If you’ve ever pulled an all-nighter, gone through a particularly stressful and hectic time in your life, or perhaps indulged in a few too many drinks the night before, chances are, at some point or another, you’re familiar with what it feels like to have intense brain fog and some serious fatigue. But what happens when this brain fog and fatigue seem to stick around – no matter how much rest you get or how well you take care of yourself?

This is the unfortunate, frustrating, and oftentimes debilitating reality for a number of people who have a complex condition known as postural orthostatic tachycardia syndrome. For some individuals, these perplexing symptoms associated with this even more perplexing disorder can be relentless – persisting even when other symptoms are kept at bay through treatment strategies.

Today we’re going to explore exactly what postural orthostatic tachycardia syndrome is, how this condition causes such intense fatigue and cognitive deficits, some tried-and-true treatment options, and a couple of surprising newer treatments. Let’s dive in.

What Is Postural Orthostatic Tachycardia Syndrome (POTS)?

Postural orthostatic tachycardia syndrome, or POTS, is a disorder that impacts your blood circulation and heart rate. Normally, your body is designed to maintain your blood flow and heart rate at a pretty steady and even state regardless of what position you’re in – whether sitting, standing, laying down, or even hanging upside down.

This ability to regulate blood flow and maintain a healthy amount of blood flowing throughout your entire body is controlled by your nervous system. For example, when you go from laying down to standing up, your nervous system fires off instantaneous signals – telling your blood vessels to narrow and your heart rate to quicken slightly in order to maintain adequate blood flow from your head to your toes.  

But in the case of postural orthostatic tachycardia syndrome, your nervous system has a tough time coordinating this delicate balance. Because POTS is actually a dysfunction of your nervous system it’s classified as a type of dysautonomia – a blanket term that describes the dysfunction of the nerves that control involuntary body functions.¹ And unfortunately, this dysfunction can lead to some serious life-altering and frightening symptoms.

Postural Orthostatic Tachycardia Syndrome (POTS) Symptoms

In POTS, your nervous system doesn’t correctly signal your circulatory system to maintain a stable blood pressure and heart rate to offset the natural effects gravity has on your body as you change positions. Because of this inability to properly regulate blood flow, when you stand up, gravity naturally pulls a larger volume of your blood into the lower half of your body. This leads to significant fluctuations in the blood supply to your brain and heart as you change positions. 

To compensate for the sudden, unexpected drop in blood flow when you stand up or change positions, your body rapidly releases the hormones epinephrine and norepinephrine to narrow your blood vessels and quickly speed up your heart rate. This combination of a drop in blood pressure, a rapid heart rate, and the release of blood vessel-narrowing hormones is what causes the unsettling symptoms experienced in POTS, including:^2,3

• Persistent and severe fatigue
• Lightheadedness 
• Fainting or near-fainting
• Intense brain fog and difficulty concentrating
• Racing and/or pounding heartbeat
• Heart palpitations (feeling of your heart skipping a beat)
• Chest pain or tightness
• Headaches
• Nausea and/or vomiting
• Digestive issues (like diarrhea and/or constipation)
• Excessive sweating and difficulty regulating temperature
• Feeling nervous and jittery
• Difficulty tolerating exercise or increased activity
• Blurred vision 
• Difficulty sleeping
• Discoloration of hands and feet 
• Digestive issues (like diarrhea and/or constipation)

While all of these symptoms can be highly unsettling and incredibly disruptive to your daily life, there is one subset of symptoms that can be particularly challenging to cope with – the extreme fatigue and intense cognitive clouding that often comes with POTS. Let’s zoom in a little closer on these specific POTS symptoms.

POTS: A Little Known Cause of Fatigue and Cognitive Dysfunction

Many individuals that grapple with POTS report that the most debilitating and frustrating symptoms are the unrelenting fatigue and significant cognitive dysfunction they experience – with many POTS patients reporting:⁴ 

• Difficulty concentrating (especially for long periods of time)
• Intense brain fog
• Slower cognitive processing time
• Difficulty learning and retaining new information
• Trouble with finding the right words
• Memory impairment
• Extreme and persistent feelings of exhaustion regardless of adequate sleep and rest

For many, these symptoms can significantly interfere with day-to-day life – making it difficult to participate in work or school and making it an uphill battle to complete even simple daily tasks. So how exactly does a condition like POTS have such a dramatic impact on your energy levels and your cognitive abilities?

What Causes Extreme Fatigue and Brain Fog In Postural Orthostatic Tachycardia Syndrome (POTS)?

While the exact underlying mechanisms triggering the intense fatigue and cognitive dysfunction seen in POTS are not totally clear, it’s speculated that it may be attributed to a combination of factors including:

• Impaired blood flow: In some cases, POTS can disrupt the flow of blood to the brain – limiting your brain's access to the nutrient and oxygen-rich blood it relies on to function properly.
• Altered neurotransmitter levels: Neurotransmitters are microscopic signaling molecules your brain cells use to communicate amongst themselves and with the rest of your body. In POTS, there can be abnormalities in how your brain secretes, transports, and responds to crucial neurotransmitters like norepinephrine and corticotropin-releasing hormone.
• Kindling: POTS is often the final pathway or end result of other underlying triggers that lead to the nervous system imbalance causing dysautonomia. It’s thought that the symptoms seen in POTS may, at least in part, be traced back to hypersensitive neurons or nerve cells in your brain. In the concept known as kindling, it’s believed that underlying triggers (like viral infections, hormonal imbalances, or trauma) overstimulate your neurons. This creates a mental state in which the mind is constantly stimulated – leading to fatigue and cognitive impairment. 

So how can we address the underlying factors that contribute to the debilitating symptoms seen in POTS – both physically and mentally?

How Is Postural Orthostatic Tachycardia Syndrome (POTS) Treated?

Treating POTS requires a multi-faceted approach that often includes things like:^6,7,8

• Addressing underlying contributing factors: POTS is a complex diagnosis that oftentimes can be traced back, at least in part, to other underlying factors like a hidden infection, Lyme disease, autoimmune disorders, or even mast cell activation syndrome. So working with an experienced Integrative and Functional Medicine Doctor to help identify and address any underlying issues can be a pivotal piece of the puzzle when it comes to treating POTS.
• Increased hydration: Hydration is key to keeping blood volume consistent which can minimize fluctuations in blood pressure.
• Increased sodium intake: Water follows salt – so oftentimes it can be helpful to up your intake of sodium to keep blood volume consistent.
• Good sleep hygiene: Sleep deprivation and irregular sleep patterns can alter your hormones and neurotransmitters, stress your body, and significantly exacerbate symptoms. So prioritizing quality sleep is essential when it comes to managing POTS.
• Elevating the head of the bed and wearing compression stockings: Elevating the head of your bed while sleeping and wearing compression stockings during the day when you're up and moving can help counteract the effects of gravity to keep your blood flow more balanced to minimize symptoms.
• Exercise: Intentional and strategic exercise regimens can help regulate your blood flow and heart rate while strengthening your muscles which can help more effectively pump blood throughout your body.
• Medications: In some cases, doctors may prescribe medications that can help manage blood flow – like a beta blocker to slow your heart rate or midodrine to narrow your blood vessels.

These steps go a long way in helping manage the symptoms associated with POTS. But unfortunately, for some people struggling with POTS, these treatment strategies simply don’t help when it comes to their persistent fatigue and cognitive dysfunction. So what other options are there when it comes to addressing these debilitating and stubborn symptoms?

Medications May Help Manage Fatigue and Cognitive Effects In Postural Orthostatic Tachycardia Syndrome (POTS) 

Research is finding that the answer to addressing the persistent and stubborn fatigue and cognitive effects seen in POTS may lay in a class of medications typically associated with the treatment of a completely separate condition – attention deficit disorder. It’s been found that the following medicines can significantly improve the brain fog and fatigue in those struggling with POTS:^9,10

• Methylphenidate: A central nervous system stimulant also commonly sold under the names Ritalin and Concerta
• Mixed amphetamine salts plus their derivatives: This class of medications also act as central nervous system stimulants by blocking the reuptake of the neurotransmitters norepinephrine and dopamine 
• Atomoxetine: This medication is not classified as a stimulant, but works by inhibiting the reuptake of the neurotransmitter norepinephrine
• Modafinil and armodafinil monoaminergic: These medications are known as wakefulness-promoting agents and work by impacting a number of various brain-related systems and signaling molecules such as catecholamines, serotonin, glutamate, gamma amino-butyric acid, orexin, and histamine

While these medications influence blood flow and neurotransmitters, the exact mechanism of action behind how these medications combat the cognitive symptoms seen in POTS is not entirely clear. And while long-term use of medications may not always be the ideal answer, sometimes they can be a key component of treatment. 

More time and research are needed to truly understand the role of these medications in POTS treatment, but for now, the use of these medications can potentially offer significant relief and lift the haze of fatigue and brain fog that can dramatically hinder your ability to function. 

Are You Struggling With Persistent Fatigue and Brain Fog Related to POTS?

If you’re grappling with ongoing fatigue and brain fog after a POTS diagnosis or if you’re struggling with unexplained symptoms that don’t seem to go away, I cannot overemphasize the importance of working with an Integrative and Functional Medicine Practitioner. Oftentimes, with complex conditions, there’s much more going on beneath the surface than it might seem. Working with a practitioner that has the knowledge and tools to dig deep to identify and address these underlying contributing factors can have a monumental impact on your ability to manage symptoms and begin healing the underlying root causes of any imbalances. 

Addressing complex conditions always requires a big-picture, whole-life approach. So if you enjoyed this article and are looking for more ways to prioritize your well-being, I encourage you to check out the hundreds of resources I have available on my blog, my YouTube channel, and via my exclusive weekly newsletter (you can sign up by entering your name and email address in the form at the bottom of this page).

Dr. Jill Health® – MCAS Bundle MCAS treatment involves identifying and avoiding triggers that exacerbate symptoms and here is what I recommend to help support and stabilize mast cells to manage symptoms.

While taking care of your physical body is obviously non-negotiable when it comes to addressing POTS or any other diagnosis, the truth is, we simply can’t neglect the way they impact us mentally, emotionally, and spiritually as well. So if you’re in the trenches and dealing with frustrating, debilitating, and confusing symptoms and need a little reminder that you’re not alone and there is light at the end of the tunnel, I encourage you to order a copy of my upcoming book Unexpected: Finding Resilience Through Functional Medicine, Science, and Faith.

I poured my heart and soul into this book and dive deep into my own health challenges and hard-learned life lessons. Sometimes all we need is someone that’s just a little further along in this journey to show us that we’re not alone and that we have the power to continue overcoming. And my hopes in writing this book are exactly that – to offer hope, connection, and inspiration as well as some practical insight into creating the vibrant health and happiness we all deserve.  Click here to learn more about my upcoming book and get your exclusive bonuses when you order today!

Has there ever been a time in your life when you’ve felt alone or unsure where to turn for answers?

In Unexpected: Finding Resilience through Functional Medicine, Science, and Faith, Dr. Jill Carnahan shares her story of facing life-altering illness, fighting for her health, and overcoming sickness using both science and faith so that others can learn to live their own transformative stories.

Dr. Jill’s riveting and compassionate exploration of healing through functional medicine demonstrates how to replace darkness and fear with hope and find profound healing, unconditional love, and unexpected miracles in the process.

Resources:

1. Postural Orthostatic Tachycardia Syndrome (POTS) | Johns Hopkins Medicine
2. Postural orthostatic tachycardia syndrome | Genetic and Rare Diseases Information Center (GARD) – an NCATS Program (nih.gov)
3. POTS: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
4. Cognitive Dysfunction Management – Dysautonomia Support Network
5. Frontiers | Cognitive impairments associated with CFS and POTS (frontiersin.org)
6. Postural tachycardia syndrome (PoTS) – NHS (www.nhs.uk)
7. POTS: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
8. Postural Tachycardia Syndrome (POTS) Diagnosis and Treatment: Basics and New Developments – American College of Cardiology (acc.org)
9. Therapy for fatigue and cognitive dysfunction in postural orthostatic tachycardia syndrome – ProQuest
10. Cognitive Dysfunction Management – Dysautonomia Support Network