If you’ve been diagnosed with Postural Orthostatic Tachycardia Syndrome (POTS), you’re not alone in wondering when or if things will get better. For some patients, it’s a temporary condition that improves over time. For others, symptoms can persist for years despite medications, lifestyle changes, and conventional care.
Many people try everything they’re told—electrolytes, compression garments, gentle exercise—yet still find themselves dealing with dizzy spells, brain fog, and exhaustion that never seems to fully go away.
That’s because, at its core, POTS is a downstream effect of dysfunction in the autonomic nervous system. When the brain’s regulation of heart rate and blood pressure goes awry, the result is the cluster of symptoms we recognize as POTS.
The way to move past symptom management toward real recovery is to treat autonomic dysfunction directly, which can help restore balance within the nervous system, providing long-term regulation gains that reduce symptoms in daily life.
This is the unique approach we take to POTS treatment at our Utah-based clinic, Cognitive FX. And this is what we recommend looking for in a clinic when seeking support for POTS.
In this article, we’ll explore what causes POTS, how it’s diagnosed, and why neurological retraining can make a lasting difference. We cover:
Understanding POTS: A Dysfunction of the Autonomic Nervous System
POTS is a form of dysautonomia, or dysfunction of the autonomic nervous system (ANS) — the part of your nervous system that regulates involuntary body functions like heart rate, blood pressure, and breathing.
It’s marked by orthostatic intolerance—excessive heart rate rise and other symptoms when moving from lying or sitting to standing. Typically, it's diagnosed when a patient’s heart rate increases by more than 30 beats per minute (or 40 bpm in adolescents) within ten minutes of standing up.
What Happens When You Stand Up
Normally, when you stand, gravity pulls blood toward your lower body. The ANS compensates by tightening blood vessels and slightly increasing your heart rate to maintain blood flow to the brain and heart.
In POTS, this system doesn’t respond fast enough. Blood pools in the lower body, which reduces the amount returning to the heart and brain. To compensate, the ANS triggers a sharply increased heart rate to maintain oxygen flow — but this isn’t always enough, leading to symptoms of dizziness, lightheadedness, and fatigue.
Lying down usually relieves symptoms because it helps restore blood flow to the brain.
The Neurological Nature of POTS
POTS continues to be viewed by much of the healthcare system as a cardiovascular (circulatory) problem. However, growing research shows it’s actually a neurological disorder — specifically, a malfunction of autonomic regulation.
While its symptoms affect the cardiovascular system, the root cause lies in the brain’s mismanagement of autonomic signals, not in a disease of the heart itself. This understanding is crucial for effective treatment.
Associated Conditions and Triggers
Cases of POTS can appear on their own or alongside other chronic conditions that affect the nervous or circulatory systems. It’s frequently linked to:
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Ehlers–Danlos syndrome (EDS), where connective tissue weakness contributes to poor blood vessel tone.
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Autoimmune diseases like lupus, which can damage nerve pathways.
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Viral infections such as COVID-19 or mononucleosis, which sometimes trigger POTS through inflammation of the autonomic nervous system.
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Traumatic brain injuries, which can cause neurovascular coupling disruption and autonomic dysfunction.
Common Symptoms of POTS
Beyond dizziness or lightheadedness when standing, POTS can produce a varied group of symptoms, including:
- Rapid or irregular heartbeat
- Fainting or near-fainting
- Chronic fatigue
- Headaches and brain fog
- Shortness of breath or chest pain
- Heart palpitations
- Excessive sweating
- Exercise intolerance
- Digestive issues such as nausea or bloating
- Anxiety, poor sleep, and trouble concentrating
Symptoms often worsen in warm environments, during illness or menstruation, or after standing for long periods or strenuous exercise.
Diagnosing POTS
POTS Diagnosis typically involves a combination of medical history, physical exams, and tests that measure cardiovascular changes when moving from lying to standing.
The Tilt Table Test
The tilt table test is the gold standard for diagnosis. Patients are strapped to a table that moves from lying flat to an upright position while their heart rate, blood pressure, oxygen, and sometimes CO₂ levels are monitored.
Patients may be diagnosed with POTS if they:
- Show an abnormal increase in heart rate when upright.
- Experience worsened symptoms in this position.
- Do not develop orthostatic hypotension within the first three minutes.
Additional tests may be ordered to rule out other causes, such as blood tests, ECGs, echocardiograms, Valsalva maneuvers, or sweat regulation tests.
Conventional POTS Treatment Options
Most current treatments focus on symptom management, combining lifestyle changes with medications as needed.
Non-Pharmacological Treatments
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Increase sodium and fluid intake: More salt helps the body retain fluid, increasing blood volume and improving circulation and hydration. Patients should discuss salt intake with their doctor, especially if they have hypertension, heart, or kidney issues.
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Wear compression garments: These garments reduce blood pooling in the legs by helping push blood toward the heart. Research suggests the best results come from combining abdominal binders with knee-high compression stockings.
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Gradually reintroduce exercise: Exercise strengthens the heart and improves blood flow regulation. Patients should start with recumbent or supine exercises and progress slowly to avoid setbacks.
Pharmacological Treatments
While no medications are FDA-approved specifically for POTS, several are prescribed off-label to help manage symptoms.
Common examples include:
- Beta-blockers (e.g., propranolol, metoprolol) to lower heart rate.
- Fludrocortisone or desmopressin to increase blood volume.
- Midodrine or droxidopa to raise blood pressure.
- Ivabradine to reduce heart rate without affecting blood pressure.
- Stimulants such as modafinil or amphetamines for fatigue and brain fog.
- SSRIs or clonidine/methyldopa to regulate autonomic signaling.
- Pyridostigmine to enhance parasympathetic activity.
While these can provide relief, side effects are common, and symptoms usually return once medication or behavioral changes stop. That’s because these approaches treat downstream effects, not the neurological root causes of POTS.
A Better Alternative: Treating POTS Through a Neurological Lens at Cognitive FX
Our 4-day program targets the root causes of POTS by retraining autonomic function. The goal is long-term regulation and sustainable quality-of-life improvements, not just short-term symptom relief.
This program grew out of the success we’ve had treating concussion patients who commonly experience POTS symptoms. As we consistently saw their autonomic function improve through neurological rehabilitation, we refined and formalized those methods into a dedicated POTS program.
The Four-Day POTS Treatment Program
Our intensive program lasts four days and includes:
- Comprehensive medical and neurophysiological assessment
- Neuro-cardio training
- Vestibular recalibration
- Breathing mechanics training
- Cranial nerve activation
- CO₂-based therapies
Each therapy targets a different aspect of ANS dysfunction, teaching the brain how to self-regulate more effectively.
How Our Therapies Work
Neuro-Cardio Training
The ANS has two main branches:
POTS patients often remain stuck in a state of chronic sympathetic overactivation. Neuro-cardio training helps the brain relearn how to shift between these states.
Patients perform brief, high-intensity exercises to trigger the SNS, followed by cooling techniques and diaphragmatic breathing to activate the PNS. Repeating these cycles retrains the body to transition smoothly between stress and rest responses.
Vestibular Recalibration
Dizziness in POTS isn’t caused only by reduced blood flow to the brain. The inner ear also plays an important role, specifically a tiny structure called the saccule, which detects changes in your body’s position on the vertical plane (such as moving from lying to sitting or standing).
The vestibular nerve and saccule communicate with the vagus nerve to help regulate heart rate based on movement. Normally, your heart rate should rise slightly when you sit or stand as your body adjusts to gravity. But if these vestibular signals are inaccurate or delayed, your brain may misjudge what’s happening and overcorrect. This can trigger a stronger-than-necessary heart rate response and lead to dizziness or lightheadedness.
Our vestibular recalibration therapy helps retrain the brain to process these signals correctly. Through targeted balance and movement exercises, patients learn to coordinate vestibular input with autonomic responses more effectively—reducing dizziness, stabilizing heart rate changes, and calming the nervous system’s overreaction to position shifts.
Breathing Mechanics Training
Breathing directly influences autonomic function.
- Inhalation activates the SNS.
- Exhalation activates the PNS.
Many POTS patients develop dysfunctional breathing patterns, leading to low CO₂ levels (hypocapnia) that worsen symptoms like dizziness and fatigue. Our breathing training focuses on slow, nasal, diaphragmatic breathing and — when needed — supplemental CO₂ therapy to restore balance.
Cranial Nerve Activation
We stimulate cranial nerves through targeted smell and taste exercises. For example, lavender, vanilla, and rose activate the parasympathetic system, while citrus and peppermint stimulate sympathetic activity. This trains sensory-autonomic connections involved in POTS regulation.
CO₂-Based Therapies
Contrary to old assumptions, CO₂ is vital for oxygen delivery. Many POTS patients have low CO₂, which limits oxygen utilization.
We use CO₂ in two ways:
- Pre-cardio inhalation to improve oxygen use during exercise.
- CO₂ bath during rest phases to enhance relaxation and circulation.
Moving Beyond Symptom Management
If you've tried cardiovascular reconditioning, medication management, and lifestyle modifications without lasting improvement, it's likely because those approaches aren't addressing the neurological regulation problem. We're treating a different layer of the problem—and that's why patients who've "tried everything" often see results they haven't experienced before.
If you’ve been diagnosed with POTS and you live in the Utah Valley area — or can travel to Provo —our clinic offers one of the few neurologically focused POTS treatment programs in the country. Fill out this form to see if you’re a good fit for our program or call our patient care coordinator at: 385-334-6093.
