Why is Sleep So Important for POTS? (& tips for improving sleep in POTS)

Sleep resets the nervous system- and POTS is an autonomic nervous disorder. Sleep is the time the body has to rest & repair itself. When we get poor sleep, our body has less time to repair & rest. Our nervous system has less time to reset.

Personally, lack of sleep is the biggest trigger for my POTS symptoms, followed closely by dehydration. Even if I take all of my medications and hydrate, if I slept poorly I generally feel poorer than usual.

Unfortunately, quality sleep can be difficult for those with autonomic disorders, POTS included.

Studies have shown that those with POTS sometimes spend less time in REM sleep. They may have a harder time falling asleep, staying asleep, or may wake up feeling unrefreshed.

If you are having trouble sleeping with POTS, talk to your doctor.

Sleep hygiene and bedtime routines are often the first line of treatment. The more clues you can give to your body and nervous system that it is time to rest, the better.

My personal tips for improving sleep in POTS:

– Take melatonin 2 hours before desired sleep time

– If adrenaline surge, lay with ice pack on chest

– No screens for 1 hour before bed

– Drink tea or do something calming before bed

– Listen to sleep story or guided meditation while falling asleep

– Ensure bedroom temperature is cool

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health pots

How is POTS Diagnosed?

POTS stands for Postural Orthostatic Tachycardia Syndrome.

The diagnoses evades many patients for several years, but it is relatively simple.

This diagnostic criteria comes straight from Dysautonomia International:

Diagnostic Criteria
The current diagnostic criteria for POTS is a heart rate increase of 30 beats per minute (bpm) or more, or over 120 bpm, within the first 10 minutes of standing, in the absence of orthostatic hypotension.1,2,3,4 In children and adolescents, a revised standard of a 40 bpm or more increase has recently been adopted.4,5 POTS is often diagnosed by a Tilt Table Test, but if such testing is not available, POTS can be diagnosed with bedside measurements of heart rate and blood pressure taken in the supine (laying down) and standing up position at 2, 5 and 10 minute intervals. Doctors may perform more detailed tests to evaluate the autonomic nervous system in POTS patients, such as Quantitative Sudomotor Axon Reflex Test (QSART, sometimes called Q-Sweat), Thermoregulatory Sweat Test (TST), skin biopsies looking at the small fiber nerves, gastric motility studies and more.

Can I Diagnose Myself With POTS?

You can certainly perform the “poor man’s tilt table test” described above, to see if your heart rate increases 30 BPM or more, and take this information with you to your doctor.

Lay down for 5 minutes. Take your HR. Stand up, immediately take your HR. Stay standing and take your HR at 2, 5, and 10 minute intervals. Do not move around or talk during this process.

1. Postural Tachycardia Syndrome. Blair P. Grubb, Circulation. 2008; 117: 2814-2817.

2. National Institute of Health, Neurological Institute of Neurological Disorders and Stroke, Postural Tachycardia Syndrome Information Page.

3. The Postural Tachycardia Syndrome (POTS): Pathophysiology, Diagnosis & Management. Satish R Raj, MD MSCI, Indian Pacing Electrophysiol J. 2006 April-Jun; 6(2): 84-99.

4. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Autonomic Neuroscience: Basic and Clinical 161 (2011) 46-48.

5. Postural tachycardia in children and adolescents: what is abnormal? Singer W, Sletten DM, Opfer-Gehrking TL, Brands CK, Fischer PR, Low PA, J Pediatr. 2012 Feb;160(2):222-6. Epub 2011 Oct 11.

diabetes health pots

Salt/ Sugar Sisters

It all started sitting on her floor. She had a needle in her arm, injecting insulin. I held a pill box with 8 pills in it for the day. I tossed the pills into my mouth, washed them down with water, and got up to continue my morning routine. She laughed, “we’re just a bunch of druggies”. I’d never noticed before, because this was just my normal. But it’s true.

Chelsea has type 1 diabetes. I have POTS. We are both dependent upon medication and lifestyle changes to live “normal” lives. But we both live “normal” lives (if you can even call any life normal). Chelsea is dependent upon insulin and glucose. I’m dependent upon a variety of medications, extra water, and salt. We joke that we’re both dependent upon white powders (sugar and salt), which is in some sense true.

If we don’t exercise, we feel crappy. If we don’t sleep enough we feel worse. If we don’t eat right… you get the picture. Self care is a non-negotiable for both of us. In 2016, when most millennials are running at light speed to achieve, socialize and have it all, this can be a hard thing to prioritize. But when it’s what you do to survive, you make it work.

I realized during this time on her floor that Chelsea and I are bonded by a dependence on something outside of ourselves. Other people could go without drinking water or eating sugar. Not Chelsea and I. How does this simple fact change the way that we view the world and live our lives?

  1. We cherish our time on this earth and every day we’re given. We know that it could be gone at any moment, and don’t take anything for granted. Likewise, we value this earth as itself a miracle, nature as sacred and something to cherish and protect *cough* recycle and compost *cough*.
  2. We value people. As autonomous cell-machines that contain the miracle of life, people are just that – a miracle. Every one is different. Every single person has value. Every single person has interests, passions, fears, trials, and victories. Chelsea and I love fiercely and yearn for everyone to see their value and worth, know themselves at their core and express themselves. How does this manifest for us? For Chelsea, this manifests through empathy and dance therapy. For me, through connected, heart conversations and photography.
  3. We don’t sweat the little things. If Chelsea doesn’t take care of her blood sugar or I don’t drink water, we could have (and have both experienced) a medical crisis on our hands. Since we’ve been through these things and made it out on the other side, life’s stresses: the unexpected curveballs and all, don’t really phase us. We’re not superhuman- we still feel the emotions associated with a break up or an apartment lease falling through, but we are able to put those things in perspective.

Is it a coincidence that both Chelsea and I are artists? That we love reading books by Brene Brown, talking about empathy and vulnerability, and loving fiercely? Perhaps. Or perhaps experiencing the fact that we are mortal- that this life is not guaranteed- puts us in a less risk averse position than our peers. We’ve lived a bit more life than your average 23-year olds, so we’re determined to live our lives how our hearts and souls guide us to, not how society prescribes.