Important Lifestyle Changes: General Advice

Postural Tachycardia Syndrome (PoTS) can be very debilitating. Fortunately, there are many adjustments to lifestyle that can lead to an improvement in symptoms. It’s hard work, but can make a real difference!

Management for PoTS falls into two different categories:  

• Non-pharmacological (without medicines) 
• Pharmacological (using medicines) 

Management needs to be individualised, with non-pharmacological therapies being the  foundation of any PoTS treatments. In milder cases of PoTS, these therapies might be enough to control symptoms, and might be all that is needed. Read more about self management here.

Input from other health professionals may be needed and might include specialist nurses, psychologists, dieticians, occupational therapists and physiotherapists or exercise physiologists. Throughout the United Kingdom, availability of these services varies from area to area and may not be available locally to all patients. Information on Cognitive Behavioural Therapy can be found here.

PoTS can have an impact on  physical, social and psychological aspects of life. Because symptoms can fluctuate wildly from one day to the next, it can make management a challenge.  

Factors which may make PoTS symptoms worse:

• Time of day – symptoms tend to be worse in the morning, particularly after getting out of bed after waking up. – Read about sleep here.
• Rapidly moving from lying or/ sitting to a standing position.
• Dehydration – Read about diet and fluids here.
• Environmental heat – Read about temperature regulation here.
• Alcohol which causes the blood vessels to widen, therefore lowering blood pressure.
• Exercise or physical exertion. (It is important to note that whilst exertion can exacerbate symptoms, an ongoing exercise program can improve symptoms, and is often recommended by specialists.) – Read about PoTS and exercise here.
• Menstrual periods
• Prolonged bed rest or deconditioning (becoming unfit)
• Prolonged standing (or sitting)
• Stimulants such as tea, coffee, alcohol and nicotine.
• Large heavy meals high in refined carbohydrates such as sugar and white flour.

Daily management of symptoms  

• Pace yourself throughout the day. Take your time and avoid rushing.
• Goals – be realistic and ensure that they are achievable.
• Planning – if there is something more challenging you need to do on a particular day, plan your activity, rest well beforehand and create time to recover afterwards.
• Limits – learn to know and live within your limits.
• Avoid stress – the autonomic nervous system is the body’s fight/flight mechanism and is activated during periods of stress. PoTS sufferers tend to be very sensitive to physical and psychological stressors.
• Infections and other illnesses can worsen symptoms – rest and accept a reduction in activity levels if you become unwell. You may take longer than expected to recover.
• Mobility aids – although keeping as mobile as possible is very important, for those with severe symptoms, the use of a wheelchair or mobility scooter may be helpful to manage daily living.
• Eat and drink regularly – symptoms are often exacerbated on busy days when routine eating and drinking patterns change; make sure you keep to your routine with diet and fluids.

Currently no available medical evidence. Based on patient or expert experience and opinion.

Thank you to Ruby Usiskin for producing the image. Subject to copyright by PoTS UK.