Dysautonomia is a dysfunction of the autonomic nervous system (ANS) — the part of the body that automatically controls things like heart rate, blood pressure, digestion, and body temperature.

Postural Orthostatic Tachycardia Syndrome (POTS) is one of the most common forms of dysautonomia. It causes an unusually high heart rate when standing or changing positions, which can lead to dizziness, fatigue, brain fog, and sometimes fainting.

Common Signs & Symptoms

• Rapid heartbeat when standing

• Lightheadedness or fainting

• Fatigue and brain fog

• Nausea or bloating

• Difficulty regulating body temperature

• Poor sleep quality

Many people with POTS also have Ehlers-Danlos Syndrome (EDS), Mast Cell Activation Syndrome (MCAS), Long Covid, Fibromyalgia and Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) — these conditions often overlap and contribute to complex, multi-system symptoms.

Tools for You

• How Do I Know If I Have POTS? Ten Minute stand Test (Website)

• Malmo POTS Symptom Score (Questionnaire)

Helpful Video links on What Are Dysautonomia & POTS?

• What Is POTS (YouTube)

• What Are Dysautonomia & POTS Playlist (YouTube)

• Connection to Other Multisystem Disorders Dysautonomia & POTs Playlist (YouTube)

Hydration and Salt (Under Medical Advice)

• Purpose: Increasing fluid and salt intake is a primary strategy to boost blood volume, which helps compensate for blood vessels that do not constrict properly. This reduces heart racing (tachycardia) and helps alleviate fatigue and dizzy spells.

• Daily Targets: Common recommendations include drinking 64 to 80 ounces of water (or roughly 6–8 glasses) daily. Salt intake often ranges from 3 to 10 grams of sodium per day, depending on individual medical advice.

• Implementation: Patients can obtain extra salt through dietary choices, salt tablets (which may be easier on the stomach), or electrolyte powders and drinks.

Compression Garments

• Purpose: These garments apply pressure to the limbs to counteract blood pooling in the lower body and improve the return of blood to the heart.

• Effective Types: While knee-high socks provide some support, waist-high compression leggings (typically 30–40 mmHg) are much more effective at pushing blood upward.

• Additional Support: Adding an abdominal binder to compression leggings can significantly further decrease heart rate by providing extra counter-pressure.

Gentle Physical Therapy and Pacing

• "Low and Slow" Approach: Exercise is vital for long-term recovery but must be introduced gradually to avoid "crashing" the system.

• Pacing with Horizontal Breaks: One of the most effective pacing tools is taking planned 10-minute horizontal breaks every 90 minutes to two hours. Doing this before symptoms become severe helps retrain the nervous system to relax rather than just forcing it into recovery mode.

• Exercise Selection: Start with recumbent (non-upright) exercises like rowing, swimming, or using a recumbent bike to build stamina without fighting gravity.

• Counter-Pressure Maneuvers: Simple "muscle pumping" activities—such as ankle pumps, glute squeezes, or leg crossing—should be used before and during standing to help move blood through the body.

Mind-Body Strategies to Calm the Autonomic Nervous System (ANS)

• The Goal: These strategies aim to strengthen the parasympathetic ("rest and digest") branch of the nervous system to balance out an overactive sympathetic ("fight or flight") response.

• Vagus Nerve Stimulation: Simple activities can activate the vagus nerve, a major player in the calming system. These include humming, singing, gargling, laughing, or deep diaphragmatic breathing.

• Mindfulness and Biofeedback: Tools like meditation, mindfulness apps, and biofeedback training can help patients gain awareness of their bodily responses and learn to normalize them over time.

• Sleep Hygiene: Maintaining consistent circadian rhythms and a dark, quiet environment is crucial for a sensitive nervous system to recover overnight.

Tools for You

• Guide to Prof. Russek’s Patient Self-Care Handouts (Handout with Links)

• Relaxation and vagus nerve activation.  (Handout)

• Overview of POTS symptoms and causes. (Handout)

• Orthostatic Intolerance and Postural Orthostatic Tachycardia Self-Care Checklist (Handout)

• Sleep Disturbance in POTS Flowcharts (Handout)

• Vagal Nerve Techniques (M&BPC Website)

Helpful Video links on Treatment in Dysautonomia & POTS?

• Treatment in Dysautonomia & POTS Playlist (YouTube)

• Basics of POTS and MCAD self-care - Leslie Russek PT (61 min Video) (YouTube)

• Exercise progression in HSD/hEDS and POTS - Leslie Russek (56 min Video) (YouTube)

• OT Emily:Oh The pOTsabilities - Emily Rich OT (YouTube channel)

• DINET - Dysautonomia Information Network (Website)

• Dysautonomia International on YouTube (YouTube)

• Dysautonomia International (Website)

• Dysautonomia - The EDS Clinic Learning Center (Website)

• POTS - The EDS Clinic Learning Center (Website)

• Leslie Russeks "Hypermobility 101" (Website)

• Bendy Bodies Podcast - Linda Bluestein MD (Website)

• Elevation Wellness - Patricia Stott PT (YouTube channel)

• Dr Claire - Claire Francomano MD (YouTube channel)

• Movement & Exercise (M&BPC Website)

• Mindfulness Activities (M&BPC Website)