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Can I Lie Down After BPPV Treatment, Such as the Epley Maneuver?

Can I Lie Down After BPPV Treatment?

In most cases, yes.

After treatment for the most common type of Benign Paroxysmal Positional Vertigo (BPPV), you usually do not need to stay upright or avoid lying flat.

You also usually do not need to:

  • Sleep sitting up
  • Use extra pillows
  • Avoid sleeping on the treated side
  • Keep your head still
  • Wait a set amount of time before lying down

If your healthcare provider gave you special instructions, follow their advice.

An example of a clinician performing the Epley maneuver, a common treatment for BPPV.

Why Was I Told Not to Lie Down?

In the past, these limits were often recommended after BPPV treatment.

The idea was that staying upright might keep the inner-ear particles from moving back into the wrong place.

Researchers have since studied this. They found that staying upright or avoiding certain sleeping positions does not appear to improve treatment results.

That is why many clinicians no longer give these restrictions.

What Happens During BPPV Treatment?

BPPV happens when tiny particles in the inner ear move into the wrong place. A clinician can use a series of head and body movements to help move them back where they belong.

 

These treatments are called canalith repositioning maneuvers. The Epley maneuver is one common example. Different types of BPPV may need different maneuvers.

What Should I Expect After Treatment?

Some people feel better right away and can return to their normal activities. Others may still feel a little dizzy, unsteady, or “off” after the strong spinning improves.

Move at a pace that feels safe. These symptoms should slowly improve as you return to your usual movements and activities.

If lying down, rolling over in bed, or looking up still causes strong spinning, contact your healthcare provider. You may need another treatment, or a different type of BPPV may be causing your symptoms.

What Can Help Lower the Chance of BPPV Coming Back?

  • Check your vitamin D. Low vitamin D is linked with repeat BPPV, and treating low levels may help reduce recurrence.
  • Take care of your bone health. Low bone density and osteoporosis are linked with a higher chance of BPPV returning.
  • Manage other health conditions. High blood pressure, diabetes, high cholesterol, migraine, thyroid problems, and sleep problems may also play a role.
  • See a vestibular specialist if the same spinning symptoms return.

When should I get urgent medical help?

BPPV can cause strong spinning, but some symptoms are not typical of BPPV.

Get urgent medical help if dizziness happens with:

  • New weakness or numbness, especially on one side
  • Trouble speaking or understanding speech
  • New double vision or major vision changes
  • Trouble walking that is new or severe
  • A sudden, severe headache
  • Fainting or loss of consciousness

These symptoms may have a cause other than BPPV and should be checked right away.

Key Takeaways

  • Most people can lie down and sleep normally after BPPV treatment.
  • You usually do not need to stay upright, avoid one side, or keep your head still.
  • Mild dizziness or feeling “off” can continue for a short time after treatment.
  • Low vitamin D is linked with repeat BPPV, and treating low levels may help lower recurrence.
  • If strong spinning continues or comes back, see a vestibular specialist.

Research References

  • Bhattacharyya N, Gubbels SP, Schwartz SR, et al. Clinical practice guideline: benign paroxysmal positional vertigo (update). Otolaryngol Head Neck Surg. 2017;156(3 Suppl):S1-S47. doi:10.1177/0194599816689667. https://pubmed.ncbi.nlm.nih.gov/28248609/
  • Ke Y, Ma X, Jing Y, Diao T, Yu L. Risk factors for residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2022;279:3237-3256. doi:10.1007/s00405-022-07288-9. https://pubmed.ncbi.nlm.nih.gov/35218384/
  • Martellucci S, Stolfa A, Castellucci A, et al. Recovery of regular daily physical activities prevents residual dizziness after canalith repositioning procedures. Int J Environ Res Public Health. 2022;19(1):490. doi:10.3390/ijerph19010490. https://pubmed.ncbi.nlm.nih.gov/35010750/