Have you ever walked into a doctor’s office with a long list of puzzling symptoms—palpitations, dizziness, fainting, swelling of your hands and feet, excessive sweating—only to be told it’s “All in your head” or offered an antidepressant? For many patients, these symptoms are not imaginary at all. They may instead point to a condition called dysautonomia, a disorder of the autonomic nervous system (ANS).
The autonomic nervous system controls “automatic” body functions such as heart rate, blood pressure, digestion, temperature regulation, and circulation. When the ANS is out of balance, these systems can malfunction, producing a wide variety of symptoms that may appear unrelated but stem from the same root cause.
What Is Dysautonomia?
Dysautonomia is an umbrella term for disorders that affect the autonomic nervous system. Because the ANS regulates so many body functions, symptoms can be broad and variable. Some patients experience chronic fatigue, brain fog, digestive issues, or headaches, while others suffer from fainting spells, rapid heart rate, or extreme intolerance to heat.
Two of the most recognized subtypes include:
- Postural Orthostatic Tachycardia Syndrome (POTS): A condition in which heart rate rises dramatically (often by more than 30 beats per minute) when standing up, without a corresponding drop in blood pressure. This can cause dizziness, palpitations, exercise intolerance, and fatigue.
- Orthostatic Hypotension (OH): A sustained drop in blood pressure upon standing, leading to lightheadedness, fainting, or weakness.
Together, these fall under orthostatic intolerance, meaning symptoms worsen when upright and improve when lying down.
Dysautonomia and COVID-19
Since the COVID-19 pandemic, cases of dysautonomia—particularly POTS—have surged. Researchers believe viral infections, including SARS-CoV-2, can trigger immune-mediated damage or dysregulation of the autonomic nervous system. Many patients with “long COVID” report orthostatic symptoms, fatigue, and brain fog consistent with dysautonomia (Blitshteyn & Whitelaw, 2021).
How Is Dysautonomia Diagnosed?
Because dysautonomia is a heterogeneous condition, diagnosis involves a combination of history, physical exam, and autonomic testing. Many patients see multiple specialists before reaching a correct diagnosis.
1. Clinical History and Symptom Assessment
- Careful review of symptoms (palpitations, fainting, brain fog, heat intolerance, GI issues).
- Family history of autonomic disorders or autoimmune disease.
- Review of medications that may worsen orthostatic symptoms.
2. Orthostatic Vital Signs (Bedside Testing)
- Orthostatic Hypotension (OH): Defined as a sustained drop of ≥20 mmHg systolic or ≥10 mmHg diastolic within 3 minutes of standing (Freeman et al., 2011).
- POTS: Diagnosed when heart rate increases by ≥30 bpm (≥40 bpm in adolescents) within 10 minutes of standing without orthostatic hypotension (Raj et al., 2021).
This is typically done with a stand test (active stand test). In our office we use the NASA Lean test which consists of a combination of laying down and standing up “leaning” against a wall with intermittent blood pressure and heart rate readings.
3. Tilt Table Test
- The patient is strapped to a motorized table that tilts upright to 60–70 degrees while monitoring blood pressure, heart rate, and symptoms.
- Helps differentiate POTS, OH, neurally mediated syncope, and vasovagal syncope (Sheldon et al., 2015).
- Unfortunately for many people with POTS or Orthostatic Hypotension, this test will bring on an increase of uncomfortable symptoms.
Treatment Options for Dysautonomia
There is no one-size-fits-all cure for dysautonomia, but symptoms can often be managed with a multifaceted approach.
1. Electrolytes and Hydration
Increasing sodium and fluid intake expands blood volume, helping stabilize blood pressure and circulation.
Recommended Dose (under medical supervision):
- Sodium: 3,000–10,000 mg/day
- Fluids: 2–3 liters/day, spread throughout the day
- Electrolyte powders/tablets: Look for products with ≥1,000 mg sodium/serving
Best Brands with Minimal Fillers/Flavors:
- BodyBio Elyte
- LMNT Recharge
- Nuun Instant
- Liquid I.V. Hydration Multiplier (unsweetened version)
Find the brand that you can tolerate, and you will stick with taking it several times a day, every day.
2. Compression Therapy
Compression stockings (20–30 mmHg, knee high) improve circulation and reduce pooling of blood in the legs. These can easily be purchased online.
3. Exercise and Conditioning
Deconditioning worsens symptoms. A structured, gradual recumbent exercise program (rowing, recumbent bike, swimming) is often recommended. Strengthening the calf and core muscles supports venous return. Be careful not to overdo it, too much strenuous exercise can also exacerbate symptoms.
4. Medications
Pharmaceutical options vary based on the dysautonomia subtype:
- Fludrocortisone: Expands blood volume
- Midodrine: Increases vascular tone, raising blood pressure
- Beta-blockers: Reduce heart rate spikes in POTS
All should be prescribed and monitored by a clinician experienced in autonomic disorders.
5. Lifestyle and Trigger Management
Patients often worsen with heat, dehydration, illness, or stress. Strategies include:
- Increase electrolytes and fluids before heat exposure (500–1000 mL extra fluid)
- Use cooling vests, ice packs, misting fans outdoors
- Practice paced breathing, yoga, or mindfulness for stress control
6. IV Infusions
Normal saline (0.9%) IV infusions can temporarily stabilize blood pressure and reduce symptoms during flare-ups or after illness/exertion. While not a long-term solution, some patients find them helpful during acute phases.
Living with Dysautonomia
Dysautonomia can be frustrating, especially when misunderstood by clinicians or minimized by others. However, with proper hydration, electrolytes, compression therapy, exercise, medications, and stress management, many can regain stability and improve their quality of life.
Resources for Further Reading
- Dysautonomia International: https://www.dysautonomiainternational.org
- The POTS Care Foundation – Patient-centered resources for POTS and autonomic disorders
- Books:
- Grubb, B. P. The Fainting Phenomenon: Understanding Why People Faint and What to Do About It
- Raj, S. R. POTS: Together We Stand – Riding the Waves of Dysautonomia
- Freeman, K., Goldstein, D. S., Thompson, C. R., The Dysautonomia Project
Dysautonomia is a complex but increasingly recognized disorder of the autonomic nervous system that can profoundly affect daily life. While symptoms often appear unrelated—ranging from dizziness and fainting to fatigue, brain fog, and digestive changes—they share a common root in autonomic imbalance. Careful diagnosis through history, orthostatic testing, and, when needed, tilt table evaluation allows for targeted treatment strategies.
Although there is no single cure, patients can often achieve meaningful improvements through a combination of hydration and electrolyte support, compression therapy, exercise, medication, and lifestyle adjustments. With growing awareness, especially in the wake of COVID-19, more clinicians are recognizing dysautonomia as a legitimate and treatable condition.
By working with knowledgeable providers, staying informed through organizations like Dysautonomia International, and building supportive networks, patients can take an active role in managing symptoms and improving their quality of life. Dysautonomia may be challenging, but with the right tools and strategies, stability and resilience are possible.
References
Blitshteyn, S., & Whitelaw, S. (2021). Postural orthostatic tachycardia syndrome (POTS) and other autonomic disorders after COVID-19 infection: A case series of 20 patients. Immunologic Research, 69(2), 205–211. https://doi.org/10.1007/s12026-021-09185-5
Freeman, R., Wieling, W., Axelrod, F. B., Benditt, D. G., Benarroch, E., Biaggioni, I., … & van Dijk, J. G. (2011). Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Clinical Autonomic Research, 21(2), 69–72. https://doi.org/10.1007/s10286-011-0119-5
Dysautonomia International. (n.d.). Dysautonomia information page. Retrieved August 29, 2025, from https://www.dysautonomiainternational.org
Raj, S. R., Guzman, J. C., Harvey, P., Richer, L., Schondorf, R., & Seifer, C. (2021). Canadian Cardiovascular Society Position Statement on Postural Orthostatic Tachycardia Syndrome (POTS) and Related Disorders of Orthostatic Intolerance. Canadian Journal of Cardiology, 36(3), 357–372. https://doi.org/10.1016/j.cjca.2019.12.025
Sheldon, R. S., Grubb, B. P., Olshansky, B., Shen, W. K., Calkins, H., Brignole, M., … & Raj, S. R. (2015). 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm, 12(6), e41–e63. https://doi.org/10.1016/j.hrthm.2015.03.029
