In medical science, “dysautonomia” is used to describe when the autonomic nervous system (ANS) does not work as it should. Fainting, low blood pressure, and breathing problems are some of the symptoms that can occur.
The ANS is in charge of maintaining a consistent internal temperature, controlling breathing patterns, maintaining a stable blood pressure, and controlling heart rate. It also affects pupil dilation, sexual arousal, and urination. These biological functions are commonly affected by conditions that induce dysautonomia.
Dysautonomias impact more than 70 million people globally, according to Dysautonomia International. They can be primary or secondary and come in a variety of shapes and sizes. Primary dysautonomia can be caused by degenerative disorders like Parkinson’s disease. Secondary dysautonomia is caused by an injury or another form of condition.
This page examines the various varieties of dysautonomia, as well as their symptoms and therapies.
Types
Dysautonomia can be classified into at least 15 different categories. Neurocardiogenic syncope (NCS) and postural orthostatic tachycardia syndrome are the most common (POTS).
NCS
The most common dysautonomia is NCS, which affects tens of millions of people around the world. The most common symptom is fainting, also known as syncope, which can occur at any time. Some people will only have it once in a while, while others will get it frequently enough to interrupt their lives.
Gravity naturally pushes blood downhill, but a healthy ANS regulates pulse and muscle stiffness to keep blood flowing to the brain and prevent blood pooling in the legs and feet.
The processes that control this fail in NCS, resulting in a momentary lack of blood circulation in the brain, which causes fainting.
Avoiding recognized triggers can benefit people who faint only rarely. The following are examples of possible triggers:
- dehydration
- stress
- alcohol consumption
- very warm environments
To treat persistent or severe episodes of NCS, doctors may prescribe medicine such as beta-blockers or the implantation of a pacemaker.
POTS
POTS affects 1–3 million people in the United States, with women accounting for around 80% of the cases. It frequently affects people who have an autoimmune condition.
Among the signs and symptoms are:
- lightheadedness and fainting
- tachycardia, which is an abnormally fast heart rate
- chest pain
- shortness of breath
- stomach upset
- shaking
- becoming easily exhausted by exercise
- oversensitivity to temperatures
POTS is usually the result of a secondary dysautonomia. In people with the condition, researchers discovered high amounts of autoimmune markers. Furthermore, people with POTS are more prone than the general population to suffer from an autoimmune condition such as Sjögren’s disease or lupus.
Aside from autoimmune causes, doctors have linked the following illnesses to POTS or POTS-like symptoms:
- some genetic disorders or abnormalities
- diabetes
- 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
MSA is an uncommon disease that affects 2–5 people out of every 100,000, according to doctors. It mainly strikes people over the age of 40. Because the early symptoms of both disorders are similar, doctors may mistake it for Parkinson’s disease.
Certain brain regions, such as the cerebellum, basal ganglia, and brain stem, steadily deteriorate in people with MSA. This causes motor difficulties, speech challenges, balance concerns, low blood pressure, and bladder control abnormalities.
MSA is not communicable or genetic, and it has nothing to do with multiple sclerosis. Researchers don’t know much else about what causes MSA. As a result, there is no cure and no particular treatment options available at this time.
Certain symptoms, however, can be managed with lifestyle changes and drugs.
Autonomic dysreflexia
People with spinal cord injuries may experience autonomic dysreflexia (AD) (SCIs). As a result, it’s classified as secondary dysautonomia by doctors. The higher the SCI, the greater the chance of Alzheimer’s disease. Up to 90% of people with cervical spinal or high thoracic SCIs may acquire Alzheimer’s disease.
The discomfort of the area below the level of a person’s injury is the most common symptom of AD. AD can be caused by a variety of illnesses and injuries, including urinary tract infections and skeletal fractures.
In AD, the damaged spine prevents pain messages from reaching the brain. The ANS reacts improperly, resulting in significant blood pressure increases. Among the signs and symptoms are:
- headaches
- blotchy skin
- a blocked nose
- a slow pulse
- nausea
- goosebumps and clammy skin near the site of the injury
The majority of therapies try to alleviate the original injury or irritation, preventing subsequent AD episodes.
Failure of the baroreflex
This is an uncommon condition that affects blood pressure.
One method the body maintains a healthy blood pressure is through the baroreflex mechanism. Stretch receptors called baroreceptors are found in important blood arteries. They detect artery wall stretching and send messages to the brain stem.
If these messages are not received, blood pressure might drop dangerously low when sleeping or increase dangerously high during periods of stress or activity.
Headaches, excessive perspiration, and an irregular heart rate that does not respond to medicine are all possible signs.
Medication to modulate heart rate and blood pressure, as well as stress management strategies, are used to treat baroreflex failure.
Autonomic neuropathy in diabetics
Diabetic autonomic neuropathy is a possible diabetic consequence. The nerves that control the bladder, digestive system, heart, genitals, and other organs are affected by this condition.
Among the signs and symptoms are:
- resting tachycardia, which is a fast resting heart rate
- orthostatic hypotension, or low blood pressure when standing
- constipation
- 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
Diabetic autonomic neuropathy is treated with a meticulous approach to diabetes management. Doctors may prescribe therapies to alleviate specific symptoms in some circumstances.
Familial dysautonomia
Familial dysautonomia (FD) is an extremely rare form of dysautonomia that primarily affects people of Ashkenazi Jewish ancestry.
The following are some of the symptoms that frequently arise in infancy or childhood:
- 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
- bed-wetting
- poor balance
- kidney and heart problems
A dysautonomic crisis, which includes fast swings in blood pressure and heart rate, significant personality changes, and full intestinal shutdown, can occur as a result of the condition.
Familial dysautonomia is a serious and typically fatal condition. There is no way to stop it. However, thanks to prenatal screening and testing, the incidence of FD is gradually reducing over time.
Causes
Dysautonomias are autonomic nerve system defects that can occur for a variety of reasons. Primary dysautonomias are caused by hereditary or degenerative brain and nervous system diseases. Secondary dysautonomias are caused by an injury or another form of condition.
Secondary dysautonomia can be caused by a variety of factors, including:
- diabetes
- lupus
- rheumatoid arthritis
- Parkinson’s disease
- celiac disease
Long COVID, a condition that can develop after someone has COVID-19, may possibly be caused by autonomic dysfunction, according to scientists. Many people with lengthy COVID experience symptoms that are comparable to those of POTS, according to a 2021 article.
Symptoms
Dysautonomia comes in a variety of forms, each with its own set of symptoms. Symptoms might come and go, making it difficult to predict when they will appear.
Symptoms that a person may experience include the following:
- an inability to stay upright
- dizziness, vertigo, and fainting
- fast, slow, or irregular heartbeat
- chest pain
- low blood pressure
- problems with the gastrointestinal system
- nausea
- disturbances in the visual field
- weakness
- breathing difficulties
- mood swings
- anxiety
- fatigue and intolerance to exercise
- migraine
- tremors
- disrupted sleep pattern
- frequent urination
- temperature regulation problems
- concentration and memory problems
- low appetite
- sensory sensitivity, especially on exposure to noise and light
Treatment
Primary dysautonomias has no known treatment. Secondary dysautonomias symptoms, on the other hand, may improve if the underlying condition is treated.
The goal of treatment is to lessen symptoms to the point where the person can begin a program to strengthen and condition their body. This can assist them in balancing the effects of the ANS not functioning properly.
The nature and precise details of each person’s combination of symptoms determine the therapy plan. A doctor will tailor the treatment to the individual, but it will most likely include physical therapy, exercise therapy, and counseling to assist a person with dysautonomia cope with the lifestyle changes that come with the condition.
A treatment plan may be aided by a variety of doctors, including cardiologists and neurologists.
A person may require medicine to alleviate some of their symptoms, and the suggested course of treatment may change over time to accommodate any physical changes.
Doctors may also recommend that people with the condition drink 2–4 liters of water per day and up their salt consumption to 4–5 grams per day. Caffeine and sugary drinks should be avoided by everyone, especially children.
A person should consult with a doctor to choose the best course of treatment for them.
Other options for treatment
Alternative treatments for dysautonomias do not exist, although complementary therapies may help people manage and live with their symptoms. The following may be beneficial to people:
- Mindfulness techniques: Anxiety is a common symptom of dysautonomia. Including soothing mindfulness practices in one’s everyday routine could be beneficial. Yoga, meditation, and breathing exercises are examples of these.
- Cognitive behavioral therapy (CBT): This strategy is used by therapists to assist people overcome thinking habits that can lead to anxiety, worry, and stress.
- Cannabidiol (CBD): This molecule is derived from the hemp plant, however it does not provide a “high” like cannabis does. CBD was used for three months in a small 2017 research of 12 females with dysautonomic syndrome after human papillomavirus (HPV) vaccination. The eight patients who finished the trial reported considerably reduced body pain and increased physical, energetic, and social functioning scores at the conclusion of the study.
Although preliminary CBD study seems promising, more research is needed to validate the effects, given this trial was limited and only included female participants aged 12–24 years.
Dysautonomia’s Effects
Every person’s life is unique, and so is their experience with dysautonomia. Dysautonomia is a complicated combination of symptoms, and the impact they have on a person’s life varies dramatically based on their specific circumstances.
Around 25% of people with POTS experience severe symptoms that prevent them from working, sleeping, or socializing with their friends and family. Some people may not be able to engage in vigorous physical activity.
Dysautonomia can also have a negative impact on one’s mental health. Depression and anxiety are typical among people who have POTS, for example.
Dysautonomia has a tangled web of connections with various illnesses. These are some of them:
- Posttraumatic stress disorder (PTSD): Psychological trauma causes the ANS to stop functioning properly in PTSD, resulting in mental and physical symptoms that are similar to dysautonomia.
- Obstructive sleep apnea (OSA): When someone has OSA, their breathing stops and resumes repeatedly while sleeping. People with OSA have ANS changes, according to a 2019 study, but additional research is needed to fully understand the link.
- Vitamin deficiencies: Vitamin D may play a role in autonomic diseases, according to experts. Low vitamin D levels appear to induce some of the symptoms that clinicians notice in people with dysautonomia, however the specific mechanism is unknown.
Conclusion
The outlook for people with dysautonomia is totally dependent on the sort of condition they have. The phrase encompasses a wide range of conditions with varying degrees of severity.
Experts at prestigious medical institutes, on the other hand, are conducting groundbreaking research that may provide hope to people suffering with dysautonomia.
According to some estimates, the majority of persons with youth-onset dysautonomia should recover or improve dramatically by their mid-20s with commitment, adequate medical therapy, and lifestyle control. When the body is under stress, such as during pregnancy or menopause, some people’s symptoms may resurface.
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