The autonomic nervous system regulates digestion, heart rate and blood pressure among other things. It is the auto-pilot of your brain. If the system isn't workng quite right, digestion might not be regulated properly. Patients with autonomic instability often have dizzy spells or episodes where their heart races. These are often mislabeled panic attacks.


Autonomic instability has a huge variety of symptoms and each patient has different clusters. The symptoms can wax and wane a lot. Females have monthly symptom spikes. It runs in families. It flares during puberty and growth spurts.

Any of these can be a clue and will often be intermittent or episodic.

  • Blood pressure drops when standing upright and very still for a few minutes.
  • Variable blood pressure readings under different conditions or at different times. (Learn to take it with an old manual BP cuff. Do it slowly, accurately and only once.)
  • Standing without moving can cause fainting.
  • Heart rate goes up more than 30% when standing.
  • Heart racing (tachycardia) or beating hard (palpitations) or extra beats (palpitations) or flutters (palpitations or arrhythmia).
  • "Panic attacks" when your mind tries to figure out why your heart is racing and decides you must be scared of something.
  • Fatigue - love to sleep, love to be horizontal.
  • Malaise - feel awful for no apparent reason, feel like you were "hit by a truck."
  • Can't tolerate exercise, inconsistent ability to exercise, can't do some types of exercise, can't exercise after meals, certain foods or in hot weather.
  • Foggy thinking like being tired or low blood sugar
  • Memory issues
  • Tendency to get dehydrated
  • Shortness of breath, need to yawn but it doesn’t help.
  • A feeling of needing to pay attention to your breathing for fear it might stop
  • Fainting - sight of blood, crowded rooms, fright, grief, standing too long, etc. (Fainting is never normal and needs medical attention!)
  • Blood tends to pool in feet or hands if they are dangling
  • Feet and hands tend to fall asleep or tingle
  • Sweating for no reason, goose bumps for no reason, various body parts are confused and arguing about the proper room temperature.
  • Pupils flutter or dilate
  • Mystery fevers when nobody else is sick
  • Can’t handle physical or mental stress – gets sick
  • Odd reactions to medications and drugs
  • Digestive upset of any sort (especially episodic) due to variable blood flow to intestines and faulty signaling from brain
  • Can't gain weight because just maintaining homeostasis burns so many calories
  • Cold hands and feet when not moving
  • Skin on hands / feet / legs turns blue / mottled / multicolored / spotted
  • Headaches, especially migraines or "ice cream" headaches. Caused by standing too fast, heat, lack of sleep, lack of food, caffeine related, crowded places, standing in lines, sitting too long
  • Salt cravings
  • Feel better when wearing tight clothes and support hose
  • Hate roller coasters, headstands, swings, hot weather (late spring), variable weather, sitting or standing still
  • Most patients are at least slightly double jointed and some have Ehlers Danlos.
  • Many patients are tall, thin, long bones, beautiful like a model and have a good singing voice
  • A few patients have excess protein in the urine
  • Dizziness while urinating or throwing up.
SAFETY WARNING - If you have a tendency to faint, practice preventive safety. Never vomit over the toilet or urinate off the side of a dock/boat. If you see blood or get hurt SIT DOWN as fast as you can. Don't get dehydrated.

There are a number of diagnostic terms that may be used - it depends on your exact cluster of symptoms. Here are a few:
  • Postural Orthostatic Tachycardia Syndrome (POST)
  • Autonomic Instability
  • Orthostatic Hypotension
  • Vasovagal Syncope
  • Neurogenic Syncope
  • Neurasthenia
  • Vasoregulatory Asthenia
  • Neurocirculatory Asthenia
  • Effort Syndrome
  • Vagus/Vagal Nerve Irritation
  • Vagal Epilepsy/Seizures
  • Orthostatic Syncope
  • Orthostatic Intolerance
  • Partial Dysautonomia
  • Soldier's Heart
  • Mitral Valve Prolapse Syndrome (no actual mitral valve dysfunction but all of the symptoms)
  • Orthostatic proteinuria

This link and the rest of the NRDF site are a good place to start learning more.

There have been several medical studies linking GERD and autonomic instability. A search of Entrez Med on "reflux and autonomic" pulled up 148 articles. Try these:

24-hour heart rate variability in patients with gastroesophageal reflux disease. Folia Med Cracov. 2005;46(1-2):53-64. PMID: 17037287

Cardiac autonomic regulation differentiates reflux disease with and without erosive esophagitis. Scand J Gastroenterol. 2006 Sep;41(9):1001-6. PMID: 16938711

Oesophageal acid exposure and altered neurocardiac function in patients with GERD and idiopathic cardiac dysrhythmias. Aliment Pharmacol Ther. 2006 Jul 15;24(2):361-70. PMID: 16842463

Disturbances of the parasympathetic branch of the autonomic nervous system in patients with gastroesophageal reflux disease (GERD) estimated by short-term heart rate variability recordings. J Physiol Pharmacol. 2004 Jul;55 Suppl 2:77-90. PMID: 15608363

Heart rate variability in patients with different manifestations of gastroesophageal reflux disease. Auton Neurosci. 2004 Nov 30;116(1-2):39-45. PMID: 15556836

Finding a doctor:

It is extremely difficult to find a doctor who treats autonomic instability and they are often not taking new patients. Try cardiologists first, then neurologist. Ask if they own and use a tilt table. If they treat autonomic instability, they will to lots and lots of tilt tests. If they don't use/own a tilt table, ask where they send people to have this test done. Your insurance company may be able to help you find a specialist.

Tilt table testing:

These are pictures of Katie Anderson being tested for autonomic instability. It looks a lot more intimidating than it really is. She basically had to stand upright and still for 30 minutes while they tested her blood pressure, heart rate, carotid pressure, temperature of her head, hands and feet. They strap you to a special table just so you don't fall over- if you get dizzy or experience pain, they tilt it back down flat.

Standing upright against the table makes healthy people bored. But people with orthostatic dysfunction can have dramatic reactions. If you "flunk" this test, expect to feel horrible for hours, be groggy the rest of the day and need a very long nap. Do not plan anything strenuous the next day.

Ready to go - this should be easy.

No longer having fun. Standing still makes her dizzy and nauseated.
Check with your
doctor first!