Dysautonomia

Overview

Dysautonomia is a general term for a group of disorders that share a common problem – that is, an autonomic nervous system (ANS) that doesn’t function as it should. The ANS is the part of the nervous system that controls involuntary body functions (functions you don’t consciously control) like your heart rate, blood pressure, breathing, digestion, body and skin temperature, hormonal function, bladder function, sexual function and many other functions.

When the ANS doesn’t work the way it should, it can cause heart and blood pressure problems, breathing trouble, loss of bladder control and many other problems.

Dysautonomia, also called autonomic dysfunction or autonomic neuropathy, is relatively common. Worldwide, it affects more than 70 million people. It can be present at birth or appear gradually or suddenly at any age. Dysautonomia can be mild to serious in severity and even fatal (rarely). It affects women and men equally.

Dysautonomia can occur as its own disorder, without the presence of other diseases. This is called primary dysautonomia. It can also occur as a condition of another disease. This is called secondary dysautonomia.

Examples of diseases in which secondary dysautonomia can occur include:

Diabetes.
Parkinson’s disease.
Muscular sclerosis.
Rheumatoid arthritis.
Lupus.
Sjogren’s syndrome.
Sarcoidosis.
Crohn’s disease, ulcerative colitis.
Celiac disease.
Charcot-Marie-Tooth disease.
Chiari malformation.
Amyloidosis.
Guillain-Barre syndrome.
Ehlers-Danlos syndrome.
Lambert-Eaton syndrome.
Vitamin B and E deficiencies
Human immunodeficiency virus (HIV).
Lyme disease.

Types

Dysautonomia is a medical term for a group of different conditions that share a common problem – improper functioning of the autonomic nervous system. Some of the conditions caused by primary dysautonomia include:

Neurocardiogenic syncope (NCS): NCS is the most common form of dysautonomia. It can cause fainting spells that happen once or twice in your lifetime or multiple times every day. NCS is also called situational syncope or vasovagal syncope.
Postural orthostatic tachycardia syndrome (POTS): A disorder that causes problems with circulation (blood flow), POTS can cause your heart to beat too fast when you stand up. It can lead to fainting, chest pain and shortness of breath.
Familial dysautonomia (FD): People inherit this type of dysautonomia from their genetic relatives. It can cause decreased pain sensitivity, lack of eye tears and trouble regulating body temperature. FD is more likely to affect Jewish people (Ashkenazi Jewish heritage) of Eastern European heritage.
Multiple system atrophy (MSA): A life-threatening form of dysautonomia, multiple system atrophy develops in people over 40 years old. It can lead to heart rate issues, low blood pressure, erectile dysfunction and loss of bladder control.
Pure autonomic failure: People with this form of dysautonomia experience a fall in blood pressure upon standing and have symptoms including dizziness, fainting, visual problems, chest pain and tiredness. Symptoms are sometimes relieved by lying down or sitting.

Symptoms

There are many symptoms of dysautonomia. Symptoms vary from patient to patient. Symptoms can be present some of the time, go away, and return at any time. Some symptoms may appear at a time of physical or emotional stress or can appear when you are perfectly calm. Some symptoms may be mild in some patients; in others, they may interfere constantly with daily life.

A common sign of dysautonomia is orthostatic intolerance, which means you can’t stand up for long, without feeling faint or dizzy. Other signs and symptoms of dysautonomia you may experience include:

Symptoms of Dysautonomia

Balance problems	Noise/light sensitivity	Shortness of breath
Chest pain/discomfort	Dizziness, lightheadedness, vertigo	Swings in body and skin temperature
Ongoing tiredness	Visual disturbances (blurred vision)	Difficulty swallowing
Nausea and vomiting, GI problems (constipation)	Fast or slow heart rate, heart palpitations	Brain “fog”/ forgetfulness/can’t focus
Large swings in heart rate and blood pressure	Weakness	Mood swings
Fainting, loss of consciousness	Sweat less than normal or not at all	Sleeping problems
Migraines or frequent headaches	Dehydration	Frequent urination, incontinence
Erectile dysfunction	Low blood sugar	Exercise intolerance (heart rate doesn’t adjust to changes in activity level)

Certain conditions and events can bring on the symptoms of dysautonomia. These triggers include:

Alcohol consumption.
Dehydration.
Stress.
Tight clothing.
Hot environments.

Causes

Dysautonomia happens when the nerves in your ANS don’t communicate as they should. When your ANS doesn’t send messages or receive messages as it should or the message isn’t clear, you experience a variety of symptoms and medical conditions.

Dysautonomia can affect ANS functions including:

Blood pressure.
Breathing.
Digestion.
Heart rate.
Kidney function.
Pupil dilation and constriction in the eyes.
Sexual function.
Body and skin temperature control.

Diagnostics

One of the tests your healthcare provider will use to diagnose some forms of dysautonomia is a tilt table test.

During this test:

You lie on a table that can lift and lower at different angles. It has supports for your feet.
You are connected to medical equipment that measures your blood pressure, oxygen levels and heart’s electrical activity.
When the table tilts upward, the machines measure how your body regulates ANS functions like blood pressure and heart rate.

Other tests your healthcare provider may use to aid in the diagnosis include sweating tests, breathing tests, lab (blood work) tests, and heart workup (electrocardiography). Other tests may be done to determine if other diseases or conditions are causing dysautonomia.

Complications

The complications of dysautonomia vary depending on the symptoms you experience. In severe cases, people might have life-threatening complications such as pneumonia and respiratory failure.

Dysautonomia can also cause:

Abnormal heart rate (too fast, too slow or irregular).
Fainting.
Breathing trouble.
Digestive problems.
Visual problems, such as blurred vision.

Treatment

There’s no cure for this condition, but you can manage the symptoms. Your healthcare provider may suggest many different therapies to manage your particular dysautonomia symptoms.

The more common treatments include:

Drinking more water every day. Ask your healthcare provider how much you should drink. Additional fluids keep your blood volume up, which helps your symptoms.
Adding extra salt (3 to 5 grams/day) to your diet. Salt helps your body keep a normal fluid volume in your blood vessels, which helps maintain a normal blood pressure.
Sleeping with your head raised in your bed (about 6 to 10 inches higher than your body).
Taking medicines such as fludrocortisone and midodrine to increase your blood pressure.