Dysautonomia is the medical term for when the autonomic nervous system (ANS) does not work properly. Types include NCS and POTS.
The ANS is responsible for maintaining a constant internal temperature, regulating breathing patterns, keeping blood pressure steady, and moderating the heart rate. It also plays a role in pupil dilation, sexual arousal, and excretion. Conditions that cause dysautonomia usually affect these bodily functions.
According to Dysautonomia International, dysautonomias affect more than 70 million people worldwide. They come in many forms and can be primary or secondary. Degenerative diseases, such as Parkinson’s disease, can cause primary dysautonomia. Secondary dysautonomia results from an injury or another type of health condition.
This article looks at some of the different types of dysautonomia, including their symptoms and treatments.
There are various types of dysautonomia, each of which has different symptoms. The symptoms can come and go, making them difficult to predict.
Examples of the symptoms that a person may experience include:
- an inability to stay upright
- dizziness, vertigo, and fainting
- fast, slow, or irregular heartbeat
- chest pain
- low blood pressure
- problems with the gastrointestinal system
- disturbances in the visual field
- breathing difficulties
- mood swings
- fatigue and intolerance to exercise
- disrupted sleep pattern
- frequent urination
- temperature regulation problems
- concentration and memory problems
- low appetite
- sensory sensitivity, especially on exposure to noise and light
There are at least 15 types of dysautonomia. The most common are neurocardiogenic syncope (NCS) and postural orthostatic tachycardia syndrome (POTS).
NCS is the most common dysautonomia, affecting tens of millions of people worldwide. The main symptom is fainting, also called syncope, which can vary significantly in frequency. Some people may only experience it occasionally, whereas in others, it will be frequent enough to disrupt their life.
Gravity naturally pulls the blood downward, but a healthy ANS adjusts the heartbeat and muscle tightness to prevent blood from pooling in the legs and feet and to ensure blood flow to the brain.
NCS involves a failure in the mechanisms that control this, and the temporary loss of blood circulation in the brain causes fainting.
For people who faint only occasionally, avoiding known triggers can help. Possible triggers include:
- alcohol consumption
- very warm environments
Doctors may recommend medication, such as beta-blockers, or the implantation of a pacemaker to treat persistent or severe cases of NCS.
POTS affects 1–3 million people in the United States, about 80% of whom are female. It often affects people with an autoimmune condition.
The symptoms include:
- lightheadedness and fainting
- tachycardia, which is an abnormally fast heart rate
- chest pain
- shortness of breath
- stomach upset
- becoming easily exhausted by exercise
- oversensitivity to temperatures
POTS is normally a secondary dysautonomia.
Apart from autoimmune factors, conditions that doctors link to POTS or POTS-like symptoms include:
- some genetic disorders or abnormalities
- Ehlers-Danlos syndrome, a collagen protein disorder that can lead to joint hypermobility and “stretchy” veins
- infections, such as mononucleosis, Lyme disease, extrapulmonary mycoplasma pneumonia, or hepatitis C
- toxicity from alcohol use disorder, chemotherapy, or heavy metal poisoning
- pregnancy, surgery, or other trauma to the body
Multiple system atrophy
Multiple system atrophy (MSA) is rare, with experts estimating that it affects 2–5 people in every 100,000. It usually occurs after the age of 40 years. Doctors may mistake it for Parkinson’s disease because the early symptoms of the two conditions are similar.
In the brains of people with MSA, certain regions slowly break down — in particular, the cerebellum, basal ganglia, and brain stem. This leads to motor difficulties, speech issues, balance problems, poor blood pressure, and problems with bladder control.
MSA is neither hereditary nor contagious, and it is not related to multiple sclerosis. Researchers know little else about what may cause MSA. As a result, there is currently no cure and no specific treatment options.
However, people can manage certain symptoms through lifestyle changes and medications.
Autonomic dysreflexia (AD) can affect people with spinal cord injuries (SCIs). As a result, doctors class it as a secondary dysautonomia. The higher the level of the SCI, the greater the risk of AD. Up to
AD usually involves the irritation of the region below the level of a person’s injury. A range of conditions and injuries can bring on AD, including urinary tract infections and skeletal fractures.
In AD, the damaged spine prevents pain messages from reaching the brain. The ANS reacts inappropriately, producing severe spikes in blood pressure. The symptoms include:
- blotchy skin
- a blocked nose
- a slow pulse
- goosebumps and clammy skin near the site of the injury
Most treatments aim to relieve the initial injury or irritation, thereby preventing further attacks of AD.
This condition is rare and affects blood pressure.
The baroreflex mechanism is one way in which the body maintains a healthy blood pressure. Baroreceptors are stretch receptors situated in important blood vessels. They detect stretching in the artery walls and send messages to the brain stem.
If these messages fail, blood pressure can become too low when a person is resting, or it can rise dangerously high during times of stress or activity.
Other possible symptoms include headaches, excessive sweating, and an abnormal heart rate that does not respond to medication.
The treatment for baroreflex failure involves medications to control heart rate and blood pressure, as well as interventions to improve stress management.
Diabetic autonomic neuropathy
Diabetic autonomic neuropathy is a potential complication of diabetes. The condition affects the nerves that control the bladder, digestive system, heart, genitals, and other organs.
- resting tachycardia, which is a fast resting heart rate
- orthostatic hypotension, or low blood pressure when standing
- breathing problems
- gastroparesis, which refers to food not passing correctly through the stomach
- erectile dysfunction
- sudomotor dysfunction, or irregularities with sweating
- impaired neurovascular function
- “brittle diabetes,” which is characterized by frequent episodes of hyperglycemia and hypoglycemia
The treatment for diabetic autonomic neuropathy focuses on the careful management of diabetes. In some cases, doctors may recommend treatments to control specific symptoms.
Familial dysautonomia (FD) is a very rare type of dysautonomia, affecting predominately people of Ashkenazi Jewish descent.
The symptoms, which typically appear in infancy or childhood, include:
- feeding difficulties
- slow growth
- the inability to produce tears
- frequent lung infections
- difficulty maintaining body temperature
- prolonged breath-holding
- delayed development, including walking and speech
- poor balance
- kidney and heart problems
The condition can lead to a dysautonomic crisis, which involves rapid fluctuations in blood pressure and heart rate, dramatic personality changes, and complete digestive shutdown.
Familial dysautonomia is a serious condition that is usually fatal. There is no cure. However, the incidence of FD is gradually decreasing over time due to prenatal screening and testing.
There is no cure for primary dysautonomias. However, the symptoms of secondary dysautonomias may improve when doctors treat the underlying condition.
Treatment aims to reduce symptoms enough that the individual can start a program to strengthen and physically condition their body. This can help them balance the effects of the ANS not working as it should.
The treatment plan depends on the type and specific details of each person’s combination of symptoms. A doctor must personalize the treatment, but it will often involve physical therapy, exercise therapy, and counseling to help a person with dysautonomia cope with the lifestyle changes that accompany the condition.
Various doctors, including cardiologists and neurologists, may help with a treatment plan.
An individual may require medication to reduce some of their symptoms, and the prescribed course may change over time to accommodate any physical changes that occur.
Doctors may also advise that people with the condition drink 2–4 liters of water per day and increase their daily intake of salt to 4–5 grams. People, especially younger individuals, should avoid caffeine and drinks high in sugar.
An individual should speak with a doctor about the course of treatment that is best for them.
There are no alternative treatments that can cure dysautonomias, but complementary therapies may help people manage and cope with their symptoms. People may benefit from:
- Mindfulness techniques: People with dysautonomia may experience anxiety. Adding calming mindfulness practices to the daily routine may help. These could include yoga, meditation, and breathing exercises.
- Cognitive behavioral therapy (CBT): Therapists use this technique to help people overcome patterns of thinking that can contribute to anxiety, worry, and stress.
- Cannabidiol (CBD): This compound comes from the hemp plant, but unlike cannabis itself, it does not cause a “high.” A small 2017 study of 12 females with dysautonomic syndrome following human papillomavirus (HPV) vaccination took CBD over a 3-month period. At the end of the study, the eight participants who completed the trial reported significantly reduced body pain and improved physical, vitality, and social functioning scores.
Although early research on CBD is promising, further studies are necessary to confirm the benefits, as this trial was extremely small and included only female participants aged 12–24 years.
Dysautonomias are malfunctions of the autonomic nervous system that can happen for many reasons. Primary dysautonomias occur due to genetic or degenerative diseases that affect the brain and nervous system. Secondary dysautonomias happen as a result of an injury or another type of condition.
Conditions that can lead to secondary dysautonomia include:
- rheumatoid arthritis
- Parkinson’s disease
- celiac disease
Scientists believe that autonomic dysfunction may also be a factor in long COVID, a condition that can occur after someone has COVID-19. A
Just as every person’s life is unique, everyone’s experience with dysautonomia is, too. Dysautonomia is a complex set of conditions, and the effects they have on a person’s life vary greatly depending on individual circumstances.
About 25% of those with POTS have severe symptoms that prevent them from working, sleeping, and spending time with friends and family. Some people may be unable to do much physical activity.
Dysautonomia can also affect a person’s mental health. For example, depression and increased anxiety are common among those with POTS.
Dysautonomia has a complicated relationship with other conditions. These include:
- Posttraumatic stress disorder (PTSD): In PTSD, psychological trauma causes the ANS to stop functioning as it should, causing mental and physical symptoms that have a significant crossover with dysautonomia.
- Obstructive sleep apnea (OSA): When someone has OSA, their breathing repeatedly stops and starts while they sleep. A
2019 studynotes that people with OSA have ANS alterations but concludes that more research is necessary to understand the link.
- Vitamin deficiencies: Experts
believethat vitamin D may play a role in autonomic disorders. Although they are unsure of the exact mechanism, it seems that low vitamin D levels can cause some of the symptoms that doctors see in people with dysautonomia.
The outlook for people with dysautonomia
However, experts at leading medical institutions are carrying out revolutionary research that may offer hope to people experiencing dysautonomia.
According to some estimates, with commitment, appropriate medical treatment, and lifestyle management, the majority of those with youth-onset dysautonomia should recover or improve significantly by their mid-20s. However, some individuals’ symptoms may return when their body is under stress, such as during pregnancy or menopause.