Postural orthostatic tachycardia syndrome (POTS) produces dizziness with standing and activity. It is a disorder of the autonomic nervous system (the autonomic nervous system controls functions that occur automatically like heart rate, blood pressure, digestion, sweating). Other symptoms include fatigue, nausea, vomiting, headaches and fainting.

We do not know what exactly causes POTS but it may come on suddenly after a viral illness, pregnancy, surgery or an injury. Many times there is no trigger. A significant percentage of people have an underlying genetic disorder of connective tissues called Ehlers-Danlos syndrome (EDS).

POTS is rather common, first showing up in adolescence or age 20-40. Both genders can be affected but POTS is more common in women. Fortunately, there is growing awareness of POTS, but even so many patients are told they are just anxious or there is nothing wrong with them.

Dr. Saperstein had diagnosed and managed over 2,500 patients with POTS. Here at the Center, we will help you deal with a potentially debilitating condition.

What Happens When You Have POTS?

With POTS, the body does not control blood pressure or heart rate as it should after you stand up. So for a brief time, you may not get enough blood to your brain.

People with severe fatigue and dizziness may find it hard to keep up with daily living. But treatment can help.

What are the Symptoms of POTS?

POTS can make you feel dizzy and lightheaded. You may faint. You may also feel tired. Blurred vision and feeling anxious are also symptoms. And you may have trouble with keeping your attention focused. Symptoms can range from mild to severe.

People with POTS commonly have gastrointestinal symptoms as well, such as nausea, bloating, diarrhea and constipation.

Some things can make symptoms worse. These include heat, eating, exercise, showering, sitting too long, and menstrual cycle changes.

When you first notice symptoms, sitting or lying down may help you feel better.

What Causes POTS?

POTS may follow a viral illness, a surgery, pregnancy, bed rest, or a severe trauma. Some patients develop POTS as part of a genetic disorder of collagen called Ehlers-Danlos syndrome. In many cases, there is no clear trigger. Experts don’t understand what causes POTS, but different body systems seem to be out of balance.

How is POTS Diagnosed?

To learn what is causing your symptoms, your doctor may:

  • Ask about your symptoms, including when and how they started.
  • Check how your blood pressure and heart rate change when you move from lying down to sitting to standing.
  • Do a tilt table test. The test uses a special table that slowly tilts you to an upright position. It checks how your body responds when you change positions.
How is POTS Treated?

Medications can help but there is also a large role for so-called “self care” that involves life-style changes.

  • Medications: For some people, taking medicine that are normally used for high blood pressure can help. Taking medicine that keeps the body’s fluids balanced may also help.
  • Everyday self-care. These practices can be a key part of helping the body get back in balance.
    • It is important to avoid standing still for prolonged periods of time. Walking in place of tensing your calves can help. If you feel lightheadedness coming on, there are some so-called “counter-maneuvers” that can help eliminate or decrease orthostatic intolerance symptoms. One is crossing your legs and tensing the muscles in your legs, stomach and buttocks until the symptoms pass. Another maneuver is squatting down on one knee.
    • Drink plenty of fluids. Daily intake should be 2 to 3 liters (70 to 100 ounces, or just under one gallon). That amounts to 4 to 6 bottled waters.
    • Some patients find that drinking a glass or bottle of water quickly can temporarily relieve their orthostatic intolerance symptoms. Drinking water before getting out of bed helps some patients.
    • Most people with POTS needs to significantly increase their daily sodium intake. Daily needs for salt for POTS range from 3 to 10 grams. One tablespoon of salt equals 15 grams.
    • Elevate your head during sleep. This is done in order to help condition the body to the effects of gravity. The best way to do this is to raise the head of the bed with a few bricks or large books. A wedge pillow is not very helpful for this. Elevating the whole body and having the feet be lower than the hip area is needed to get the intended benefit. A wedge pillow only elevates the shoulders and head, but does nothing to change the position of the hips or the lower legs. .
    • Compression garments. Compression support hose and abdominal binders can be helpful for some POTS patients by lessening pooling of blood in the legs and, therefore, keeping more of the blood getting to the brain. The most effective compression hose are 30-40 mm Hg of ankle counter pressure and go waist high. There are many different varieties such as closed toe and open toe, knee high and waist high. All varieties are available for each gender and may be subsidized through some insurance plans as a durable medical good with a doctor’s prescriptions. Some brands are more comfortable and breathable than others, so don’t give up on compression stockings simply because the first pair you try are not comfortable. Two websites that are helpful for finding compression stockings are and will tell you how to determine what size you need. Do not wear compression stockings to bed.
    • Avoid heat as much as possible. Heat can aggravate the symptoms of POTS.
    • Try a special exercise program. Your doctor may give you a program of specific exercises. You start short and slow, especially if fatigue is a problem. Add a little at a time. At first, you only do exercise when you’re reclined. After a few weeks, you start to add upright exercise.
    • Adjust your activities. POTS may require you to reduce your activity load, get more sleep, and change your schedule. It is helpful to plan activities for the time of day that is best for you; for many POTS patients, the morning is particularly difficult. It is also helpful to keep your schedule flexible as symptoms can flare-up without much notice or forewarning.
    • POTS symptoms can be aggravated by a variety of situations and activities. It’s helpful to find out what exacerbates your symptoms so you can avoid or mitigate a flare-up and plan ahead.

POTS & Dysautonomia Videos Playlist

POTScast E:90 POTS, Small Fiber Neuropathy, & Mystery Symptoms

Host: Jill Brook, M.A. w/Guest: Dr. Saperstein
Segment: How Did You Become an Expert in POTS

POTS (Postural Orthostatic Tachycardia Syndrome) Symptoms & Treatments

Presented by:
Dr. David Saperstein

POTScast E:90 POTS, Small Fiber Neuropathy, & Mystery Symptoms

Host: Jill Brook, M.A. w/Guest: Dr. Saperstein
Segment: How Do You Describe POTS to People at a Cocktail Party?

What is Dysautonomia & POTS?

Brain Fog

Seizures & Fainting in Dysautonomia

POTScast E:90 POTS, Small Fiber Neuropathy, & Mystery Symptoms

Segment: Neuropathy & How it Relates to POTS
Host: Jill Brook, M.A. w/Guest: Dr. Saperstein

“Coat Hanger Pain”
Part 1

“Coat Hanger Pain”
Part 2

Salt Supplementation in POTS Part 1

Salt Supplementation in POTS Part 2

Salt Supplementation in POTS Part 3