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What You Must Know About Dysautonomia

Introduction to Dysautonomia

The autonomic nervous system is a distributed system in the body with many critical functions necessary for survival including regulation of heart rhythm, pupil dilation, digestion and more. Dysautonomia is a broad term used to describe many different kinds of conditions that cause problems with this type of regulation. In general, dysautonomia refers to loss or impairment in the function within autonomic systems but can also refer to anomalies in the processing from sensory input from internal and external sources. The spectrum ranges from very subtle changes/differences in cognitive processes all the way to debilitating disease.

One way to understand dysautonomia is as an impairment in the ability of the nervous system to respond correctly to input from the environment. Aspects of this can range from subtle differences between individuals, such as personality or preferences, all the way to more significant impairments which affect overall quality of life on a daily basis.

The treatment for any kind of dysautonomia is going to be different because it requires taking into account not only the type and severity of symptoms that are present but also how these symptoms impact their quality of life. In addition, some people who have similar types/severities/symptoms within a given category may experience different outcomes if they have other types of differing symptoms or diseases which can complicate treatment. This is because dysfunctional patterns of autonomous Automatic Regulation Systems (ARS) result from problems with both input signals (excitatory irritants), as well as output responses generated internally due to individual differences between people.

Types of Dysautonomia

The three main types of dysautonomia are mild dysautonomia, postural orthostatic tachycardia syndrome (POTS) and neurocardiogenic syncope.

Most people have mild dysautonomia, which is commonly associated with impaired quality sleep. Those with sleep apnea, narcolepsy, hypersomnia (too sleepy during the daytime) can have mild dysautonomia. Although it's called "mild" the effect on the quality of life can be debilitating.

POTS patients present with many classic symptoms, including lightheadedness upon standing, extreme fatigue, heart palpitations, tremulousness or shaking in the hands or feet. These are all signs that there is a problem with blood pressure control by the autonomic nervous system because for healthy individuals standing up should not cause these symptoms. 

Neurocardiogenic syncope is often preceded by warning signs such as blurred vision or nausea/vomiting. The loss of consciousness associated with this condition is caused because the abnormal decrease of volume to the brain causes it to lose function.

There is a fourth category which is based on brain disorders such as seizure or seizure-like disorders. There is debate on whether this category can be considered dysautonomia at all since they are classified in other neurological and psychiatric disorders. The brain is constantly adapting itself based on what it learns from our experiences throughout life which results in memories being formed within individual neurons called synaptic connections. These connections form patterns of activity within the brain as a result of repeating stimuli received from the environment. 

Testing and Diagnosis

The autonomic nervous system can be constantly tested for problems by recreating specific circumstances that would trigger a response from the ARS. One common test is measuring cardiovascular responses while standing still and then again while moving; this is called postural testing. This kind of testing seems simple enough, but many people (up to 80%) who suffer from POTS and neurocardiogenic syncope who test normal on tests like these because there are some dysautonomia symptoms which do not manifest during testing.

Treatment

In order to address problems with coordination within autonomic systems there are various treatments that address the different parts of physiological processes. Treatments can include drugs or supplements, invasive medical devices, and neurofeedback, which changes the electrical properties of brain cells in a targeted area.

In addition to these treatments, lifestyle changes are absolutely necessary for management of autonomic problems such as maintaining a stable schedule with adequate sleep and making sure to get enough exercise on a daily basis. There have been cases where interventions have helped patients manage autonomic issues by reducing symptoms from chronic pain, stress, PTSD, anxiety, and sleep impairments.

Symptom Breakdown

Disorders of the parasympathetic nervous system

This is one of two main branches of the autonomic nervous system which regulates internal body processes that occur in periods of rest. When this subsystem isn't working correctly, symptoms can include if you're more prone to fainting when transitioning from sitting to standing or getting up quickly, problems fully emptying bladder etc.

Disorders of the sympathetic nervous system

The other branch of the autonomic nervous system regulates all activities that result from effort and emotion such as rapid heart rate, upset stomach from fear/anxiety, reduced feedback from sweat glands leading to sweaty palms etc. In conditions where this function is not working properly patients may experience fatigue easily during activity that would otherwise be manageable without feeling symptoms like symptoms of autonomic dysregulation, orthostatic intolerance/postural orthostatic tachycardia syndrome (POTS).

Disorders of the central nervous system - This refers to problems with the processing center for the autonomic nervous system which is located deep within midbrain. Don't feel like you can do anything to manage symptoms and treatments are difficult. Symptoms may include nausea, vomiting, blurred vision etc.

Diffuse dysfunction - More than one category listed above present at once or general symptoms that can't be categorized into any other types. It's also possible to have symptoms on some subsystems but not others which makes it harder for doctors to reach a specific diagnosis if they don't know what questions to ask their patients. Symptoms range from severe chronic constipation from gastroparesis, to chronic bladder inflammation without infection (interstitial cystitis), to short term memory loss, brain fog, and attention deficit.

Disorders of the sensory nervous system - This refers to problems with interpreting information from various sensory organs for the brain. Symptoms may include lightheadedness when standing up, dizziness when turning head side to side, fluctuation in how severe/noticeable symptoms are etc.

The Takeaway

It's important to know that many people have dysautonomia without having any kind of known diagnosis because it is so complex and there are so few doctors who understand all aspects of it.

If you have been found to have a condition that fits into one or more of these categories then please do not assume that your doctor has figured out what's wrong just from knowing this fact.

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