Hypermobility series 1 - why am I always feeling dizzy?

If you have hypermobility and often feel dizzy or lightheaded, you may have dysautonomia, a condition that affects your ability to regulate heart rate and/or blood pressure adequately when you move into upright positions. The most common form of dysautonomia in hypermobile people is known as Postural Orthostatic Tachycardia Syndrome (POTS), where one’s heart rate increases excessively with change in position (usually from lying to upright or from sitting to standing). The blood pressure may drop a little but it often stays stable. Symptoms can range from feeling light-headed to almost fainting, low exercise tolerance, nausea, breathlessness and if severe, can adversely impact one’s quality of life.

There are some common clinical tests for POTS to confirm this condition. A tilt table test (where they monitor your heart rate and blood pressure as they gradually tilt you head up) must be done in a specialist setting and will require a medical referral from your doctor or specialist. In a clinic setting, your healthcare provider can perform a simplified version of the test by checking your heart rate and blood pressure when you change positions and at a few fixed time intervals. Once confirmed, your doctors and healthcare provider will try to help work out some of the potential contributing factors and come up with a plan to manage this.

Each person is unique and may have different triggers to their POTS, so the following advice is for general informational purposes only and is not intended to replace professional medical advice. We recommend that you seek the advice of your doctor or healthcare provider before starting any new healthcare regimen including those presented here. Some of the common contributing factors and helpful mitigation strategies to consider are:

1. Low blood volume: this can be helped by increasing your fluid intake (aiming for 2-3L a day) and upping salt intake (aiming for 3000 to 10000mg a day). It can be difficult to add more salt to your diet, so having electrolyte drinks can boost your intake without having a very salty diet.

2. Blood pooling in legs and reduced blood return: changing positions slowly, wearing compression garments (especially abdominal and thigh) and lower leg exercises (consider starting in lying down positions) that increase the flow of blood back up.

3. Heat: hot environments (e.g., summer weather, hot showers) can cause your blood pressure to drop, so being aware of the temperature and modifying your activities (e.g., exercise in an air-conditioned room and not having hot showers) is another way of prevention.

4. Meals with a lot of carbohydrates or sugar: large amounts of carbohydrates or sugar in one meal can similarly cause a drop in blood pressure, so having a balanced diet or having smaller meals at more frequent time intervals can help avoid the “carb crash”.

5. Fatigue, stress and anxiety: stress causes the “fight or flight” response which increases heart rate, so finding ways to recognise your triggers for stress and anxiety and having coping strategies (such as using abdominal breathing, sleeping with weighted blankets, having good sleep hygiene) allows you to regain control over your triggers.

6. Medication: some medication can help with controlling your heart rate and blood volume, and this is one area that you should discuss with your doctor if your symptoms are not helped with the non-medication strategies.

7. Exercise: exercise needs to be performed with caution and be tailored to your triggers, and this is an area that we will discuss in more detail at another time!

We hope this post has provided some understanding POTS in hypermobility, if you have any concerns or questions, do seek out your health professional promptly.

Keep your eye out for our next posts where we will look into exercises to help with POTS!