POTS and Dysautonomia: A Complete Guide

Last reviewed October 31, 2026

I've treated EDS in my own family across three generations, including my son. I watched his joints, his blood pressure and his reactions get handled by different doctors who never talked to each other. That's what taught me these problems have to be treated together. If you've lived that too, this guide is for you.

Dysautonomia means your autonomic nervous system, the part that runs heart rate, blood pressure, digestion and temperature without you thinking about it, is not working as it should. POTS (postural orthostatic tachycardia syndrome) is one common type, where your heart races when you stand up. It is very common in people with hypermobility, and it usually improves with a steady, layered plan. You do not need to hit the official POTS cutoff for these symptoms to deserve treatment.

POTS rarely comes alone. It usually travels with some hypermobility and some mast cell symptoms. In my medical practice focused on individuals with POTS and dysautonomia, I build one plan, in four steps, that I walk through below.

In this guide:

Dysautonomia is the umbrella term, and POTS is one condition under it. Dysautonomia will also frequently be a driver of sleep disorders and GI dysfunction stemming from slow motility, as the autonomic nervous system regulates all of these things.

POTS has a specific definition. In adults, your heart rate rises by 30 beats per minute or more within 10 minutes of standing, without a big drop in blood pressure. The symptoms must last at least several months.¹ ²

How POTS is diagnosed. A doctor checks your heart rate and blood pressure lying down and then over 10 minutes of standing, or on a tilt table.¹ If you try a stand test at home, have someone with you in case you feel faint.

Common POTS symptoms:

Yes, and it is common. Many people have autonomic symptoms but do not meet the exact POTS numbers. Others have different patterns, such as:

In my patients, every one has some dysautonomia, along with some hypermobility and some mast cell symptoms. For some it is mild and for others it shapes their whole day. That is my experience in my hypermobility practice, not a proven rule for everyone with POTS.

If you have good days and bad days and can't tell why, triggers are usually part of the answer. Most POTS triggers do one of two things. They lower the amount of blood returning to your heart, or they widen your blood vessels. Common ones include:

Keeping a simple symptom log for two weeks can show you which ones matter most for you.

There is no single cure. Treatment works best in layers.² Experts agree that non-drug steps come first, and medicines are added when needed.¹ ²

For many people with POTS, more fluid and more salt raise blood volume and ease symptoms.¹ The right amount depends on your blood pressure, kidneys and heart, so check with your doctor before you start.

"Drink more fluids" is not a plan. Instead, we review your home blood pressure logs and other data first, then set a specific amount of fluid in milliliters and sodium in milligrams for you. We adjust those targets as we learn how your body responds. Your targets are personal, so we do not list numbers here. We also spread fluids through the day and front-load them in the morning, when many patients feel worst.

Electrolyte drinks and salt tablets are an easy way to add sodium. Look at the sodium content on the label. Many sports drinks have more sugar than salt, so we help patients pick a product by its sodium per serving and fit it to their own salt target, instead of guessing from the label claims.

Waist-high compression garments, or abdominal binders, help keep blood from pooling in the legs and belly. For patients with hypermobility, we look for options that are easy to put on without straining fingers, wrists or shoulders.

A slow, structured exercise program is one of the best-studied POTS treatments. Start lying down or seated, with a rowing machine, recumbent bike or swimming. Move to upright work over weeks to months. In one well-known study, three months of exercise training improved quality of life, while the beta blocker propranolol did not.³

Some people also need medicines to lower heart rate, raise blood volume or tighten blood vessels.¹ ² These are chosen one patient at a time.

I am careful with supplements sold to "boost circulation." Many of them, such as high-dose nitric oxide boosters, work by widening blood vessels, which may make symptoms worse in some people, so ask your doctor before you start one.

It depends. Many people improve over time with treatment.⁴ Others have symptoms that come and go for years. Flares are common with illness, surgery, pregnancy or hormone changes.

There is little evidence that age alone makes POTS worse. In my experience, deconditioning is a common reason symptoms creep back. Staying active, even at a low level, is one of the best ways to protect your progress.

We do not yet know the full answer, and research is ongoing, so this is the working model I use:

For POTS, this means fluids and salt alone may not hold. If your joints keep you from exercising, your muscle pump stays weak, and if mast cell flares go untreated, they keep widening your blood vessels. Here's what treating them together can look like.

A story typical of what we see

Picture a woman in her late 20s who comes to us unable to stand in line at the store without feeling faint. She is working from the couch most afternoons, and meals often leave her shaky. We set exact fluid and sodium targets from her home blood pressure logs, adjust her meals, and treat her joint and mast cell symptoms alongside. Within a few months, she is standing through errands, back to walking most days, and having far fewer crashes after eating. She still plans around hot days and long standing, and she still has some rough days, but most of her days are hers again.

This is a composite of patients we see, not one real patient, and details have been changed. Everyone's progress is different.

Here are the four steps I mentioned at the top, and how they play out for POTS:

These steps rest on a few beliefs, built from what I see in my own patients. Research is still catching up on some of them.

Sodium is only part of it. In my experience, potassium and magnesium make a real difference too. Once fluids and sodium are steady, we often then turn to pharmacological intervention to manage blood pressure, and help patients find high-water, high-potassium foods they tolerate well to pair with our sodium/fluids strategy.

One office blood pressure reading tells us very little. Nerves can push a reading up, and a "nice low" number can actually be too low, so we review your home blood pressure and heart rate readings instead.

We watch for swings, not just one blood pressure number. Many of my patients run too high or too low in their blood pressure at different points in the day. Meals are a common trigger. We aim to keep blood pressure out of both extremes, using lifestyle changes, medicine, or both.

If you're wondering what working with me actually looks like, here are the questions I hear most often.

How is treatment at Hypermobility Medicine different? I treat POTS and dysautonomia as part of a bigger picture, in a practice built around four things that are hard to find together. First, we understand it from the inside, because my own family lives with hypermobile EDS and the autonomic symptoms that come with it. Second, everything is under one roof. I look at your dysautonomia, joints and mast cell symptoms in one plan, and I also address sleep problems and GI dysfunction, since an MCAS or dysautonomia component is typically driving them. For patients whose issues stem from the cervical spine, our team reviews eye imaging to look for signs of raised pressure in the head. And most importantly, strength and rehab coaching is built into the practice. That brings me to the third point: I am trained in the principles of biomechanics and rehabilitation along with medicine, so the way you build joint stability is part of your medical care, and we share that guidance with your physical therapist. Fourth, our care is longitudinal: we start with a two-hour diagnostic visit, and members are then seen about every 60 days, with electronic check-ins about every two weeks so we can adjust your plan as your symptoms change.

How much does it cost, and do you take insurance? We are out of network and self-pay, so we do not bill insurance for visits. The diagnostic visit is $1,500. Membership is optional and costs $425 a month, or $385 a month on the annual plan, and if you join, the diagnostic fee covers your first month. You can still use your insurance for the medicines I prescribe and the imaging and labs we order, and you will find full details on our Services page.

What happens at the first visit? Your first visit is a two-hour diagnostic visit where I look at your autonomic symptoms alongside your joints and mast cell symptoms. I take a careful history of how standing, heat, meals and activity affect your dizziness and energy, along with your joint, gut and allergy-type symptoms, and we review your past labs, imaging and any symptom logs you bring. Afterward you receive a written care summary with a phased plan that you can share with your other doctors.

Do you offer telehealth, and can you see me if I'm not in New York? Yes, we offer telehealth for patients who are physically in New York State at the time of each visit, and we see patients in person near Albany, New York. If you live in another state, you can still travel to New York to be seen in person. Because we are licensed in New York, we cannot yet see you while you are in another state, but more states are coming soon, and if you join our waitlist we will let you know when we can see you.

How do I get started? You start by booking a 20-minute complimentary intake call through our contact form. Our office follows up to set up the call, which is not the diagnostic visit, so we can learn about your symptoms and your history and see if there's a mutual fit.

If this sounds like you, you don't have to sort out your dizziness, your joints and your reactions one specialist at a time, because I look at all three together.

What happens next: this button opens a short contact form, and our office follows up with you. You'll find pricing on our Services page.

Outside New York? You can travel here to be seen, or join our waitlist and we'll let you know when we can see you in your state.

Not ready for a visit? Get Beyond the Joint: one short weekly email of doctor-written articles on hypermobility, POTS and MCAS and how they connect, plus a heads-up when we add new states.

This guide is for education and is not medical advice for your situation.