Understanding POTS: A Guide to Postural Orthostatic Tachycardia Syndrome and How OT Can Help
Living with POTS can feel like your body is constantly working against you. One moment you're upright and feeling okay, and the next you're dizzy, lightheaded, and your heart is racing. For those living with chronic illness, especially POTS, finding care that actually helps can be an exhausting journey.
Let’s walk through what POTS really is, the different subtypes, and, most importantly, how occupational therapy (OT) can support people living with this complex condition.
What Is POTS?
POTS, or Postural Orthostatic Tachycardia Syndrome, is the most common form of dysautonomia, a disorder of the autonomic nervous system, which regulates things like heart rate, blood pressure, digestion, and temperature.
What makes POTS unique is how the heart responds when you stand up:
POTS is defined by an abnormal increase in heart rate upon standing, more than 30 beats per minute in adults, and more than 40 bpm in teens, without a significant drop in blood pressure.
This sudden spike in heart rate is your body’s attempt to compensate for blood that pools in the lower half of the body. But it often causes a cascade of other debilitating symptoms.
Common Symptoms of POTS
The symptoms of POTS go far beyond a racing heart. Because the autonomic nervous system affects nearly every system in the body, POTS can show up in a wide variety of ways, including:
Lightheadedness or dizziness
Fatigue and brain fog
Palpitations
Nausea or GI discomfort
Orthostatic intolerance (difficulty standing)
Syncope or presyncope (passing out or feeling like you might)
Temperature regulation issues
Exercise intolerance
Shortness of breath
Cold extremities
Tremors
Abnormal sweating
Sleep disturbances
Migraine and sensory sensitivities (light, sound, heat)
It’s not uncommon for people with POTS to be misdiagnosed with anxiety or other conditions for years before getting an accurate diagnosis.
The 4 Subtypes of POTS (and Why They Matter)
Not everyone with POTS experiences the condition in the same way. Identifying your subtype is key to personalizing care. Here’s an overview:
Neuropathic POTS
Caused by nerve damage that impairs blood vessel constriction in the limbs and abdomen. Symptoms often include blood pooling, numbness, bluish discoloration in the feet, and reduced sweating in the extremities.
Hypovolemic POTS
Driven by low blood volume, this subtype can make it harder for the body to circulate blood efficiently. Dizziness, cold hands/feet, fatigue, and orthostatic intolerance are hallmark signs.
Hyperadrenergic POTS
Involves excess norepinephrine and overactivity of the sympathetic nervous system. Linked to conditions like MCAS, symptoms include high blood pressure, tremors, heat intolerance, and anxiety like symptoms.
Secondary POTS
Secondary POTS occurs as a result of another underlying condition, such as:
Hypermobile Ehlers-Danlos Syndrome (hEDS)
Autoimmune disorders
Lyme disease or other infections
Post-viral syndromes (like long COVID)
In these cases, treatment focuses on managing the root cause while supporting the autonomic nervous system. For example, someone with hEDS may benefit from connective tissue support, fascial release, and joint stabilization work in addition to POTS-specific strategies.
Why Subtype Identification Matters
Identifying your specific POTS subtype can help tailor treatment strategies. For example:
Hypovolemic POTS often benefits from increasing salt and fluids.
Neuropathic POTS may respond well to compression garments and gentle movement.
Hyperadrenergic POTS may require medications to modulate the sympathetic nervous system.
Other supportive strategies include exercise, nutrition, nervous system regulation, and environmental modifications, which lead us to the next key player.
The Role of Occupational Therapy in POTS Management
Living with POTS can affect nearly every part of your day, from getting out of bed in the morning to preparing meals, working, parenting, or even showering. This is where a POTS-informed occupational therapist can make all the difference.
Here’s how OT can help:
Energy Conservation Techniques
Learn how to pace your day and manage tasks without crashing or worsening symptoms.
Activity Pacing
Understand how to gradually build tolerance without triggering a flare.
Nervous System Regulation
Work on vagus nerve exercises, breathwork, and grounding strategies to calm sympathetic overdrive.
Adaptive Equipment & Environment Modifications
Make daily tasks easier with tools that reduce strain and fatigue, like stool seating for meal prep or a handheld shower head.
Graded Exercise Support
Gentle, customized movement plans (like reclined exercises or movement “snacks”) can help improve blood circulation and function.
Managing a POTS Flare
Even with support, flares can happen. Here are strategies I often recommend to clients when symptoms spike:
Lie down and elevate your legs
Hydrate + electrolytes (add salt or oral rehydration solutions)
Regulate your nervous system through deep breathing or mindfulness
Gentle movement if tolerated (lying down exercises help prevent deconditioning)
Avoid triggers like heat, stress, or dehydration
Eat small, balanced meals to prevent post-meal dizziness
You Don’t Have to Navigate POTS Alone
If you’re living with POTS, I want you to know that you’re not imagining your symptoms, and you’re not “just anxious.” This is a real condition, and it deserves real support.
As an occupational therapist specializing in chronic illness and dysautonomia, I help clients with POTS regain function, improve quality of life, and feel more in control of their day-to-day.
Want to learn how OT can support your journey with POTS?
📩 Send me a message or schedule an appointment to learn more.