In some people it can last longer. I find that it is longest after the first episode of BPPV. 50% of people with BPPV have recurrent BPPV. Fortunately, the post maneuver feeling lasts for a shorter and shorter time each episode – and and be only a few hours.

  16. Pam

    I had an empley maneuver Thursday afternoon and I think it worked, because I am not getting that spinning when I lay down but I feel groggy and just weird. How long will this last normally?

  17. Drew Laskowski

    A week ago I experienced an onset of extreme vertigo – could not open my eyes without instantly vomiting. After days of medication to treat the nausea and a lot of sleep, the vertigo seemed to subside. Finally my doctor diagnosed BPPV (right) as a result of a complicated mono infection, it just messed up a lot in my body. He showed me how to do the Epley Maneuver at home, and although nystagmus is no longer noticeable with the Dix-Hallpike, the world still slowly spins when looking into the right periphery. The Epley definitely worked, however I still feel off. My eyes seem to lag when moving my head and looking around, I would describe the visuals as similar to those while drunk. Hopefully it wears off soon!

  18. Clearwater Clinical

    Thanks for your comments. Hmm,… it isn’t too clear what is going on yet. Do you know what diagnosis you have? Given your description it would be best to seek medical advice from your own physician. I hope you feel better.

  19. Clearwater Clinical

    Thanks for your description which is spot on normal. It is totally common to have a week or so of “off balance” following an attack of BPPV. No one really knows exactly why but people postulate that you are getting used to the “new normal” but others also suggest some damage can be done by these crystals and you are adapting, others suggest that the resultant cerebellar excitement from uni-canal stimulation takes a while to settle back down. Regardless, if you have a positive Hallpike, followed by an Epley in which you experience vertigo, followed by no more vertigo but a sensation of movement which is worse with motion, then you have had a very typical experience. Feel free to retest the next day. The DixHallpike maneuver and the associated nystagmus fatigues with time so even if you repeated it without treating the BPPV it will eventually “wear out” so it is better to get a good nights sleep and test first thing in the morning. Good luck.

  20. robin

    I have had intermittent bouts of vertigo in the past that resolved with medication or on its own. Usually, it seems that it was a horizontal canal issues. Friday while rolling over in bed, I suddenly had vertigo. I am a physical therapist and have gone to a few classes along with co-treatments of patients. I immediately did a log-roll correction with did not work. I tested for left canal posterior issue without response. When I tested for right posterior canal, I had immediate response which was text book, lasting about a minute and managed to hold the position. I then did remainder of Epley with extreme nausea and vomiting, but held the positions. I got up and could barely walk, but could tell the vertigo was not there. Extreme fear of head movement, but decided that the symptoms were not totally gone and wanted to retest. I did test and did not have the vertigo throughout the Epley which I repeated. It took about a day before I felt human again. I had no issues with movement in vertical, but still seem a little “OFF and paranoid” when moving in bed. Not sure I buy the “getting use to particles being out of place” since I immediately did a treatment. It has been two days and can still say I feel off for a few hours after getting up in the morning. I plan to check myself on the weekend again, if the bed mobility is still causing issues. Is this normal and should I feel totally okay within a week? When would you re-test if you wanted to continue to work? Weekend as I have planned? Thanks

  21. Judy

    I had vertigo the other night,the dizziness lasted about 2 hours. My head felt different for a while. I went to bed because it was 10:30 at night. The next day all I wanted to do was sleep. I got up that evening for about three hours and went back to bed. I slept 14 hours. During this sleep I did wake up to go to the restroom. My head feels tight, it feels kind of hot inside the top of my head. Is this normal,I have had vertigo before and just want to sleep, but I don’t remember my head feeling like this. Is this normal ?

  22. Bonnie landfair

    I’m going through the same thing, however, my doctor
    ordered Vestibular Therapy to help with my balance issues. I start next week! I just feel horrible at times, like I’m on a boat, and fatigued. Can’t wait to feel normal again.

  23. Clearwater Clinical

    Post maneuver “off balance” feeling is common and does not mean the Epley did not work. If you have recurrent spinning then you might seek another maneuver. Home treatments like the DizzyFIX are alternatives. You might like to discuss with your own physician.

  24. jen

    Hoping for some insight. I awoke with spinning vertigo August 7th. I then experienced positional vertigo for the next month and a half. At that time I went to physic for the Epley maneuveur. During the maneuver I experienced strong spinning at the final stage. The problem is, since then (2 weeks ago now) I feel terrible. I have constant nausea, dizziness, and feel ‘woozy’. I feel as though I am completely out of sorts and sometimes have difficulty focusing in on things with my eyes because I my heads feel like it’s full of water and wavy. Does this mean the Epley was unsuccessful? This is worse than the positional spinning unfortunately. Thanks

  25. Bonnie Landfair

    I was cleaning in my bathroom and leaned up and hit my head on the left side front forhead.on the edge of my marble bathroom cabinet, wow it hurted for a minute ….a week later i had my first attack of Vertigo. Went to my ear dr. and he did the epiley maneuver, i felt much better, however i’m having some off balance and light headedness which my dr. said would go away after a couple of days. He gave me some exercises to do at home, can’t wait to get back to normal. By the way, he told me i hit my head a lot harder than I expected….called a light concussion!

  26. Clearwater Clinical

    Thanks for your comments.

    If you don’t feel well then don’t drive. Talk to your own doctor about your safety to drive. With that said,.. most people don’t get spinning dizziness with BPPV. Also it is quite normal to have a “weird” feeling after doing the Epley maneuver. See this blog link: Why am I still dizzy?

    If you need to do another maneuver you may find a home device helpful to ensure you get the maneuver correct.

  27. nicky

    I had epily manoeuvre done a few days ago and its been successfull although my eyes head feel very weird my question is is this safe too drive like this only I’m due too go back too work in a couple of days ?

  28. Clearwater Clinical

    Thanks for your comments. There is a great deal of discussion around post maneuver precautions but there is little evidence. The most recent guidelines do not suggest anything in particular except being safe (no ladders or roofing etc).

    We wrote a blog post here about the subject.

  29. Carole

    I had the eply done this morning by my ear doctor . I know I will feel off for a while after this maneuver .. my question is … how long do I need to stay “upright” ? Can I bend over to put on shoes .. in other words, should I just go about my Normal day things ? Thank you for any feedback you can give me in this matter 😉

  30. Clearwater Clinical

    Thanks for your qustions.

    Usually BPPV is associated with spinning but people describe this differently. Some people call it a wave, others light headed so it is difficult to rely entirely on the description.

    If you have BPPV then yes you should get and Epley maneuver or use a home treatment device ( which can help you do the approved maneuver.

    Stress makes all forms of vertigo worse but it does not cause vertigo.

    Yes – try to keep as active (and safe) as possible. Keeping active improves your vestibular function.

  31. Carol Hilliard

    I have only just started experiencing BPPV symtoms about 2 months ago – could it be an ear infection and not Bppv

  32. Luisa P


    I would like to know if it is possible to have positional vertigo without the spinning. My neurotologist sent me home with a sheet of the brant dorrof maneuver to do at home. I have been doing it for almost 2 weeks and I thought I was getting better since the dizziness went away and I only had the rocking sensation( when actually not moving) left but the last 3 days I have been feeling as dizzy as the fist day I got it 2 months ago, Plus the boat sensation like if I am in a bout. He never performed the EPLEY nor he mention it to me. Should I just go with a certify therapist to perform it on me? I wonder if instead I have vestibular migraines since the dizziness started during a stressful time of my life worrying about a breast lump that turned out to be benign? I come up with this thoughts because during this waiting stressful time I had some pressure on my forehead and some couldn’t sleep or relax much. I had hearing test that came back normal (does that exclude labyrinthitis or was it healing by the time I got the test which was a month after all this started?) I do have the herpes virus and I read that it can cause problems to the ears. I am trying to stay away from the Internet since I read that some people stay like this forever or for many years and I am doing my best to recover since I have a 2 year old and I wonderful husband to live a normal life for plus I have dreams of continuing my career and being as active as before, will it take physical therapy? I don’t know? I have a “lazy eye” as the doctor said but… Could this be making me dizzy by perceiving the images in the wrong way and sending the wrong signal to the brain? I have heard of people having to retrain their eyes and wearing prism glasses. Please I need to insight. Thank yoj

  33. Clearwater Clinical

    Possibly. The DizzyFIX works only for BPPV. You should get a diagnosis from your physician first. BPPV is characterized by spinning dizziness which comes on only in certain positions and lasts only for seconds.

  34. Clearwater Clinical

    Hard to say why so severe. Some people get conversion from posterior to horizontal canal BPPV which can be very severe vertigo indeed. Usually it is quite short lived and goes away spontaneously – so that could explain it, but it is very hard to comment without seeing your eyes during the treatment.

  35. Clearwater Clinical

    Sometimes the treatment can be as bad as the episodes (usually during active periods) however usually this is the last episode. Normally you don’t have any more spins after successful treatment. Success is 88% with DizzyFIX. Most people do feel a bit “wonky” for a while after.

  36. Alex

    I had Epley a few weeks ago by experienced therapist. I had very intense vertigo during procedure and couldn’t walk unaided immediately after. It was 24 hours before I could walk to the toilet at home. i had 2 spontaneous spins during that 24 hrs. A bit wonky for next few days. Is this unusual?.

  37. Alex

    I’m 69 and I’ve had BPPV for a long time and have had the Semont and Epley done successfully a number of times. 3 weeks ago, I went to my therapist with some vertigo symptoms and we identified the left ear as the problem. In the first and second positions of the Epley, I had the most intense and scary vertigo ever. We did it twice. But afterwards, I felt completely drunk and couldn’t walk unassisted. It took a full 24 hours before i could walk around the house. During that 24 hours I had 3 spontaneous ‘spins’ lasting about 10 seconds each. I have never had such severe after effects before from the Epley. My therapist said I had a LOT of particles which shifted. I feel OK now, just a bit of occasional unsteadiness. Why the severity?

  38. cathy

    I just had the Eply manuver done for a severe bout of BVP(I later found out that is what it was and that I have had less severe attacks in the past ,and that my brain has been compensating for this all along without me knowing what was wrong with me). After a couple of years of not feeling right (off balance,foggy and difficulty focusing my eyes when reading or watching TV), I finally feel normal again,except for the light headedness while sitting or lying down, which I am confident will resolve in a couple of weeks. The feeling of falling when I am sitting still or lying down can be managed by moving a lot.t I have read that after years of being out of balance, my brain is readjusting itself. I have heard this takes a couple of weeks. I am especially ecstatic that I can read again without squinting and feeling like my eyes were always so tired, I just could not keep them open. I think my brain was constantly adjusting to the imbalance in my ears and my eyes were constantly trying to adjust to the imbalance. Needless to say my eyes and head always felt exhausted. This problem has completely disappeared , my eyes are not squinty and fatigued anymore! This is nothing short of a miracle!

  39. gloria

    I am off balance and have to hold on to things to keep balance doctors said I had ear infectionand I’m a bit dizzy can this product work for me?

  40. Clearwater Clinical

    Thanks for the question. Yes you are right that post maneuver disequilibrium is quite common, meaning that aften after a maneuver you can feel “off”. This usually goes away. The best way to speed the process is to keep up with some activity (but be careful – as in don’t climb ladders).

    However, if you are experiencing unusal, new or severe symptoms then you should certainly seek the advise of your own physician. Sometimes you can have more than one cause of vertigo and sometimes following a maneuver you can get horizontal canal BPPV which is similar to regular BPPV but more intense and usually self limited (meaning you don’t need treatment) but is easily treated with a “log roll” maneuver.

    Given all the above, it is common to have symptoms of “off balance” following a BPPV treatment and usually it goes away – day by day.

    Good luck.

  41. Gene r

    Experiencing BVVP for 6weeks went yesterday and had treatment maneuver I was little dizzy right after but got better as day went on woke up this morning and now am very dizzy and “off” feel like I am walking on the deck of a ship. I read that is normal sometimes and should go in a week or two. Problem is I am non functional and don’t think I can wait a week. Should I alert my doctor or is she just going to tell me to wait also. Help!

  42. leisure

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    I’ll definitely digg it and personally recommend to my friends. I’m confident they will be benefited from this website.

  43. Clearwater Clinical

    No it is, in my opinion, not necessary. See this blog posting for details.

  44. Kristen Mayo

    Is it necessary to keep your head upright for 48 hours after an Epley maneuver? The PT that performed the procedure told me to not bend over, etc. for the day. Do I really need to sleep upright?

  45. Clearwater Clinical

    Hmm, that is a really tough question. BPPV can act in a variety of ways depending on the person and the situation. If you have BPPV usually you get spinning dizziness when moving in certain ways. Usually if you move quickly it is worse. When BPPV is going away you may just get some light sensations. The best way to get a diagnosis is to see an ENT specialist who can look in your eyes when they perform a special maneuver called the Dix-Hallpike Maneuver, they look for something called Nystagmus (click the link and watch the video to see what it looks like). You can usually determine which side you have BPPV by trying both sides and seeing which side makes you dizzy. As you indicate it is not always perfectly clear.

    Good luck.

  46. Dianne Trinder

    I have been experiencing BPPV symptoms for several weeks now. I purchased the dizzy fix to help but it does not seem to be helping much. Whenever I would do the procedure I really did not experience that much dizziness. I mostly feel light headed, nausea with some dizziness if I moved quickly. I have been using the dizzy fix now for almost 2 weeks now because I was not sure what side it was. Do I have BPPV?

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