by Neil Bauman, Ph.D.
More than 7 million people in the USA suffer from vertigo, a condition where they feel the room is spinning around them. One of the most common forms of vertigo goes by the tongue-twisting name of Benign Paroxysmal Positional Vertigo (BPPV). It is also one of the easiest forms of vertigo to treat.
In the past you would go to an ear specialist (ENT doctor) and he would typically perform the Epley maneuver on you to reposition the otoconia (tiny rocks in your head made of calcium carbonate crystals). These tiny crystalline rocks help you keep your balance by sensing gravity. They normally reside in the utricle in the vestibular (balance) part of your inner ear. However, sometimes these “rocks” get jarred out of their normal location and “fall” into one of the three semi-circular canals. (The semi-circular canals sense turning motions in each of three different planes.)
When the “rocks” touch the tiny cilia in the semi-circular canals, they generate false balance signals. As Dr. Carol Foster explains, “The semicircular canals are only capable of sensing turning motions, so the presence of particles moved by gravity causes tilting motions of the head to be incorrectly sensed as violent spinning” (1) or vertigo.
Often the vertigo first strikes you when you are in bed and not when you are standing. This is because when you are upright the entrance to the semicircular canals lies just above the gravity sensors (utricle)—and “rocks” don’t fall upward! However, when you are lying flat on your back, the entrance to the semi-circular canals is located just below the utricle. This means that gravity coupled with side-to-side rolling movements as you roll over in bed can accidentally “knock” the otoconia into the opening of the semi-circular canals.(1)
As Dr. Foster explains, “Rolling over in bed to one side can cause a very sudden, strong sensation of head-over-heels whirling that lasts for several seconds and then dies away. If the eyes are open the room can appear to spin violently. Attempting to sit up from lying down, to lie down from sitting, or to roll over while lying down can cause the symptoms to recur. After getting out of bed, symptoms can be brought on by tipping the head upward (while shampooing or reaching up toward a high shelf, for example), looking back over one shoulder, or by bending over forward and then lifting the head quickly.” (1)
The good news is that recently Dr. Foster discovered a do-it-yourself method to reposition these “rocks” and thus alleviate the vertigo. She calls it the Half Somersault maneuver.
If you have BPPV and want to try it for yourself, here is the link to the instructions for the Half Somersault maneuver. Just be prepared for some vertigo in the process, but it should go away as you progress through these maneuvers.
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(1) Carol Foster. Benign Paroxysmal Positional Vertigo (BPPV). Marion Downs Hearing Center. Boulder, CO. http://www.halfsomersaultmaneuver.com/.
This maneuver asswers a lot of questions I had about my problem. I noticed in your video, you gave your patients a sheet of instructions on the maneuver. Could I please impose on you to send me one of those instruction sheets. Please and thank-you for your help.
The manuever worked perfectly! Do you recommend I do the half somersault on a daily basis to prevent vertigo?
Hi Denise:
No. You only need to do it whenever the “rocks” get out of place. If they stay where they are supposed to stay, you may never need to do it again in your life. Thus you don’t need to be proactive and do it as a preventative.
Regards
Neil
Do I do the maneuver when I’m having a vertigo attack, or do I wait for it to subside and then do the maneuver?
Hi Paul:
If you are having a bad vertigo attack, I can’t see how you can do this maneuver as your balance is gone, so you’d have to wait until the attack is past. However, if the vertigo isn’t too bad, you can do it whenever–during or after. I don’t think it makes any difference.
Cordially,
Neil
I have used the epley repeatedly without the success I usually have with it. I have just used the half somersault for the first time yesterday. It took 5 repetitions for me to work the particles into the spot where I did not have any spinning at any of the positions. I experienced inductions much stronger than any I have had with the epley. My question is this…do I need to keep my head level for 48 hours afterward as I do with the epley? I usually sleep for 2 nights at a 30 degree or more slant.
Thank you.
Hi Jane:
I’m glad the half somersault worked for you. I really don’t know about keeping your head level for 48 hours. I’m sure it won’t hurt, but I’m not sure it is required. I guess the easy way to find out is to move your head. If you get dizzy again–whoops–you should have waited until the otoconia were”glued” back in place.
Cordially,
Neil
Hi I had horrible onset effects with the Eply maneuver. I only use the half somersault. It works best for me
I did it the first time and it was a success. Few months later, some symptoms returned. Is it alright to continue doing the manuver over and over again?
Hi Silvia:
I don’t see any reason why not? If the otoconia get out of place (over and over again), this is the way to get them back into place (over and over again). Furthermore, it’s fast, effective, simple and free.
Cordially,
Neil
What if I don’t know what ear it is? By doing both ears will this be harmful?
Hi Colleen:
It shouldn’t be. You see the otoconia stick to the gel in the utricle so if you do the Epley maneuver or somersault, they are not knocked out of position. Only the otoconia that are already out of place will be moved back into place.
Cordially,
Neil
Should I have feel I’ll for a couple of days plus pulsated tinnitus real acts up after the manurer
Hi Deb:
I’m not sure I understand your post, but if it makes matters worse, then either you are not doing it correctly, or you have another problem entirely.
Cordially,
Neil
I went to a chiropractor who used an activator tool on my neck behind my right ear. The next day I woke up with vertigo on that side. He told me to google the Epley Manuever and do it which I was afraid to do on my own. I found the half somersault which looked much easier. I did it and nearly got sick, broke out in a drenching sweat, and couldn’t walk or drive. My medical doctor put me on Hydroxyzine 25 mg. I did the maneuver exactly 14 days ago and my vertigo is just starting to subside. I never experienced vertigo before and I hope I never do again. That is if this ever goes away. I’m glad the maneuver works for some people, but people should be cautious and so should Drs./chiropractors telling their patients to do these maneuvers alone.
Hi Riley:
If you are not certain about doing this maneuver yourself, go to an ENT who can do it on you properly.
Rather than suffering for 2 weeks, you should have gone to an ENT and had the proper Epley maneuver to get the otoliths back in place right away, rather than going to a medical doctor who just gave you drugs which do NOT get the otoliths back in place so you still can have the underlying problem unless they fall into place by themselves.
Cordially,
Neil
I know I have BPPV in my left ear. Judging from the room spinning when I rolled onto my right side in bed last night, I probably have it in my right ear too. How do I do this when it is in both ears? First left, then right? Do for both or wait a day in-between before doing it for the other ear?
Hi Joan:
I suggest you got to an ENT and let him figure out how to get the otoliths back in their right places. Just make sure he is familiar with the Epley maneuver and practices it so he knows what he is doing.
Cordially,
Neil
Have had the Canalith maneuver done a week ago, have some slight symptoms that have returned and am thinking of trying the half summersault maneuver at home but how can you tell which side is causing the vertigo. My practioner did both sides when he did it. Would be acceptable to both sides with the half summersault?
Hi Margaret:
I think so. The idea is to put the otoliths in their proper position. If they are already there, I don’t think they’ll move out of place, because the movements make them fall into place. (But I’m no expert on this.)
Cordially,
Neil
Hi. I have been feeling these same spinning sensations while lying down. When I turn from left to right. It’s been 15 days. I haven’t got any tests done yet. M 35 weeks pregnant so obviously my first priority is safe arrival of a bub. Just wanted to ask if I can do this during pregnancy? I have tinnitus I right ear pre pregnancy. I did all required tests which says issue with inner ear.
Could you please guide how I can reduce my symptoms of vertigo? Or do I need to have diagnosis first? Thanks.
Hi CB:
If you really have BPPV, then the Epley maneuver is probably the way to go. It will not hurt you or your baby. Personally, I’d go to an ENT, have him check you out, and have him do the Epley maneuver, rather than trying to do the half-somersault yourself.
Cordially,
Neil
I had a go,at the half-somersault did it 2times and feel wabbal when I stand up.how many times should I do it ,getting fed up with my virtigo
Hi Dave:
IF you have BPPV, then you should only have to do it once or twice–assuming you are doing it correctly. Maybe you should go to an ENT and have the doctor do the Epley maneuver for you. Then you know it is done correctly.
The other possibility is that you don’t have BPPY, but your vertigo is from some other cause. If that is the case, the Epley maneuver or the half somersault won’t help at all.
Cordially,
Neil
Hi,
My general doctor referred me to a PT because of my vertigo symptoms. The PT told me I had BPPV and she did the epley maneuver. During the treatment I experienced extreme dizziness and vomited, afterwards I had chills and fever for 2 days. She said I would need several treatments since she only got a few back in place. I really don’t want to go again since it was worse than my vertigo experience. I have never been so miserable. Should I go to an ENT for other solutions or try the half somersault? Thanks , Annette
Hi Annette:
I’m wondering whether the PT did the Epley maneuver properly since she made matters worse. I think your better solution is to go to an ENT and let him do it. Given your history, I don’t think you should try the half somersault yourself.
Note: you have to do the various Epley maneuvers in the right order or you can make matters worse as the crystals won’t stay in their proper places.
Cordially,
Neil
Thanks Neil! I did go back and see my doctor yesterday and he recommended I just take it easy for a few weeks and see if the vertigo goes away on its own. I was relieved since I am not up for any maneuvers right now. I have read that vertigo can naturally go away in a few weeks to a few months. Do you find that to be the case?
Hi Annette:
If you truly have BPPV, then you have the otoconia in your semi-circular canals. You need to get them out of there in order to get rid of the vertigo. I’m sure that during the course of your everyday living, you can just happen to turn your head the right way to slowly get all of them to “fall out” into the Utricle where they belong. But there are no guarantees.
If you vertigo is from something else, then time may be all you need.
Cordially,
Neil
I feel dizzy when I turn my head to look for oncoming traffic, and when I look up.
I have suffered from vertigo for years. I had an episode last summer. I did the eplay maneuver and also did the half somersault and was pretty much cured. I have had 3 episodes recently where I wake up in the morning with the room spinning. My question is can I take meclazine so that when I perform the maneuvers I don’t experience so much vertigo? Will the maneuvers be less effective while on meclazine?
Hi Paty:
I don’t see that taking Meclazine will affect the results of your maneuvers–since the Epley and half somersault mechanically move the otoconia in your inner ears to the right place.
However, taking the Meclazine may make it harder for you to tell if you got the otoconia moved to the right places as your dizziness won’t be a guide if it is suppressed by the Meclazine. But feel free to try it and see if it works for you.
Cordially,
Neil
Hello Neil,
My vertigo started when I was 20, it went away for 5 years, then it comes back, I’m 43 now and I feel it more frequently now, it came back 2 months ago and I feel dizzy everytime I go to bed specially. I did the summersault yesterday , like 3 times but today it hasn’t really gone away. How many times should I do it?. And will it also help turn my head from right to left when I’m lying in bed? Thanks.
Hi Gladys;
If you’ve tried the half-somersault and it hasn’t fixed your vertigo, I suggest you go to an ENT doctor and have him do the Epley maneuver on you, and at the same time, check you out for any other possible causes of vertigo.
Cordially,
Neil
I was told the spinning sensation is less when doing the 1/2
Somersault compared to Epley.
The intensity of the spin is extreme.
Any suggestions ?
Would medication help to get threw it..
Hi John:
It is possible. I’m not an expert on this so can’t really give you a definitive answer.
Do you know that your vertigo is the result of the otoconia being out of place–or could it be from some other cause. The half somersault and Epley maneuver are only for if your otoconia are out of place and have fallen into the semicircular canals.
Medication may help you, but my fear is that if you take the medication before you do the maneuvers, you may not be able to tell whether the otoconia are falling into proper position or not.
Cordially,
Neil
Hi there! About a month and half ago I suddenly lost 75% of my hearing in my right ear and also have tinnitus, I do notice first thing in the morning after getting up I am not dizzy but my balance is off when I turn my head only and usually takes about 30 minutes for it to clear up, should I try the summer salut? Also is there anything I can do to help this ringing and ear loss?
Hi Dianna:
When you lost your hearing suddenly, did you also start having balance problems of any kind? If yes, then you have a damaged vestibular system. Your balance problems would not be because the otoconia are out of place–so doing the half somersault won’t help.
From what you say about the sense of imbalance only lasting about 30 minutes, I don’t think it is the otoconia out of place, but problems with your vestibular system.
Typically, tinnitus accompanies hearing losses. Since you had a sudden severe hearing loss, you could expect the tinnitus to accompany it. If your hearing would come back, likely your tinnitus would go away.
What can you do? A lot of people find that wearing a hearing aid gets rid of their tinnitus during the day when they wear it. But the tinnitus comes back at night when it is quiet and you take your hearing aid off.
If your tinnitus isn’t really annoying you, the best strategy is to just ignore it, focus on the loves of your life and let it fade into the background. This can take a number of months. The worst thing you can do is focus on your tinnitus and get upset with it. That will only make it get worse and never go away.
Cordially,
Neil
Hello,
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?
Hi Hue:
I’m not sure. Maybe you are doing the Epley wrong. Normally, you have somebody do the Epley to you–it’s not something you do yourself.
Cordially,
Neil
Thank you for the reply. My doctor gave me a sheet showing how to do the Epley and I also watched some videos on the Internet. I will follow up. thanks again.
I just attempted this exercise this morning due to a recurrence of vertigo this past weekend. Not only did it not help, IT WENT FROM MILD TO SEVERE. I was unable to get off the floor for 45 minutes and eventually maneuvered myself/crawled to my bedroom to get my cell phone to call a neighbor. Vomited 3 times. I should have known better and researched this more thoroughly.
Hi Mia:
I’m sorry this didn’t work for you. Are you sure you did it properly? Your results don’t seem to bear this out.
I’m all for researching everything before you do it. The lady that designed this maneuver is Dr. Carol Foster, MD who is an associate professor and the Director of the Balance Laboratory at the University of Colorado hospital. She also has vertigo herself. I think she has the necessary qualifications regarding this maneuver.
Cordially,
Neil
Hi, can I try this even if i dont feel dizzy? I have a sligt hearing loss on my left ear with low tinnitus. My ent performed the epley 3 days ago while having a slight dizzyness (no spinning). I feel kind of relief. But after 4 days Im having a mild hearing loss again. But i was diagnosed with BPPV. The epley worked for me 2 years ago, then I wear neck brace for 3 days. The symptoms started this month again.
Hi Karla:
The Epley maneuver shouldn’t affect your hearing at all. It only has to do with balance. Nor will doing it affect your hearing. So if it helps you feel better (less dizzy), by all means, do it again.
Cordially,
Neil
dr bauman, like many srs, i have bad knees and want to try the half somersault. how about doing it from a
chair? i am so happy to read about this maneuver. i can try the eply but this looks better. btw, when this first occurred..two bouts ago…i went to the ER they found nothing and suggested my ENT who said it was a virus. thanks
Hi Katherine:
Feel free to try it. If it works,, great. The important thing is the position you have your head in, not the position the rest of your body is in. So if you can do the half somersault while sitting in a chair, and if you have your head in the right position it should work just as well as any other way.
Cordially,
Neil
I have dealt with Veritgo symptoms for over 10 yrs but have never had to seek treatment as they would g go away in 15-30 mintues. Recenlty though I have had acute attacks that have caused me to fall and have lasted 5-6 hrs to 2 days. I saw MD DX with Vertigo. Set up for vestibular therapy. Can’t get in for 2 more weeks. Struggling so bad. If I have it both sides when doing the Foster Manuever do I just pick a side and then do the other 15 mins later? Thanks Jeannine
Hi Jeannine:
I’m not an expert on this, but I think you have the right idea–pick an ear and do the half-somersault for it. Then sometime later do it for the other ear if necessary.
Cordially,
Neil
If I get dizzy when I lay on my left side, which way do I turn my head in the half somersault?
Hi Jan:
You’ll have to read the article and follow the instructions in the link. I don’t know any more about this than what you can read in this article. I’ve never tried the half somersault maneuver myself, I’ve just reported on it in order to help people.
Cordially,
Neil
I had an episode 2 months ago, but secondary symptoms have persisted for 2 full months. Does this mean the rocks are still in the canal?
Should I try the maneuvers?
Hi Charles:
You haven’t given me near enough information to advise you one way or the other. First, how do you know you had BPPV in the first place and not another cause of vertigo? What “secondary” symptoms remain? What other symptoms did you have? How did you get rid of the primary symptoms in the first place?
Cordially,
Neil
Dear Neil
I have low blood presure and mild vertigo as a result. I sometimes have difficulty walking a straight line. I feel unbalanced looking for traffic. Thats the extent of my symptoms. The GP gave me sea sickness pills, they work sporadically if at all. Ive not been diagnosed with bbpv as such. Will the somersault help or make me worse
Thank you for any advice
Geraldine
Hi Geraldine:
If your balance problems are because the “rocks” (otoconia) in your inner ears are out of place, then the half somersault could help, but if not, doing it shouldn’t make any difference.
Cordially,
Neil
Hello! I woke up this morning to a spinning room, I have never experienced vertigo until today. If I move my head to the left or to the right the room starts spinning and I get extremely nauseous. I watched the training video on the 1/2 summersault and I was fine to look up on my knees, but when I try to do the half somersault I started throwing up uncontrollably from all the spinning. Should I try again? I really can’t handle this feeling of nausea and spinning. It is normal to feel way worse doing this before it gets better?
Hi Amy:
What makes you think that your vertigo is from the otoconia in your inner ears being out of place? The vertigo could be from other causes such as taking an ototoxic medication or a virus, etc. If this is the case, then the half-somersault maneuver won’t help.
I’m no expert on the half-somersault maneuver and don’t know whether trying again is a good idea or not. I’ve just reported on it. If your vertigo is due to the otoconia being out of place, and doing the half-somersault makes it worse, I’d suggest you go to an ENT and have him perform the Epley Maneuver. Maybe you need professional help at this stage.
Cordially,
Neil
Ok. Thank you for replying! I have no idea what it’s from.. I just woke up like this. I’m a little better now as long as I don’t look right or left. Thanks for your help!
I woke up with severe vertigo 3 days ago for the first time in my life . Had about 20 episodes that day when I went from lying to sitting or standing. Saw a dr that day and she sort of did the epely on me in office but I was so vertigo I could barely do it. she told me to do it at home. I did it a bit but wasn’t totally sure about the angles, plus I was shown to do it on a bed with a pillow under my shoulders. My mother in law suggested I try the half sommersault. I did that a bunch too The vertigo diminished by the next days but I wa dizzy all day even while still and I have a fullness/ache in my right ear. I ended up going to the ER yesterday because I was scared about the al day dizziness and it was a weekend. They tested a bunch of things on me but were not able to give me a full diagnosis of the dizziness- the ER dr said either BPPV or the virus of the inner ear ( vestibular neuritis). today I am still dizzy and my equilibrium is off. I took off work for a few days but have to work in a couple of says. how do I know if I have the vestibular virus or bppv? I have been doing both the half sommersault and epley but then I read I shold only do one or the other! I see my dr again tomorrow but I don’t know if she knows which one I have. If it is the virus wil it go away on its own? how many times a day should I do the sommersault? any way to know if my right ear feels clogged achy and full what it is? ER dr said there was a tiny bit of fluid behind the ear drum but the ear did not look red or infected otherwise.
Hi Kate:
If you have a viral infection in your inner ear, you could also have symptoms such as tinnitus or hearing loss along with balance problems. If you only have BPPV, then you would only have balance problems.
Normally, you only do the Epley maneuver (or half-sommersault) once or twice. If it is done properly, all the otoconia will “fall” into place and your vertigo/dizziness will go away. The trick is to do these maneuvers in the right order so the otoconia fall out of the semi-circular canals and into the utricle. If you do them in the wrong order, you won’t get all the otoconia out of the 3 semi-circular canals at the same time so will have continued episodes of vertigo.
Cordially,
Neil
I always had the epley manouvre until I found dr fosters manouvre this has opened new doors for me with overnight recoveries
Hi Liz:
Great that it works so well for you and that you can do it yourself rather than going to an ENT for the Epley maneuver.
Cordially,
Neil
Cordially,
Neil