Decoding Dysautonomia Part 1: Understanding the Condition

Exploring the Long COVID–Dysautonomia Connection

Understanding Dysautonomia: Breaking Down the Term

Dys-: This prefix originates from Greek, meaning “impaired” or “abnormal.” In medical terminology, it signifies dysfunction or a disruption in normal processes.

Autono-: Derived from “autonomic,” referring to the autonomic nervous system (ANS), the part of the nervous system responsible for regulating involuntary bodily functions such as heart rate, blood pressure, digestion, and temperature control.

-Mia: This suffix has Greek roots and relates to a condition or state.

Together, “dysautonomia” describes a condition in which the autonomic nervous system no longer regulates essential functions properly.

Your body continuously adjusts heart rate, blood pressure, digestion, and temperature—without you even noticing. But when these automatic processes become dysregulated, symptoms can arise that disrupt daily life. For people with dysautonomia, this dysfunction leads to a wide range of debilitating effects, from dizziness and fatigue to digestive issues and rapid heart rate.

Despite its impact, dysautonomia remains widely misunderstood—even within the medical community—leaving many searching for answers. While this condition can stem from various causes, including genetic, autoimmune, and neurodegenerative factors, this series will primarily explore its connection to long COVID, a growing contributor of autonomic dysfunction.

To understand why dysautonomia causes such widespread symptoms, let’s first break down how the autonomic nervous system functions.

What Is the Autonomic Nervous System?

Think of your nervous system as the body’s control center—managing everything from your heartbeat to your digestion. Within this system, there’s a subdivision called the autonomic nervous system (ANS), which acts like an autopilot for your body, handling all the functions you don’t consciously control.

The term ‘autonomic’ comes from the Greek word for ‘self-governing,’ reflecting the ANS’s ability to regulate vital functions without conscious effort. It manages essential bodily functions, including:

• Heart rate – Maintains steady heartbeat at rest and adjusts it when you move, exercise, or experience stress.

• Blood pressure – Ensures stable circulation by widening or narrowing blood vessels as needed.

• Digestion – Controls the movement of food through the digestive tract, the release of digestive enzymes, and nutrient absorption.

• Breathing – Automatically regulates breathing rate, increasing it when needed (e.g., during exercise) and slowing it at rest.

• Temperature control – Helps maintain body temperature by adjusting blood flow, triggering shivering to generate heat, or prompting sweating to cool down.

• Pupil response – Adjusts pupil size in response to light and darkness, ensuring clear vision in different environments.

The ANS has two main branches:

1. The Sympathetic Nervous System ("Fight or Flight") – Prepares your body for action, increasing heart rate and blood pressure while slowing digestion.

2. The Parasympathetic Nervous System ("Rest and Digest") – Helps your body relax, slowing heart rate, lowering blood pressure, and promoting digestion.

When working correctly, these two branches keep everything in balance. But in a condition like dysautonomia, there is a dysregulation of the ANS, leading to a wide range of unpredictable symptoms that vary from person to person.

What does dysautonomia feel like?

Here are some of the most common symptoms:

• Shortness of breath

• Tachycardia or bradycardia

• Chest pain & heart palpitations

• Dizziness & fainting

• Fatigue & exercise intolerance

• Blood pressure instability (highs & lows)

• Temperature dysregulation (hot/cold intolerance, excessive sweating or reduced sweating)

• Nausea, vomiting, & digestive changes

• Brain fog & anxiety

Types of Dysautonomia: Key Conditions to Know

Dysautonomia is an umbrella term for disorders that affect the ANS, each with distinct effects on autonomic function. While there are 15 recognized conditions under this umbrella, many people experience overlapping symptoms or meet the criteria for multiple of these conditions, making diagnosis challenging. In this Decoding Dysautonomia series, which explores the connection between dysautonomia and long COVID, we will focus on four conditions that are particularly relevant to this discussion. In the following section, we’ll examine these conditions and their impact.

1. Postural Orthostatic Tachycardia Syndrome (POTS): A disorder characterized by an excessive increase in heart rate (≥30 BPM) upon standing, often accompanied by palpitations, fatigue, and presyncope. POTS itself has different subtypes, including:

   • Neuropathic POTS: Dysfunction of the nerves regulating blood flow in the legs, leading to poor circulation and blood pooling.

   • Hyperadrenergic POTS: Overactive sympathetic nervous system causing excessive norepinephrine and adrenaline release, leading to tachycardia, palpitations, high blood pressure, and tremors.

   • Hypovolemic POTS: Associated with low blood volume, leading to poor circulation and symptoms like dizziness, rapid heart rate upon standing, and fatigue.

   • Secondary POTS: Develops as a result of another underlying condition, such as Ehlers-Danlos Syndrome (EDS) or an autoimmune disease.

2. Orthostatic Hypotension (OH): A condition where blood pressure drops significantly upon standing, leading to dizziness, lightheadedness, and fainting. This happens when the autonomic nervous system fails to properly regulate blood vessel constriction.

3. Neurocardiogenic Syncope (NCS) / Vasovagal Syncope (VVS) – A condition where the body's autonomic reflexes overreact to certain triggers—such as standing for long periods, heat, pain, or emotional stress—causing a sudden drop in heart rate and blood pressure. This leads to reduced blood flow to the brain, resulting in dizziness, nausea, and fainting.

4. Inappropriate Sinus Tachycardia (IST): A condition in which the heart beats excessively fast at rest or with minimal exertion, even without a clear trigger like exercise or stress. People with IST may experience palpitations, dizziness, shortness of breath, and fatigue.

Why Diagnosis Can Be Difficult

Recognizing these conditions is only part of the challenge—on average, patients wait six years for an accurate diagnosis due to the wide range of symptoms and a general lack of awareness in both the public and medical community. Dysautonomia is complex and often overlooked or misdiagnosed, making it difficult for those affected to get the care they need.

By understanding how the autonomic nervous system functions—and what happens when it becomes dysregulated—people with dysautonomia can take the first step toward effective management and finding the right support.

In the next part of this series, we’ll dive into the connection between dysautonomia and long-COVID, exploring how viral infections may trigger or worsen autonomic dysfunction.

Stay tuned for Part 3 of Decoding Dysautonomia, where we’ll explore evidence-based nutrition and lifestyle strategies to help you navigate life with dysautonomia.