Objective To explore the optimal timing and acute reduction plan for benign paroxysmal positional vertigo (BPPV) patients. Methods Select patients (184 cases) with BPPV in the posterior semicircular canal who visited our hospital from January 2021 to July 2023 as the research subjects; Divided into Group A (n=56, <24 h), Group B (n=68, 24 h~7 d), and Group C (n=60, >7 d) according to the course of the disease; Observe the effective rates and other parameters among the three groups within 1 d, 1 week, and 1 month after reduction, and according to the reduction treatment method, they were divided into Semont group (n=96) and Epley group (n=88). Generalized estimating equation (GEE) was used to evaluate the improvement of symptoms and quality of life among patients in different treatment groups. Results There were significant differences in the total effective rates of patients in groups A, B, and C with different disease courses after 1 d and 1 week of reduction (P<0.05); Group B had the highest total efficacy, with 92.65% and 95.59% respectively. After 1 day and 1 week of reduction, the dizziness handicap inventory (DHI) scores of patients in Group B were significantly lower than those in Groups A and C (P<0.05). Compared to the Semont group, patients in the Epley group had higher overall effective rates after 1 d, 1 week, and 1 month of reduction (P<0.05). Compared to the Semont group, patients in the Epley group had lower symptom scores after 1 d and 1 week of reduction (P<0.05). Compared with the Semon group, patients in the Epley group had lower DHI physical and functional dimension scores after 1 d and 1 week of reduction (P<0.05). The GEE analysis results showed that the improvement in symptoms and quality of life of patients in the Epley group after 1 d and 1 week of reduction was significantly better than that in the Semont group (P<0.05). Conclusion There is significant difference in clinical efficacy among patients with BPPV in the posterior semicircular canal of different disease stages, and the optimal period for restoration is 24 h~7 d after onset of the disease, with good patient experience and a high effectiveness rate. The Epley method is more effective than the Semont method in treating BPPV in the posterior semicircular canal, which can significantly improve the patient"s discomfort symptoms and reduce the impact of the disease on their daily life.