Dysautonomia

Medically Reviewed by Brunilda Nazario, MD on July 31, 2023
Written by Alexandra Benisek
4 min read

Dysautonomia, autonomic dysfunction, or autonomic neuropathy refers to a group of medical disorders caused by problems with your autonomic nervous system (ANS). Your ANS controls your body’s automatic functions, like your heart rate, digestion, blood pressure, kidney function, and more. 

Dysautonomia can show up in your body in many ways, since it affects various parts of your ANS. 

The condition isn’t rare. It affects over 70 million people globally of all genders, races, and ages. 

Research shows having long COVID puts you at higher risk for dysautonomia. One study found it in almost 70% of those living with lasting COVID effects.

When nerves in your ANS don’t work the way they should, a type of dysautonomia occurs.

Side effects can range from less serious issues, like lightheadedness, to severe complications and even death. Symptoms can span from being “invisible” to others to causing severe and obvious disabilities.

There are about 15 types of dysautonomia. You can have more than one type at the same time. They include:

Postural orthostatic tachycardia syndrome (POTS). This is a more common form of the disorder. Symptoms might include a higher heart rate when you stand. They can also include dizziness, weakness, lightheadedness, shortness of breath, chest pain, chest tightness, heart palpitations, tremors, fatigue, headaches, sleep troubles, or a hard time exercising.

Orthostatic hypotension (OH). This happens when your body isn’t able to regulate your blood pressure when you stand. Symptoms might include dizziness, lightheadedness, fatigue, blurry vision, brain fog, nausea, headache, weakness, heart palpitations, shortness of breath, or chest, neck, or shoulder pain. Other health problems can also cause OH.

Noncardiogenic/vasovagal syncope (VVS). This causes you to pass out. It happens because your ANS doesn’t work the way it should, which causes you to have low blood pressure and a low heart rate. Before passing out, you might feel clammy or have sweating, feel nauseated, feel warm or flushed, or have hearing changes, paleness, graying vision, or vision loss.

Inappropriate sinus tachycardia (IST). This causes your resting heart rate to go above 100 beats per minute without a known cause. Normal resting heart rate is 60 to 100 beats per minute. The main symptoms of IST are heart palpitations. But you might also have fatigue, dizziness, weakness, shortness of breath, or you might pass out or not be able to work out.

Autoimmune autonomic ganglionopathy (AAG). This is also called acute pandysautonomia or idiopathic subacute autonomic neuropathy. It’s a rare form of dysautonomia. It can lead to OH. Other symptoms include dry mouth or eyes, bladder issues, burning or prickling in your arms or legs, Adie’s pupil (which causes your pupil dilation to change), or gastroparesis (which affects the muscle movements in your stomach and can cause nausea and vomiting).

Baroreflex failure (BF). This is rare. It affects how your body controls your blood pressure. Symptoms include high or low blood pressure, blood pressure that changes often, passing out, headache, flushing, or heart rate issues.

Familial dysautonomia (FD). This is also called Riley-Day syndrome. It’s a rare genetic disorder that only affects around 350 people in the world. It mainly affects Ashkenazi Jews, but it can happen in any race or ethnicity. 

Symptoms include lower pain sensitivity, lack of tears, unstable body temperature and blood pressure, heart issues, not being able to swallow or suck, growth issues, vision problems, digestive complications, or breathing troubles.

Pure autonomic failure (PAF). This rare form of dysautonomia is also called Bradbury-Eggleston syndrome. It causes issues with your ANS cells. It’s usually severe and causes OH, dizziness, and passing out. It’s linked to Parkinson's disease and dementia. This form usually happens in middle age, and it’s more common in males than females.

Multiple system atrophy (MSA). This is also rare. There are two types. With MSA-P, symptoms include tremors, rigid muscles, a hard time swallowing, slow movements, and balance and posture issues. With MSA-C, you’ll notice coordination issues, tremors, and slurred speech.

Experts found dysautonomia in those who had COVID-19. Some of their symptoms include tissue damage, immune issues, hormonal disturbances, higher cytokine levels, and constant infection. 

The tie between these symptoms and COVID-19 may play a role in your odds of surviving the virus. This is because dysautonomia symptoms affect your breathing and heart and brain function. The drugs used in intensive care units may also lead to issues with your ANS.

Studies found 30% to 67% of those with long COVID had dysautonomia after having COVID-19. POTS is the type of dysautonomia that’s most commonly linked to COVID-19.

There are many ways to diagnose disorders within your ANS. One of them includes a tilt table test.

With this, your doctor has you lie on a table. They connect you to medical tools that measure your oxygen, blood pressure, and heart activity. The table tilts you to see how your heart rate, blood pressure, and other ANS functions change.

Your doctor might also perform breathing tests, sweat tests, and bloodwork, or take a closer look at your heart activity.

While there’s no cure for dysautonomia, you may be able to ease some of your symptoms.

Based on your symptoms, your doctor may suggest you:

  • Add salt to your diet, which can help control your blood pressure.
  • Drink more water to keep your blood volume up.
  • Take meds like fludrocortisone and midodrine to raise your blood pressure.
  • Raise the head of your bed 6 to 10 inches higher than your body while you sleep.