Why Standing Up Should Not Leave You Breathless: Understanding POTS
Standing up is something most people do without a second thought. For those living with Postural Orthostatic Tachycardia Syndrome, or POTS, it can trigger a racing heart, dizziness, and a wave of fatigue that makes ordinary daily life feel like an uphill climb. If this sounds familiar, it is worth understanding what POTS actually is, why it happens, and what can be done about it.
What is POTS?
POTS is a disorder of the autonomic nervous system, the part of the body responsible for regulating functions that happen without conscious control, including heart rate, blood pressure, and blood vessel tone. In a healthy autonomic response, standing up triggers a quick adjustment: blood vessels constrict slightly and heart rate increases slightly to counteract gravity pulling blood toward the legs.
In POTS, this response is exaggerated. Heart rate rises sharply, often 30 beats per minute or more within ten minutes of standing, without the corresponding drop in blood pressure seen in other fainting disorders. The result is a cluster of symptoms including palpitations, dizziness, brain fog, fatigue, and in some cases a feeling that the body cannot keep up with the demands of upright posture.
Who gets POTS and why?
POTS most commonly affects women between the ages of 15 and 50, though it can occur at any age and in any gender. Rather than a single cause, POTS is best understood as a final common pathway that several different underlying issues can lead to.
Nervous system stress load
Prolonged physical, emotional, or physiological stress can disrupt the HPA axis — the communication system between the brain and adrenal glands that helps regulate the body's stress response. When this system becomes dysregulated it can directly affect autonomic control of heart rate and blood pressure.
Infection and injury
Viral illnesses and concussions are two of the most consistently reported triggers for new-onset POTS. Both are thought to disrupt regulatory centres in the brainstem and autonomic nervous system — a pathway that has become significantly more recognised following COVID-19.
Deconditioning
Time spent inactive — whether due to illness, injury, or lifestyle circumstances — reduces blood volume and blood vessel tone, which can worsen orthostatic symptoms and create a difficult cycle in which reduced activity leads to worse symptoms, which further limit activity.
Gut and immune factors
Increased intestinal permeability and mast cell activation are commonly seen alongside POTS and may add to the overall inflammatory and immune burden the nervous system is managing — making gut assessment a relevant part of a complete POTS investigation.
Does this sound like you?
POTS is frequently misidentified as anxiety, deconditioning, or a psychosomatic presentation for years before a proper assessment is sought. The physiological reality is that the autonomic nervous system has lost its ability to regulate blood flow and heart rate appropriately in response to postural change.
The symptoms are real, measurable, and have identifiable drivers. Diagnosis rates have risen noticeably in recent years, partly due to greater clinical awareness and partly due to a well-documented link between POTS and viral illness — particularly COVID-19 — and head injury.
Symptoms that build
the moment you stand up.
Why a root cause approach matters
Because POTS can arise from several overlapping pathways, effective management usually requires more than a single intervention. Identifying which factors are driving symptoms in a particular individual, whether that is HPA axis dysregulation, post-viral autonomic injury, deconditioning, gut health, or a combination, allows care to be targeted rather than generic.
Objective measurement plays an important role here. Heart Rate Variability analysis offers a window into how the autonomic nervous system is functioning, showing the balance between the sympathetic and parasympathetic systems. This gives both practitioner and patient a clearer picture of where things stand and how they are changing over time, rather than relying on symptoms alone.
A structured path forward
Recovery from POTS is rarely linear, but it is achievable for many people with the right structure in place. Care is combined and sequenced appropriately to address underlying drivers rather than only managing symptoms as they arise.
HRV biofeedback and neurofeedback
Nervous system regulation to help retrain autonomic balance and rebuild flexible shifting between sympathetic and parasympathetic states
Chiropractic care
Reducing physical stressors on the nervous system, particularly where cervical spine dysfunction may be contributing to autonomic dysregulation
Frequency Specific Microcurrent
Supporting tissue and nervous system recovery, particularly relevant in post-viral and post-concussion POTS presentations
Functional medicine investigation
Assessment of gut health, inflammatory load, HPA axis function, hormonal factors, and blood volume — addressing the physiology maintaining the autonomic dysfunction
Graded reconditioning
Carefully structured physical reconditioning where deconditioning is a contributing factor — paced to avoid worsening symptoms while gradually rebuilding tolerance
Hydration, electrolytes, and nutrition
Practical guidance to support blood volume and vascular tone — foundational elements of POTS management that work alongside clinical intervention
This approach is designed to work alongside any existing medical management, not to replace it. If you have already received a POTS diagnosis, functional assessment adds a layer of investigation into what is maintaining the dysfunction.
When to seek support
If standing up regularly leaves you lightheaded, breathless, or foggy, and rest does not seem to resolve ongoing fatigue, it is worth having the underlying cause properly investigated rather than assuming it is something to push through. A thorough assessment can clarify what is driving the symptoms and what an appropriate, structured path toward improvement looks like.
Standing up should not feel like something to manage.
It is worth finding out why it does.
At Wave Functional Health we use clinical HRV analysis and functional medicine assessment to investigate the autonomic, inflammatory, and physiological drivers behind POTS — working alongside your existing medical team to find what is maintaining the dysfunction.
Book a ConsultationDr Matt le Roux is a chiropractor and functional medicine practitioner at Wave Functional Health, Suite 326, 34-36 Glenferrie Drive, Robina QLD 4226. Consultations available in clinic in Robina Gold Coast and worldwide via telehealth.