What to Avoid after BPPV treatment
Believe it or not, when I first started treating BPPV in 2006, we used to have our patients sleep upright and wear a soft cervical collar for a few days after treatment.
Yes, it is true! Things have changed since then.
The research has evolved at this point, so we have new instructions on what to avoid after BPPV treatment.
In this blog, I will give you the official evidence-based precautions of what to avoid after BPPV treatment.
I will also share with you additional precautions that I have learned from my patients who had a recurrence of BPPV shortly after I successfully treated them.
I hope this information helps you maximize your recovery from BPPV!
Evidence-Based Precautions after BPPV Treatment
The only precautions that are now supported by research after BPPV treatment are these:
- Sit up for 20 minutes after treatment is completed. What to avoid after BPPV treatment includes bending forward to put on your shoes, leaning back to recline, and tipping your chin down to check your phone. It is important that you just sit upright with your head level for a 20 minute rest break, on a chair or the couch.
- Avoid vigorous head shaking for one week.
These two evidence-based precautions will allow the BPPV crystals to settle in after treatment.
Do I Need to Sleep Upright?
For some very difficult or extremely stubborn cases, I may suggest for my patient to sleep propped up until treatment is all completed. But most people do not need to take that precaution.
Sleeping upright is considered an old recommendation and I rarely recommend it.
One doctor that I work very closely with recommends for all of his patients with BPPV to sleep upright for the rest of their lives.
In my experience, sleeping upright causes people to develop neck pain.
The most important thing is get a good night’s sleep after BPPV treatment so your brain can reset.
How to Avoid Vigorous Head Shaking
If my patient feels the recurrence of BPPV within the first week after I had completed their treatments, I have always asked them what they were doing.
I have been gathering information from my patients so I can learn more about what to avoid after BPPV treatment.
With the information I have gathered from my patients over the years, I learned that a lot has to do with head shaking/movement. I have made a list for you of specifically what to avoid after BPPV treatment for the first week.
These are some examples of activities that caused my patients to get BPPV again, within a week after we finished their care.
Research indicates that returning to your normal activities as soon as possible after an episode of BPPV is associated with better outcomes.
That is true, but I still caution you to avoid the following activities that can jar or shake your head to possibly dislodge the crystals again during the first week of your recovery.
What To Avoid after BPPV treatment (for one week):
- Using an electric toothbrush (Tip: You can use it without the vibration for the first week.)
- Enthusiastic dancing, such as headbanging or bobbing your head in the car
- Shaking your head around vigorously while exercising, including bouncing and jumping jacks
- High impact exercises such as running, burpees, or jump squats
- Jumping on a trampoline
- Using a handheld blender, or mixer with beaters, such as to make cake batter or guacamole
- Putting your hand on a blender to stabilize the base or the lid, while you’re making a smoothie
- Blowing raspberries on the belly of a baby
- Bouncing a baby on your lap vigorously
- Sitting or lying on a vibrating mat for a back massage
- Sitting on a vibrating massage chair at the nail salon, such as during a pedicure
- Holding any kind of vibrating massager or activator tool near your head, neck, or arms
- Using handheld power tools, such as a sander, drill, or dremel – This is especially true for certain profession like dentists, jewelers, mechanics, and building contractors.
- Listening to extremely loud music or audio, especially through headphones or earbuds
- Riding in a bouncy or bumpy vehicle, like a jeep, truck, or tractor – Also avoid riding in any vehicle on a bumpy road or rough terrain.
- Gymnastics and tumbling
- Diving off a springboard, high dive, or cliff
- Cliff jumping – You may want to consider avoiding this type of activity longer than one week for safety reasons! 🙂
Pro Tip: Make sure you tell any provider that works on you, like a chiropractor or massage therapist, to avoid using any vibrating tool near your head or neck for at least a week after BPPV treatment.
I hope these tips on what to avoid after BPPV treatment are helpful.
What if BPPV Recurs?
If you notice dizziness with lying down, rolling over, or turning quickly, then you likely need more treatments for BPPV. The crystals can dislodge anytime, but may never come back at all.
For more tips on recognizing a recurrence of BPPV, click here.
The key is to get BPPV treated right away, so you can move on with your life!
If you find that you are getting “recurrent idiopathic BPPV,” which means no known cause of recurrences, then you may want to adopt a lifestyle of less vigorous head motions. This may help reduce how often the BPPV crystals are dislodging. However, this precaution is only necessary in persistent cases.
Most people are able to resume normal activity one week after BPPV is resolved. I suggest you discuss that with your Vestibular Provider.
Returning to your normal activity as soon as possible after recovering from BPPV is important to avoid getting out of shape!
For more tips on BPPV prevention, click here.
For information about Driving after Vertigo Treatment, click here.
Disclaimer
This blog is provided for informational purposes only. The content and any comments by Dr. Kim Bell, DPT are not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. The details of any case mentioned in this post represent a typical patient that Dr. Bell might see and do not describe the circumstances of a specific individual.
Thank you for identifying those great and very specific actions to avoid after BPPV treatment. That is much more helpful than the usual advice of … “there’s really nothing you can do to avoid a recurrence”. And then staying well hydrated and keeping optimal vitamon D levels can help further.
Thank you for this information.
Thank you and bless you for the tips. I have been dealing with BPPV for 32 years now. It doesn’t get any easier.
Do you still do your VRT exercises after treatment and that first week? Or do you skip the the exercises that have you bending down to touch the floor?
Hi Constance,
This question is best directed to a Vertigo Professional who has evaluated you.
Some people need exercises after BPPV treatment and other people do not need any VRT exercises after BPPV treatment.
That depends on your individual situation and symptoms.
I am sorry you have been dealing with BPPV for so long and I hope you are able to find a good provider in your area to help you!
Sincerely,
Dr. Kim Bell, DPT
Dr. Bell. You are an angel. People need to know what you did for me. I live in Maui. I contacted you via text on a Sunday hoping we could work remotely during the following week. You contacted me back the same day saying you didn’t work remotely but were willing to help me think things through. You sent me a number oif extremely helpful links, one of which pointed out a very unique and rare situation that seemed like it might fit my symptoms, and IT DID. I was cured THAT DAY. You also followed up with me the next day, no charge, just because you cared, and, well, I have no idea how to thank you. I’m not sure there is anyone that could have figured this rare form of vertigo out besides you. I owe you so much. My life is suddenly back to normal. Shout out: If you have vertigo — SEE THIS DOCTOR. You will be in the best of hands!
Thank you Gary! I really appreciate your time in sharing your experience.
Best wishes,
Kim Bell, DPT
May I ask your unique case? I have been in therapy for over 2 weeks now trying to get the crystals back to normal.
What about sleeping on that side? I initially had it in my right ear 4 years ago. Did the Epley and fixed it. I always used to sleep on two pillows after that but felt more comfortable with one. Sure enough about a month and a half after switching to one pillow, three days ago it happened in my left ear (because I didn’t sleep on my right side after that). Can I still sleep on my left side with two pillows and be fine? I cannot stand sleeping on my back because it is not comfortable and I wake up with a stiff neck. I fixed it with an Epley maneuver and I feel fine now thankfully!
Hi Matt,
Some doctors will advise patients to avoid sleeping on the side that was treated for BPPV for a week after treatment. In extreme cases of frequent BPPV recurrence, the doctor may advise the patent to avoid sleeping on that side indefinitely.
I suggest that you follow the instructions given by your doctor or healthcare provider for your specific case.
Research has shown that the rate of recurrence is not necessarily dependent on which position you sleep in.
If the BPPV is going to come back, there is not much you can do to prevent it. Supplementing Vitamin D if your level is below 30 on a lab test is one strategy that may reduce the frequency of BPPV recurrence.
The key is to recognize BPPV recurrence and get it treated to resolution as soon as possible.
Some people choose to sleep propped up so that they do not feel the BPPV symptoms, which are commonly felt lying flat or lying on one side.
Once BPPV is successfully treated, the symptoms should no longer be present while lying flat or on one side.
I agree that sleeping propped up is not great for your neck.
Getting good sleep is important for your full neurological recovery after successful BPPV treatment.
I am glad that you are feeling fine now! That’s wonderful news.
Warmest regards,
Kim Bell, DPT
I recently woke up w severe vertigo…did the epley maneuver….i no longer have vertigo when i look up..havent tried looking down or laying flat on ground yet bc it hasnt been 24 hours after i did the maneuver…..but im now extremely nauseous and have been for the past 14 hours or so…how long does this nausea last after epley maneuver? Thank you
Hi Peter,
Even if they BPPV treatment is successful, you can have a hangover effect.
I describe it as similar to drinking too much tequila.
If you need some Home Remedies, check this out.
If you want to get professional help, this may help.
Best wishes,
Kim Bell, DPT
Hey Dr. kim , thanks for the help you provide for us i have a continues vertigo for 2 months now and don’t really know how to deal with that i visited so many dr for ears and one of them detected that i have crystals in my right ear and did VRT exercise but still i feel a little improvement and also i hear Tinnitus sound since it is started. If it is possible you can provide some tips or guide me what should i do i wish i was able to visit you but i am life very far from where you are
Hi Alex,
It sounds like you might need to see two different types of specialized physical therapists.
You can find a Vestibular Physical therapist using this blog article with two online provider directories.
You can find an Orthopedic Manual physical therapist using the search directory on this website.
I hope you find answers and relief soon!
Best wishes,
Kim Bell, DPT
Dear Dr. Kim
I’m 18 and I have been dealing with BPPV for almost 1 year I can’t lay on my back and whenever I lie down on my left side i feel dizzy. Now i have tinnitus in my left ear this is so disturbing as my left ear ringing nonstop. ☹️ I went to many ENT doctors where i live they couldn’t find which canal the crystals get dislodged. I‘m scared of sleeping because of this. I feel dizzy whenever i woke up. I‘m so desperate
Hi Julia,
I am sorry to hear all this!
This blog may help you find a vestibular provider in your area who offers particle repositioning maneuvers, which is treatment for BPPV.
I have been dealing with BBPV symptoms for about 5 months now. I am waiting for a VNG test. My doctor said I did not show any rapid eye movements when trying to diagnose me with BBPV. I am going to be seeing a physical therapist next week. Is the therapy the same or different when one is not showing rapid eye movements? I am confused. Is certain eye movements only visible in certain tests, like the VNG testing for example. Should I be starting therapy before the VNG testing? help.. This whole condition is hell.
Hi Mary,
I am sorry to hear what you are going through!
You may be interested in this blog and this blog.
I hope those two blogs help to answer your first question.
In general, you can start vestibular therapy before completing VNG testing.
This blog has some Home Remedies that may help you.
Best wishes,
Kim Bell, DPT
Dear Dr Kim,
I would appreciate your advice. I had lateral bppv last year for the 1st time left side. It was treated by doctor but I still had mild symptoms like I can’t sleep on left side at all as I feel dizzy.
That symptom didn’t go away for 1 year 🙁
I also have constant rhinitis (probably allergy) and there is like clicking sound in my left ear because of that. My doctor considered that it also can be the reason for mild vertigo during walking sometimes and when I try to sleep on left side.
Maybe I should try some different maneuvers to get rid of it constantly?
Hi Irena,
I am sorry to hear what you are going through!
I think it sounds like you might need to address three things, and possibly see three different specialty providers.
I suggest for you to deal with the rhinitis, which can precede a new onset of BPPV (a recurrence).
I also suggest for you to return to the provide who diagnosed and treated your BPPV to get a check up, to make sure you are still all clear.
For the clicking in your ear, you may want to see a manual therapy provider, like a physical therapist or chiropractor who specializes in upper cervical issues.
I hope that helps!
I hope you feel better soon.
Sincerely,
Kim Bell, DPT
Hello,
My first instance of vertigo was rolling over in bed. An inner ear infection was discovered three weeks later. It’s been 60 days and this morning it happened again. I thought I was in the clear. I did jump on a trampoline two days prior and had a severe headache prior to this vertigo episode. I am 40 years old and used to be very active. I’m afraid I will never return to normal.
Hi Jennifer,
This blog with home remedies may help.
This blog regarding how to find a Vestibular provider in your area may help as well. I suggest looking for a Vestibular Physical therapist if possible.
Dizziness in the morning usually BPPV, so I suggest you notify your Primary doctor and seek a vestibular PT as soon as possible.
Especially since you have a history of inner ear infection, you can experience recurrent BPPV in the future. Or these two incidents could be unrelated, if the inner ear infection did not damage your ear.
The best plan is to get it treated ASAP whenever it recurs. Hang in there!
I have linked to a number of my other educational blogs which may help you learn more. The more you understand, the less you might worry.
Best wishes,
Kim Bell, DPT
Hello,
Just wondering if your have an acute episode of BPPV and you perform the Epley Manoeuvre and the severe dizziness symptoms start to reduce if you continue to do the exercise for a few days will it dislodge the crystals again? This is my second BPPV attack in two years. The first one was my left side and now it’s my right side. After I had my first attack on my left side I became a right side sleeper and now it’s on my right side.. I guess I will have to try to remain on my back! BPPV may be benign but it’s very real and debilitating 🙁
Hi Jacqui,
I am sorry to hear you are having a BPPV recurrence!
It is important to consult with a professional for an exam, since the past episodes of BPPV vertigo have little predictive value of the type of BPPV you may get in a recurrent episode.
The key is to find a local professional who you can see for an exam, for any BPPV recurrence.
You can use this blog for home remedies that may help.
This blog may help you find a local provider.
This blog explains more about why I do not recommend for people to try to treat themselves for BPPV before seeing a professional.
I hope those resources are helpful.
I hope you feel better soon!
Best wishes,
Kim Bell, DPT
Thanks for this post. Is it ok to use the computer or watch tv after Epley? Thanks again
Hi Nancy,
I usually advise my patients to “take the rest of the day off,” meaning no cooking, no working, no chores, no exercise, no other appointments and minimal to no screen time.
I hope you feel better soon!
Sincerely,
Kim Bell, DPT
Thank you so much for this information!
I just came down with BPPV on both sides last Tuesday and I have been very confused about it. My ENT sent me home after fixing it with Epley and told me to sleep upright for 48 hours and wear a cervical collar. I stayed up most of the night both nights bc sleeping upright hurts and on the third night it came back anyway. If you have time, I’d love your opinion on providers in the Atlanta, GA area. I thought ENTs were specialized enough. Maybe not?
Hi Gwen,
In Atlanta, I recommend the Vestibular Rehab clinic in the Dizziness and Balance Center at Emory University.
I also recommend seeking care from Gaye Cronin, OT at Vestibular Atlanta. She is pretty great!
Those are two good options for vestibular health care in Atlanta.
I hope you feel better soon!
Hi! I am suffering from post concussion syndrome and whiplash.
My upper cervical (C1 bone) won’t stay in alignment from my injury causing dizziness 🙁
I also have vision issues and working with a neuro optometrist to help with visual vertigo 🙁
I also have had a lot of reoccurrence of BPPV.
I am five years in from my initial injury.
I am a complicated case – it’s horrible and I need help!
I see an upper cervical chiropractor, an neuro-optometrist and a vestibular physical therapist.
How can I stop the BPPV? My vitamin d level is 90.
I am tired of this life!
Do you do telemedicine? I am in Sacramento, CA.
Or do you know of a great vestibular PT like you?
Thanks
Hi Tina,
It does sound like you are a complicated case, as you said. I’m sorry to hear all that you are facing.
No I do not offer Telehealth. If you want to learn more about my services, which are offered in Encinitas, CA, click here.
If you want to search for other vestibular physical therapists, you may want to search the directories I share in this article.
Regarding upper cervical dizziness, I am in the process of publishing a series of blogs on this topic. Two are already published and two more will be published sometime this month.
I’m also in the final editing phase of my first book on vertigo, in which I discussed BPPV in depth and share about cervical dizziness in one of the chapters. You can join my mailing list if you want to be notified when that comes out.
In this article on my other website BetterBalanceInLife.com, I discuss how I personally approach and sequence upper cervical dizziness and BPPV treatment for patients who have both issues.
Any restrictions in blood flow to the ears can cause recurrent BPPV.
That’s why BPPV has such a high incidence in people with diabetes, high blood pressure, high cholesterol, tobacco smoking, etc.
The upper cervical (C1) subluxation can restrict blood flow to the ears. That’s why it’s so important to address concurrently with the BPPV.
Sometimes, food sensitivities can cause C1 to keep coming out. I discuss that a bit more in this blog and my response to the first blog comment from Simon.
I will be publishing a blog article this month on other causes of chronic, C1 alignment issues, so be sure to check back for that information.
There is so much depth to the potential interplay of the chronic alignment C1 issue and the recurrent BPPV, that I suggest you explore how those two issues may be continually perpetuating or triggering each other.
For whiplash, you may also benefit from soft tissue work to help your adjustment hold in place and relieve some dizziness.
I like to refer my patients to soft tissue providers who are trained in active release technique. This website has a directory of practitioners and explains the technique.
Also when I got my 3rd concussion in 2020, I had a really tough time recovering. My doctor recommended neurofeedback with a specific dynamical software that you can learn more about and possibly rent a unit at this website. Please tell Nikki that I referred you.
I hope some of that is helpful!
It sounds like you have all the right players on your health care team.
Perhaps you may need to sequence your treatments differently or add in a few more things to the treatment plan to address all the factors concurrently that are playing into your complex case.
I hope you feel better soon!
Keep going and don’t give up hope for a full recovery.
Sincerely,
Kim Bell, DPT
Thank you! What do you think about cervical instability?
I would love to have a PT that believes in upper cervical dizziness ;(
I pray someone comes my way soon!
Would it be a good idea to have a cranial sacral done on my jaw and ear area?
And maybe massages in that area?
Thank you for shinning the light on people like me, it’s been so hard.
God bless you
Hi Tina,
I’m happy to help by sharing educational resources.
I agree that upper cervical instability should always be considered for whiplash-associated dizziness.
This article published by an upper cervical chiropractor in Denver has some helpful information on cervical instability, including diagnosis and treatment options.
For soft tissue work or massage, I prefer the active release technique that I’ve already shared with you in my first response.
Myofascial release is also helpful for some people.
I personally do not refer my patients to craniosacral therapy.
I am a born again Christian so I stay away from various alternative therapies that involve energy healing, even though I used to be into all that and even practiced energy healing before I came to the Lord in 2017 and repented of it.
I pray that you find the right providers and gain insight so you can get relief as soon as possible!
God bless you too!
Sincerely,
Kim Bell, DPT
Can I ask how you treat multiple canal BPPV?
It’s horrible!
Thank you
Hi Tina,
Multi-canal BPPV needs to continually reassessed and treated by a vestibular professional based on symptoms and nystagmus.
They will have to follow whatever the assessment is showing and treat what they find.
I suggest being seen at least once a week until it clears up.
I hope you feel better soon!
Hi, so I had my first (scary) episode of BPPV on left side. Got through it with no procedure, only Dramamine.
I was waiting to see DR. and they could not get me in until the following day. No treatment maneuver was performed due to no present symptoms at that point.
Does this mean I’m fine? Are the crystals back in place?
Having some sleep anxiety due to staying on my back which is not my norm.
When can I start exercising again?
They did say I had fluid in the left ear (allergy related) and to take a decongestant.
Hi Jennifer,
You are asking all the right questions and have done all the right steps so far. Well done!
This blog talks about the link between anxiety and dizziness.
This blog talks about the importance of sleep to recovering from vertigo.
I suggest you ask the doctor to refer you to a vestibular PT to get a full evaluation.
You can use this blog to search for vestibular PT in your area.
If you have any residual BPPV they may find it and treat it.
If you have any Kinesiophobia (fear of movement), they can give you exercises to help you break through it back to normal.
I’m glad you were feeling better so quickly. Best wishes for a full recovery!
Thank you for this helpful information.
I would like to know if it is ok to read a book or watch tv with BPPV vertigo.
I have the kind with loose crystals in my ear.
Your list was quite enlightening.
Hi Annie,
I would say it’s ok as long as it’s not triggering your symptoms.
It’s important for your brain to have a deep rest break and get extra sleep after each BPPV treatment, so it can recalibrate the vestibular system.
Some people find reading or watching TV is relaxing, and not triggering any symptoms, so that is fine.
If it triggers dizziness, then it’s not ideal for recovering from BPPV treatment.
I hope you feel better soon!
I had BPPV in my left ear several months ago and since I cannot lay on my left side which was my preferred side to sleep on without my head starting to feel funny/off. Is there anything I can do to be able to lay on my sides or more flat on my back again? I sleep more propped up on my back only now.
Hi Kellie,
I suggest you seek treatment for the BPPV.
You can use this blog to search for a local provider.
Best wishes!