Orthostatic Intolerance and POTS

Feeling Dizzy or Faint When You Stand Up?

Sometimes, when you stand up, you might feel dizzy, lightheaded, or like you’re about to faint. You might notice your vision going dark or that you feel super tired. This is called orthostatic intolerance, and it means your body has a hard time dealing with changes in position, like going from lying down to standing up.

Why does this happen?

The problem usually comes from how your blood moves in your body and how your nerves and hormones respond.

When you stand up:

• Gravity pulls blood down into your legs.
• Your body is supposed to pump that blood back up to your brain.
• If it doesn’t work well, not enough blood gets to your brain.

This can make you feel dizzy, faint, or just weird. Sometimes your body sends out extra adrenaline (a “fight or flight” hormone), which can make your heart beat faster and cause sweating, nausea, or pale skin. If this keeps going, you might faint – your body’s way of saying, “Lie down so your brain can get blood again!” 

How your nervous system helps

• The sympathetic system speeds things up, like heart rate and blood pressure, when you’re scared or excited.
• The parasympathetic system calms things down and helps with digestion, relaxing, and slowing your heart.

What causes orthostatic intolerance?

Orthostatic intolerance can happen for lots of reasons:

• Vasovagal syncope: You get dizzy or faint when standing. Salt, water, and rest can help.
• Post-viral: You feel this way after being sick with something like COVID or mono.
• Deconditioning: After being sick or not moving much, like after surgery.
• Orthostatic hypotension: A drop in blood pressure when standing. This is more common in adults.
• Postural orthostatic tachycardia syndrome (POTS): Your heart rate up 40 beats or more when you stand up. You might feel sick almost every day for months.

What Does POTS Feel Like?

People with POTS might experience:

• Dizziness or feeling lightheaded
• Tiredness or brain fog
• Nausea
• Headaches
• Shaking
• Sweating
• Chest tightness
• Hands and feet turning purple when hanging down 

The good news? Lying down usually helps you feel better quickly. continue

How Do We Treat It?

There are several ways to manage POTS. Start with the
basics:

• Drink more water. Aim for 80-100 ounces every day, or about 10-12 glasses.
• Salt is your friend. Eat salty snacks or talk to your doctor about taking salt tablets.
• Avoid caffeine and energy drinks.
• Get more exercise, even if you need to start slowly. Walking, biking, and swimming help your body get stronger.
• Wear compression socks to help improve your blood flow.
• Practice good sleep hygiene. Try to go to bed and wake up at the same time every day. Avoid using screens before bed.
• Stay out of the heat. Use cooling towels or ice packs on hot days.

Yoga and Movement Tricks

Try the mountain pose (Tadasana) to help your circulation:

• Stand tall with feet together.
• Rock forward and back – lift your toes, then your heels.
• Stretch arms overhead, breathe in deeply, rise on tiptoes.
• Slowly breathe out and bring arms and feet back down. 

Do this for 15 minutes, twice a day.

Click here for more ways to manage POTS.

Take Care of Your Mind, Too

POTS can be stressful. A therapist trained in cognitive behavioral therapy can help you learn ways to manage anxiety and stress, so you feel more in control. Mindfulness and journaling can also help. 

Will POTS Ever Go Away?

Sometimes POTS gets better for a while, and it might even go away. Sometimes it comes back. Either way, you’re not alone, and there’s help to manage it. 

Who Can Help?

Your pediatrician or primary care doctor is a great place to start. They may also work with heart doctors (cardiologists), brain and nerve doctors (neurologists), or physical medicine specialists who understand POTS.

Remember:

You’re not making this up. You’re not lazy. And you’re not alone. There are lots of tools to help you feel better and live your life fully!