This leaflet provides detailed information about exercises designed to help manage Benign Paroxysmal Positional Vertigo (BPPV). It includes instructions for two common types of exercises: the Brandt-Daroff exercises and the Home Epley Manoeuvre. Please read all the information carefully before you begin.

Understanding Benign Paroxysmal Positional Vertigo (BPPV)

Benign Paroxysmal Positional Vertigo, or BPPV, is a very common cause of dizziness and a feeling of spinning (vertigo). It happens when tiny calcium crystals, called otoconia (pronounced oh-toe-KOH-nee-uh), become dislodged from their usual place in your inner ear.

Your inner ear contains delicate tubes and chambers (often called the labyrinth) that help you hear and maintain your balance. Within this labyrinth are three loop-shaped tubes called the semi-circular canals, which are responsible for sensing head movements. Normally, the otoconia crystals sit in a different part of your inner ear, where they help sense gravity and linear motion.

If these crystals break loose and float into the semi-circular canals, they can send confusing signals to your brain when you move your head. This causes sudden, brief, but often intense, spinning sensations. These dizzy spells are typically triggered by specific head movements, such as looking up, lying down, turning over in bed, or sitting up quickly. While BPPV often gets better on its own over several weeks, it can sometimes return.

What Are BPPV Exercises and How Do They Help?

The exercises described in this leaflet are a very effective way to treat BPPV. They work in one of two main ways:

• Repositioning the Crystals: Many exercises, particularly the Epley Manoeuvre, use gravity and a series of specific head and body movements to gently guide the dislodged crystals out of the sensitive semi-circular canals and back into an area of your inner ear where they won't cause problems. This helps to stop the confusing signals that lead to vertigo.
• Helping Your Brain Adjust: Other exercises, like the Brandt-Daroff exercises, might help by repeatedly exposing you to the movements that cause dizziness. Over time, this can help your brain get used to these sensations and reduce how much they bother you. This process is sometimes called 'vestibular compensation'.

The Brandt-Daroff exercises are generally simpler to perform at home without specialist supervision, while the Epley Manoeuvre can be performed at home or by a specialist in a clinic.

Important Safety Advice Before You Begin

It's very common to feel dizzy or experience vertigo during these exercises – that's actually a sign they are working and that the crystals are moving! However, this means safety is extremely important. Please keep the following in mind:

• Have Someone With You: Especially for the first few times you try these exercises, ask a friend or family member to be present. They can offer support, help you if you feel unsteady, and ensure you are safe.
• Safe Environment: Always perform the exercises on a bed or a firm, stable surface where you won't fall. Make sure there's nothing you could trip over nearby.
• Close Your Eyes: If the spinning sensation becomes too intense, closing your eyes can sometimes help to reduce the feeling of vertigo.
• Start Slowly: Begin gently and gradually increase the speed and duration of the movements as you become more comfortable and confident.
• Consult Your Doctor First: If you have any existing neck problems, joint issues, heart conditions, or certain eye problems, it's very important to speak with your doctor or ENT specialist before attempting these exercises. They can advise if these movements are safe for you.

Performing the Brandt-Daroff Exercises

The Brandt-Daroff exercises are designed for unsupervised home use due to their simpler nature. They involve repeated movements to either relocate the inner ear crystals or help your brain get used to the dizziness.

Step-by-Step Guide

You will need a bed or a firm, comfortable surface.

1. Starting Position: Sit upright on the edge of your bed.
2. First Movement - Head Turn: Turn your head 45 degrees (about halfway towards your shoulder) to your left.
3. First Movement - Lie Down: Quickly lie down on your right side, keeping your head turned to the left. Your head should be resting on the bed, with the back of your head behind your ear touching the surface.
4. Hold Position: Stay in this position for 30 seconds, or until any dizziness completely stops, whichever is longer.
5. Sit Up: Slowly sit back up to the starting position on the edge of the bed.
6. Second Movement - Head Turn: Turn your head 45 degrees to your right.
7. Second Movement - Lie Down: Quickly lie down on your left side, keeping your head turned to the right.
8. Hold Position: Again, stay here for 30 seconds, or until any dizziness completely stops, whichever is longer.
9. Sit Up: Slowly sit back up to the starting position.

Steps 1-9 count as one full repetition.

How Often Should I Do Brandt-Daroff Exercises?

• Perform a set of 5 repetitions (meaning you've done both sides five times).
• Do these exercises three times a day (for example, once in the morning, once at midday, and once in the evening).
• Continue these exercises consistently for two weeks.

Performing the Home Epley Manoeuvre

The Epley Manoeuvre is a highly effective treatment that uses gravity to guide the dislodged crystals back to their correct position. Your doctor or specialist will usually tell you which ear is affected by BPPV. It's important to know this, as the manoeuvre is performed differently depending on whether your right or left ear is the problem.

Identifying Your Affected Ear

Before starting, you need to know which ear is causing your BPPV. Your doctor or ENT specialist will have diagnosed this. If you are unsure, please check with them before attempting the Epley Manoeuvre.

Step-by-Step Guide for Right-Sided BPPV

If your right ear is the affected side, follow these steps:

1. Preparation: Sit on your bed. Place a pillow behind you so that when you lie back, it will be under your shoulders, allowing your head to hang slightly over the edge of the bed.
2. Step 1: Turn your head 45 degrees (about halfway towards your shoulder) to your right.
3. Step 2: Quickly lie back, keeping your head turned 45 degrees to the right. Your head should be hanging slightly over the edge of the bed. Hold this position for one minute, or until any dizziness completely stops.
4. Step 3: Slowly turn your head 90 degrees to the left, so it's now turned 45 degrees to your left (and still hanging over the edge). Hold this position for one minute.
5. Step 4: Turn your entire body to the left, rolling onto your left side. Your head should remain turned 45 degrees to the left, so you are now looking towards the floor. Hold this position for one minute.
6. Step 5: Slowly sit up, tucking your chin towards your chest as you do so.

Step-by-Step Guide for Left-Sided BPPV

If your left ear is the affected side, follow these steps:

1. Preparation: Sit on your bed. Place a pillow behind you so that when you lie back, it will be under your shoulders, allowing your head to hang slightly over the edge of the bed.
2. Step 1: Turn your head 45 degrees (about halfway towards your shoulder) to your left.
3. Step 2: Quickly lie back, keeping your head turned 45 degrees to the left. Your head should be hanging slightly over the edge of the bed. Hold this position for one minute, or until any dizziness completely stops.
4. Step 3: Slowly turn your head 90 degrees to the right, so it's now turned 45 degrees to your right (and still hanging over the edge). Hold this position for one minute.
5. Step 4: Turn your entire body to the right, rolling onto your right side. Your head should remain turned 45 degrees to the right, so you are now looking towards the floor. Hold this position for one minute.
6. Step 5: Slowly sit up, tucking your chin towards your chest as you do so.

How Often Should I Do the Home Epley Manoeuvre?

• After completing one full Epley Manoeuvre, rest for 15 minutes.
• Then, repeat the entire sequence once more.
• Some people experience significant improvement after just one or two attempts. However, others may need to perform this manoeuvre daily for a few weeks to achieve the best results.

Important Advice After the Epley Manoeuvre

To help prevent the crystals from moving back into the wrong place after the manoeuvre, please follow these recommendations:

• Try to remain upright for the rest of the day after performing the manoeuvre. Avoid lying flat.
• For a few days, try to avoid sleeping on the side that was affected by BPPV. For example, if your right ear was affected, try to sleep on your left side or on your back.
• For about a week, try to avoid tilting your head upwards, especially towards the affected side.

What to Expect and When to Seek Further Advice

• Initial Dizziness: It is very common and normal to feel more dizzy or unsteady during and immediately after performing these exercises. This sensation usually settles down quickly.
• Gradual Improvement: You should notice a gradual reduction in your dizziness and vertigo symptoms over the course of the treatment period.
• BPPV Can Recur: While these exercises are very effective, it's important to know that BPPV can sometimes return in the future. If it does, you can often repeat the exercises.

When to Contact Your Clinician:

Please contact your doctor or ENT specialist if:

• Your dizziness does not improve, or if it gets worse, after two weeks of consistently performing the Brandt-Daroff exercises.
• Your BPPV symptoms return and persist for a couple of weeks after performing the Epley Manoeuvre.
• You develop any new or worrying symptoms that are different from your usual BPPV.
• You have any concerns or questions about performing the exercises.

Remember

These exercises are a powerful tool to help manage your BPPV and significantly improve your quality of life. Be patient with yourself, follow the instructions carefully, and don't hesitate to reach out to your healthcare team if you have any concerns or if your symptoms don't improve as expected. Your well-being is our priority.