Objective To explore the optimal timing and acute reduction plan for benign paroxysmal positional vertigo (BPPV) patients. Methods A total of 184 patients with posterior semicircular canal BPPV who visited our hospital from January 2021 to July 2023 were selected as the research subjects. They were 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, and the effective rates and other parameters among the groups at 1 day, 1 week, and 1 month after reduction were observed. 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 in patients among different groups. Results There were significant differences in the total effective rates 1 day and 1 week after reduction among groups A, B, and C (P<0.05), while the total effective rates of group B were the highest, 92.65% and 95.59%, respectively. One day and 1 week after 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 with the Semont group, patients in the Epley group had higher total effective rates 1 day, 1 week, and 1 month after reduction (P<0.05). Compared with Semont group, patients in Epley group had lower symptom scores 1 day and 1 week after reduction (P<0.05). Compared with the Semont group, patients in the Epley group had lower DHI physical and functional dimension scores after 1 day and 1 week of reduction (P<0.05). The GEE analysis results showed that the improvement in symptoms and quality of life in patients of the Epley group after 1 day and 1 week of reduction was significantly better than that of the Semont group (P<0.05). Conclusion The clinical effect of posterior semicircular canal BPPV patients with different course of disease is significantly different, and the optimal period for reduction is 24 hours to 7 days after onset of the disease, with good patient experience and high effective rate. The Epley method for reduction of posterior semicircular canal BPPV is more effective than the Semont method, which can significantly improve the patients’ discomfort symptoms and reduce the impact of the disease on the daily life.