Dysautonomia & POTS: Symptoms, Causes & Naturopathic Support

What Are the Different Types of Dysautonomia?

Dysautonomia doesn’t always mean POTS. There are several recognised patterns of autonomic dysfunction, and what happens to your heart rate and blood pressure when you’re upright can help distinguish between them.

POTS (Postural Orthostatic Tachycardia Syndrome) is characterised by an excessive increase in heart rate after standing, accompanied by symptoms of orthostatic intolerance, without the sustained fall in blood pressure that defines orthostatic hypotension.

Orthostatic hypotension is different. Here, blood pressure falls significantly after standing, which can reduce blood flow to the brain and cause dizziness, weakness, blurred vision or fainting.

Vasovagal syncope involves an autonomic reflex that can suddenly lower blood pressure and heart rate, sometimes resulting in fainting. Triggers can include prolonged standing, heat, pain, emotional distress or medical procedures.

There are also people who experience clear orthostatic intolerance – symptoms that worsen while upright and improve when they sit or lie down – without meeting the diagnostic criteria for POTS or orthostatic hypotension.

Two people can both say, “I feel terrible when I stand,” while their heart rate and blood pressure are doing very different things.

That distinction matters, because the same experience of dizziness, weakness or feeling unwell upright doesn’t necessarily point to the same form of autonomic dysfunction.

What Is POTS – And What Is the Heart Rate Actually Telling You?

It can be easy to come away from a POTS diagnosis thinking the problem is that your heart beats too fast when you stand. After all, the change in heart rate is one of the things used to diagnose it.

But a racing heart may be part of the body’s attempt to compensate for something else.

POTS is a form of dysautonomia characterised by orthostatic intolerance alongside a sustained increase in heart rate when upright. In adults, this is generally an increase of at least 30 beats per minute within 10 minutes of standing or head-up tilt, without the significant fall in blood pressure seen in orthostatic hypotension.

When you stand, gravity shifts blood towards your legs and abdomen. Normally, your autonomic nervous system responds almost immediately – blood vessels constrict, circulation adjusts and enough blood continues returning to your heart and brain.

In POTS, maintaining that circulation can become more difficult. Your heart may then beat faster as part of the body’s attempt to keep blood moving where it needs to go.

This creates an important shift in how the heart-rate rise can be interpreted. Instead of seeing it only as the problem, it can also be a clue to what the body is trying to compensate for.

And that leads to a much more useful clinical question: why has staying upright become something your body needs to work so hard to achieve?

Why Does Standing Make POTS Symptoms Worse?

One of the strangest things about POTS can be how quickly your body changes with your position. You might feel relatively okay lying down, then stand to make breakfast and suddenly your heart is racing, your head feels light or your legs become heavy. Sit or lie back down, and the symptoms may begin to settle.

That change with posture is an important clue.

When you’re upright, your body has to work against gravity to maintain enough blood returning to your heart and brain. With POTS, that adjustment is harder to maintain, which is why symptoms can build the longer you’re on your feet and improve when you lie down.

So feeling better lying down isn’t simply because you’re resting. Changing position is changing the circulatory demand being placed on your body.

Why Can Dysautonomia and POTS Symptoms Change From Day to Day?

You manage a walk easily one day, then the same distance leaves you dizzy and exhausted the next. A shower is fine in the morning but wipes you out later. It can make symptoms feel frustratingly unpredictable.

But your threshold isn’t necessarily the same from one day to the next.

Heat, hydration, poor sleep, illness, meals, hormonal changes, stress and previous exertion can all add to the demands your body is already managing. The more of those factors that overlap, the less capacity you may have for something you’d normally tolerate.

So when the same activity affects you completely differently from one day to another, it doesn’t necessarily mean the activity was the problem. What else your body was managing that day may be just as important.

Why Do Some People Develop Dysautonomia or POTS?

Getting a POTS or dysautonomia diagnosis can answer one question while immediately creating another: why did your autonomic nervous system stop regulating normally in the first place?

There isn’t one answer that applies to everyone. For some people, symptoms begin quite clearly after an infection. For others, the picture develops alongside hypermobility, autoimmune illness or another health condition. Sometimes there is no single obvious starting point at all.

And importantly, these aren’t necessarily competing explanations. Different problems can interfere with autonomic regulation in different ways while producing a remarkably similar experience when you’re upright.

This is where looking beyond the POTS label becomes useful. The next question is not simply whether your heart rate meets the criteria, but what may be contributing to the autonomic dysfunction underneath it.

Dysautonomia After Infection and Long COVID

For some people, there is a surprisingly clear dividing line: you were functioning normally, you became unwell with an infection, and you never quite returned to your previous baseline.

Post-viral autonomic dysfunction isn’t unique to COVID, but Long COVID has brought much greater attention to the connection. POTS and other forms of dysautonomia can emerge after infections, with symptoms such as orthostatic intolerance, palpitations, fatigue, brain fog and exercise intolerance persisting long after the acute illness has resolved.

Exactly why this happens isn’t fully understood. Immune and inflammatory changes, altered blood-vessel function and autoimmunity are among the mechanisms being investigated, and they may not be the same for every person.

The important distinction is that the infection may have been the event that preceded the change without necessarily being the whole explanation for why the autonomic dysfunction persisted.

Dysautonomia, Hypermobility and Connective Tissue

If you’re unusually flexible, have joints that frequently ache or feel unstable, bruise easily or have been diagnosed with a hypermobility disorder such as Ehlers-Danlos syndrome, those features may seem completely separate from dizziness or a racing heart when you stand.

But hypermobility and POTS are seen together often enough that the connection is worth considering.

One proposed explanation is that differences in connective tissue may affect how effectively blood vessels maintain their shape and support circulation when upright, potentially making blood pooling more likely. However, the relationship is still being investigated, and having hypermobility doesn’t mean it is automatically the cause of someone’s dysautonomia.

The more useful clue is the pattern. When joint hypermobility, orthostatic symptoms, circulation changes and other connective-tissue features occur together, they may be pieces of the same clinical picture rather than unrelated problems that need to be considered separately.

Dysautonomia, POTS and Autoimmunity

If you already have an autoimmune condition, or autoimmune disease runs in your family, you may wonder whether it could be connected to your POTS.

There is growing evidence that autoimmunity may play a role in some cases of POTS, although the relationship isn’t fully understood. In some people, antibodies may interfere with signals involved in regulating heart rate and circulation.

But this doesn’t mean POTS is automatically an autoimmune condition – or that autoimmunity is relevant in every case.

The important distinction is whether there are other clues in your health history or pathology that make autoimmunity part of your particular picture.

Dysautonomia, Low Blood Volume and the Renin-Aldosterone System

If you have POTS or another form of dysautonomia, you can be drinking plenty of water and still feel as though your body struggles to maintain enough circulation when you’re upright. The issue isn’t always how much you’re drinking, but how effectively your body is maintaining blood volume.

Lower circulating blood volume has been found in some people with POTS. Normally, when blood volume falls, the body responds by activating hormones that help the kidneys retain sodium and water. In some people with POTS, however, this response appears to be weaker than expected.

This may help explain why simply drinking more water doesn’t always make a significant difference, and why sodium and fluid balance can be an important part of the picture for some people.

Dysautonomia, Cortisol and the Stress-Response System

One pattern I see surprisingly often in people with POTS or dysautonomia is a body that seems to have very little reserve left when more is asked of it.

You might wake feeling exhausted despite sleeping, crash after relatively minor activity, struggle much more when you’re stressed or unwell, or feel as though it takes very little to completely deplete you. When I see that pattern, one of the things I may investigate is how the body’s stress-response system is functioning.

Cortisol is one of the hormones that helps your body respond to demand. It plays a role in maintaining blood pressure and blood glucose, mobilising energy when it’s needed and helping you adapt to physical and psychological stress. In some of the people I see with dysautonomia, testing such as a DUTCH test shows that their cortisol output or daily cortisol rhythm isn’t particularly robust either.

This isn’t considered a cause of POTS, and it isn’t something I expect to find in everyone. But if the stress-response system is also struggling, it may leave the body with less capacity to compensate for the demands dysautonomia is already placing on it.

Clinically, I find that when this pattern is genuinely present, working on the factors affecting cortisol and the stress-response system can sometimes improve fatigue, resilience and the severity of dysautonomia symptoms alongside the other pieces of the picture.

Dysautonomia, MCAS and Histamine

You may have started with the dizziness, racing heart and fatigue, then gradually noticed there was another layer to the picture. Certain foods leave you flushed or congested. Alcohol suddenly doesn’t agree with you. Heat doesn’t just make you lightheaded – it can make you itchy, nauseous or feel as though your whole body is reacting.

When those symptoms sit alongside POTS or dysautonomia, MCAS and histamine often enter the conversation.

There is some overlap between the two symptom pictures, and mast cells release histamine and other chemical messengers that can influence blood vessels, heart rate and digestion. But experiencing both doesn’t automatically mean MCAS is driving the dysautonomia – or even that MCAS is the right diagnosis.

What interests me clinically is whether there is a genuine mast-cell or histamine pattern adding to the autonomic symptoms. If there is, identifying and addressing that additional source of reactivity can sometimes reduce the overall symptom burden rather than expecting the dysautonomia diagnosis alone to explain everything.

Why Can Dysautonomia Be Worse Around Your Period?

You can spend most of the month feeling as though you’ve finally worked out how to manage your dysautonomia – then the week before your period arrives and suddenly the same strategies aren’t doing the job. You’re dizzier when you stand, your heart rate is harder to settle, your legs feel heavier and the fatigue hits much harder.

It can feel like you’ve gone backwards. But if this happens at roughly the same point each month, the timing itself tells us something.

Oestrogen and progesterone can influence blood vessels, fluid regulation and the autonomic nervous system. As hormone levels change across the cycle, the amount of support your circulation needs can change too. Then menstruation adds blood and fluid loss, which may be particularly noticeable if you’re already prone to lower blood volume.

Heavy periods can add another layer. Gradually depleted iron stores can contribute to fatigue, breathlessness, palpitations and poor exercise tolerance – symptoms that can easily be assumed to be “just the POTS”.

So rather than seeing those few difficult days as proof that your dysautonomia is getting worse, the pattern can help explain why your body copes better at some points in the month than others – and reveal hormonal, blood-volume or iron-related factors that may be making your symptoms harder to control.

Why Can Eating Make Dysautonomia and POTS Symptoms Worse?

You eat lunch, then twenty minutes later you’re wondering why your heart is racing and you suddenly need to sit or lie down. Maybe you feel lightheaded, foggy or overwhelmingly tired. When it keeps happening after meals, it’s understandable to start looking at what you’re eating for the explanation.

But sometimes the clue isn’t what you ate. It’s what your body has to do after you eat it.

Digestion requires increased blood flow to the digestive system. Normally, your circulation adjusts automatically to accommodate that shift. If maintaining circulation is already more difficult because of dysautonomia, a meal can create an additional demand – particularly a large meal or, for some people, one higher in carbohydrates.

That distinction can completely change what you do next. If you’ve started cutting out foods because you assume you’re reacting to them, you may end up with an increasingly restricted diet without addressing why eating itself is making you feel unwell.

The pattern around meals can help separate a genuine food reaction from the circulatory demands of digestion – and sometimes, understanding that difference is the first step towards being able to eat without anticipating the crash that follows.

Why Can Weather Make Dysautonomia and POTS Symptoms Worse?

You can be managing reasonably well, then a hot or humid day arrives and suddenly the things you normally manage become much harder. Your heart rate climbs more easily, you feel washed out or lightheaded, and an outing that was fine last week leaves you needing much longer to recover.

It can make your capacity feel frustratingly inconsistent. But sometimes it isn’t your body that has suddenly changed – the conditions it is trying to compensate for have.

Heat, Blood Vessel Dilation and Blood Pooling

When you’re hot, your blood vessels widen and more blood is directed towards the skin to help your body release heat. If maintaining circulation while upright is already difficult, this can make blood pooling more pronounced and leave less blood returning to the heart and brain.

That helps explain why a hot shower, standing in the sun or walking outside on a warm day can provoke symptoms so quickly. The same activity can become physiologically much more demanding simply because your body is also trying to keep you cool.

Why Humidity Can Make Heat Harder to Tolerate

Then there are the days when you check the temperature and think, it’s not even that hot – why do I feel so much worse?

Humidity can be the missing part of that equation. When the air is humid, sweat doesn’t evaporate as effectively, making it harder for your body to release heat. That places additional demand on circulation and temperature regulation.

So the temperature alone may not tell you how challenging the weather will be for your body. A humid 27-degree day may affect you very differently from a dry one.

Barometric Pressure and Weather Changes: Is There Really a Connection?

Perhaps you’ve even noticed that you feel worse before a storm or when the weather suddenly changes, but you’ve never been sure whether there could actually be a connection.

People with dysautonomia do report sensitivity to changes in barometric pressure, although the evidence here is much less established than it is for heat. At this stage, we can’t confidently say that falling air pressure directly causes a POTS flare.

That doesn’t mean you need to dismiss a pattern you’ve repeatedly noticed in your own body. Tracking weather changes alongside your symptoms can help establish whether there really is a pattern for you, while keeping the interpretation grounded in what we actually know.

POTS, Exercise Intolerance and Post-Exertional Malaise

Exercise is often recommended for POTS, and for some people, gradually rebuilding strength and cardiovascular fitness can be genuinely helpful. But “you just need to exercise more” can be a very poor fit for someone whose symptoms become significantly worse after exertion.

The important part is understanding how your body responds to activity.

With dysautonomia, movement increases the demands on several systems that may already be struggling to adapt. Heart rate and circulation need to change, blood has to be directed towards working muscles and body temperature needs to be regulated. If those automatic adjustments aren’t happening effectively, even relatively ordinary activity can become much more physiologically demanding.

For some people with POTS or dysautonomia, this shows up as exercise intolerance. You might become dizzy, breathless or weak, or experience a racing heart while you’re exercising, then begin to recover once you stop. In this situation, the activity itself is exposing the difficulty your autonomic system has keeping up with the increased demand.

But some people with dysautonomia experience a very different pattern. They may manage the activity itself reasonably well, only to deteriorate hours later or the following day. Fatigue, brain fog, pain and other symptoms can intensify, and it may take much longer to return to their previous baseline. This delayed and disproportionate response is known as post-exertional malaise (PEM).

PEM isn’t considered a defining feature of POTS itself. However, it becomes particularly important when dysautonomia has developed alongside ME/CFS, Long COVID or another post-viral illness, where the two can coexist.

Knowing which pattern you’re experiencing can completely change what sensible movement looks like. Gradually rebuilding capacity may help someone whose main limitation is exercise intolerance, while repeatedly pushing through activity that triggers PEM may make symptoms worse.

So before assuming you need to exercise more – or deciding that exercise simply isn’t possible for you – what happens to your symptoms during activity, in the hours afterwards and even the following day can provide important clues about what kind of exertion your body can currently tolerate and recover from.

Is It Dysautonomia, Anxiety or Both?

When your heart is racing, you’re shaky, lightheaded and suddenly feel as though something is wrong, being told “it’s probably anxiety” can be incredibly frustrating – particularly when you know the symptoms reliably appear after standing, walking, showering or being in the heat.

The difficulty is that anxiety and dysautonomia can feel remarkably similar from the inside. A racing heart, shakiness or adrenaline-like feeling tells you what you’re experiencing, but not necessarily what started it.

With POTS, standing creates a measurable physiological change. Your heart rate rises as your body tries to maintain circulation while you’re upright. That can produce sensations that feel very much like anxiety, even if you weren’t anxious before they began.

This is where the sequence can tell us more than the symptom itself. Did you feel anxious and then notice your heart racing? Or did you stand up, feel your heart take off and then become anxious because your body suddenly felt unsafe or out of control? Those are very different starting points.

Of course, both can coexist. Living with unpredictable symptoms, worrying about fainting or becoming unwell away from home, or repeatedly experiencing intense physical sensations can understandably make you more vigilant about what your body is doing. Anxiety can then add another layer to symptoms that already have a physiological trigger.

So rather than deciding that a racing heart, shakiness or dizziness “must be anxiety”, the pattern around the symptom matters – what happened before it, what makes it worse and what makes it settle.

Can the Autonomic Nervous System Become Sensitised?

If your heart rate genuinely rises when you stand, your blood pressure changes or you’ve been diagnosed with POTS, being told to work on your nervous system can sound almost insulting. There is measurable physiology happening in your body – so how could the nervous system becoming sensitised possibly be relevant?

Because the two aren’t mutually exclusive.

You can have genuine autonomic dysfunction and a nervous system that has become increasingly reactive after months or years of experiencing it. Repeated episodes of dizziness, tachycardia, weakness or feeling physically unsafe give the brain a lot of information about which situations have previously caused problems.

Over time, the nervous system can learn from those repeated experiences and begin anticipating problems earlier. This ability of the brain and nervous system to adapt and change in response to experience is known as neuroplasticity. In dysautonomia, it may mean your body becomes more reactive to standing, exertion, heat or other situations it has repeatedly learned are difficult – sometimes before the original physiological demand would have produced such a strong response.

This is where sensitisation and neuroplasticity can become relevant for some people. They don’t explain every case of dysautonomia, and their relevance will vary from person to person. But because the brain and autonomic nervous system directly influence heart rate, blood-vessel tone and other aspects of cardiovascular regulation, changing an overly sensitised autonomic response may also change some of the physical responses we can measure – not simply how strongly the symptoms are perceived.

And that distinction matters clinically. If sensitisation has become part of your particular picture, working with the nervous system isn’t about trying to convince yourself that you’re well. It’s about asking whether every response your body is producing today still needs to be as protective as the one it originally learned.

How Are Dysautonomia and POTS Diagnosed?

One of the difficulties with dysautonomia is that many of its symptoms – fatigue, dizziness, palpitations, brain fog, nausea or exercise intolerance – can occur in plenty of other conditions. The symptoms may suggest autonomic dysfunction, but the pattern of what happens when your body is placed under an autonomic demand can tell us much more.

For POTS, one of the most useful places to look is what happens when you move from lying down to standing. Heart rate and blood pressure can be measured over several minutes to see how your cardiovascular system responds to being upright.

What Can an Active Stand Test Tell You?

An active stand test compares your heart rate and blood pressure while lying down with what happens after you stand and remain upright.

For POTS, clinicians are looking for a sustained increase in heart rate of at least 30 beats per minute in adults, or 40 beats per minute in adolescents, within 10 minutes of standing, alongside orthostatic symptoms and without the sustained blood-pressure drop that would indicate orthostatic hypotension.

But the numbers need context. A heart-rate increase on one stand test doesn’t diagnose POTS by itself. The symptoms need to form a persistent pattern of orthostatic intolerance, and factors such as medications, hydration, anaemia, thyroid dysfunction and other conditions that could explain the tachycardia also need to be considered.

When Is a Tilt-Table Test Used?

A tilt-table test examines the same basic question under more controlled conditions. You’re secured to a table that moves from horizontal to upright while heart rate and blood pressure are monitored.

It can be useful when the diagnosis remains unclear, when fainting is part of the picture or when a clinician needs more detailed assessment of the body’s response to being upright. Not everyone with suspected POTS needs a tilt-table test before the condition can be diagnosed.

Can You Have Dysautonomia Without Meeting the Criteria for POTS?

Yes – and this is an important distinction.

You can experience significant dizziness, weakness, palpitations, brain fog or other symptoms while upright without your heart rate increasing by the amount required for a POTS diagnosis. Your blood pressure may be doing something different, another form of autonomic dysfunction may be present, or you may have orthostatic intolerance without meeting the criteria for a specific syndrome.

Not meeting the POTS criteria doesn’t automatically mean your autonomic symptoms aren’t real. It may simply mean POTS isn’t the right label for the pattern your body is showing.

What Else Can Cause Symptoms That Look Like Dysautonomia or POTS?

Once you have a POTS or dysautonomia diagnosis, it can become very easy for every episode of dizziness, fatigue, palpitations or exercise intolerance to be explained by it.

But having one diagnosis doesn’t protect you from developing something else – and sometimes a change in your usual symptom pattern is the clue.

That’s because many of the symptoms associated with dysautonomia aren’t unique to dysautonomia. Iron deficiency or anaemia, for example, can contribute to palpitations, breathlessness, fatigue and poor exercise tolerance. Thyroid dysfunction can affect heart rate, energy and temperature regulation. Dehydration, low blood pressure, blood glucose changes, medication effects and some cardiac conditions can also produce symptoms that overlap with dysautonomia.

This becomes particularly important when something about your usual pattern changes. Perhaps your fatigue becomes much more pronounced, your heart rate suddenly becomes harder to control, or strategies that normally help stop making the same difference.

Rather than automatically assuming your dysautonomia has become worse, that change can be a reason to look again. Sometimes the most important clue isn’t the symptom itself – it’s that the symptom is no longer behaving the way it normally does.