Skip to main content

If you don't feel well when upright: manage & check for POTS

Many folks, including those recovering from Covid, report that their symptoms get worse when sitting or standing. They may be experiencing a phenomenon called Orthostatic Intolerance, or OI.

Sometimes, OI is caused by Postural Orthostatic Tachycardia Syndrome, also known as POTS. There are other related conditions, such as OCHOS. I'll post more about these syndromes soon.

In the meantime, you can use these guidelines to help determine if you have OI -- and possibly to get some degree of relief.

How to manage & check for POTS syndrome

There are some practical things you can do to manage POTS and orthostatic syndromes. In a nutshell, you need to encourage increased bloodflow to your upper body and brain.

Everyone's a little different. "Trial-and-error" may be the best way to identify which ones work best for you.

Check with your doctor before making any major changes.

1. Increase fluid and salt intake

Increase fluid and salt intake to increase blood volume, ensuring that plenty of blood (with oxygen and nutrients) can travel up to your head.

Be sure to get 2 liters of water and consume 3 to 5 grams of salt per day. It's easy when you use electrolyte drink mixes or salt supplement pills. I like SaltStick Vitassium the best.

You need BOTH water and salt to increase blood volume.

2. Try compression garments

When you're upright, gravity pulls blood down. This can cause blood to pool in your lower body.

Compression socks, hose or abdominal binders can be helpful because they reduce the amount of blood that pools.

  • There are different levels of compression. Try starting with 30 mm Hg of counter pressure. Be sure to follow vendor's measuring instructions carefully to get the right size.
  • Some might be covered by insurance if you can get a doctor's prescription. In my case I did some research and bought some good ones online.
  • Some brands are more comfortable and breathable than others, so don't give up on compression stockings simply because the first pair you try are not comfortable.
  • Getting a professional fitting at a medical supply store may help, and you may even be allowed to try on a few pairs before purchasing them. Or, buy online from a vendor that allows free returns.
  • There are many varieties (closed toe, open toe, knee high, waist high, etc.) that you can choose from.

Personally, I found the waist-high compression hose to be awkward. So I decided to get creative.

Through trial-and-error I now use over-the-knee socks, plus I wear snug bicycle shorts for compression around my thighs. I wear them at the same time to maximize effectiveness and comfort.

Some people find added benefit from torso compression with abdominal binders. (I personally did not, but they might be worth a try.)

3. Use physical counter-maneuvers

To keep blood moving through your body, you can do easy little counter-maneuvers throughout the day -- especially when you're sitting or standing for a period of time.

These don't cure you from POTS, but they can reduce or slow-down onset of symptoms.

When sitting:

  • Try tensing, flexing and squeezing your feet, leg and gluteus maximus muscles.
  • Get up and move around periodically throughout the day to keep the blood flowing.
  • If you need to be at a desk or computer for awhile, consider using a recliner if possible.

When standing:

  • Avoid prolonged standing as this can cause POTS symptoms to get worse.
  • Try tensing, flexing and squeezing your feet, leg and gluteus maximus muscles.
  • Try shifting your weight from one foot to the other.
  • The more you can move your lower half while standing, the better your blood will pump back to your heart and beyond.
  • In any case if you're feeling faint or dizzy, sit or lay down.

More resources:

4. Plan your day well

  • It can be helpful to drink a large glass of water or other hydrating fluid before you get up in the morning.
  • When standing up, go slow.
  • Plan activities to work-around your symptoms; for many POTS patients, the morning is particularly difficult.
  • POTS may require you to reduce your work load, get more sleep, or rearrange your schedule.
  • Build-in flexibility into your schedule as much as possible, since symptoms can flare-up without much warning.

5. Identify your triggers

POTS symptoms can be exacerbated by a variety of situations and activities. It's helpful to identify what these things are. You may need to pay close attention and listen to your body to find them out.

Examples of things to look for:

  • Too much sun
  • Too much food
  • Too much exertion
  • Certain medications
  • Certain types of food
  • Temperature

6. Maintain an even temperature

Air conditioning, body cooling vests, sun shirts, handheld misters/personal fans, hats, layers in case of temperature fluctuation, and quick drying clothing and sheets can all be helpful in maintaining an even temperature.

It's important to maintain an even temperature as extremes, particularly heat, can exacerbate symptoms.

Some patients use an old fashioned bag of frozen peas as an ice pack during extreme heat. The peas mold to the body, and can be used and re-frozen over and over again.

Learn more about temperature regulation at POTS UK.

7. Eat smaller meals (postprandial blood)

After eating a large meal, much of our blood is redirected to aid in the digestion process, which, for POTS patients, can increase symptoms. Try eating several smaller meals throughout the day instead of two or three large ones.

8. Avoid Alcohol

Alcohol can worsen symptoms for POTS patients. Alcohol is dehydrating and can lead to increased hypotension through dilation of the veins and thus should be avoided by most POTS patients.

9. Examine your reactions to dairy, gluten, sugar and caffeine

Even if you don't have lactose intolerance or celiac disease. Even if you don't have allergies. Even if you've tolerated these items well in the past, it's possible to develop transient sensitivities to them.

Try cutting these items from your diet for a few days.

Some POTS patients report feeling less symptomatic consuming fewer or none of these items.

10. Lower Carbs/Lean Protein

Patient who notice a worsening of symptoms after eating may want to try consuming fewer simple carbohydrates (like refined sugars and flours) and consuming healthy protein with each meal (such as skinned chicken breasts, salmon, skim milk or low fat yogurt).

11. Consider other overlapping syndromes

It might be wise to be evaluated for Mast Cell Activation Syndrome, histamine intolerance, sleep apnea and other potential things that might make POTS symptoms worse.

12. Elevate Head During Sleep

Some people report improvements by slightly elevating the head during sleep. This can help recondition the body to orthostatic stress, and can help with acid reflux or GERD.

The best way to do this is to raise the head of the bed with a few bricks or large books.

Elevating the whole body and having the feet be lower than the hip area is needed to get the intended benefit. A wedge pillow is not recommended because it only elevates the shoulders and head, but does nothing to change the position of the hips or the lower legs.

13. Exercise

POTS patients may find it difficult to do normal aerobic exercise. It's recommended to do simple stretches each day.

Once you have a little more energy, you may benefit from reclined aerobic exercise, such as swimming, rowing or recumbent bicycling.

But don't overdo it! If you also have Chronic Fatigue Syndrome, too much exercise can make you feel worse hours or days afterward. Learn more about Post Exertional Malaise.

As you improve, strengthening of the abdomen and legs have been found to be beneficial, as they improve the vascular tone and improve POTS symptoms. I've experienced this myself!

14. Showering

A shower chair can be helpful for some people. It may be helpful to use lukewarm water, since hot or cold water can trigger POTS symptoms.

Some patients also find it better to shower just before bed, since showering can leave them very tired.

Another technique is to avoid putting your hands above your head to wash your hair, by bending forwards and flipping your head upside down in the shower, as if you were washing your hair in the sink.

15. Have a "Go Bag"

Keep a bag or knapsack with all of the items you're likely to need when leaving the house. Be sure to include water, salt supplements (or salty snack), your medications, handheld fan, etc.

16. Take the active stand test at home

There's a self-test that might help you know if you have POTS, but it's not foolproof.

Measure heart rate and blood pressure after resting lying down, then immediately upon standing and after 2, 5 and 10 minutes.

Be careful; this test may bring on symptoms of POTS and some people may feel unwell or faint.

17. Other treatments

There are other treatments too, including prescription medications.

Find a doctor that can treat POTS. They can be very difficult to find.

The doctor may prescribe medications, or they may order a "tilt table test" to determine if you have clinical POTS.

More resources