“My heart races when I stand up.”

“I’m always too hot or too cold.”

“I feel exhausted after taking a shower.”

“Doctors keep telling me my tests are normal, but I feel terrible.”

If these statements sound familiar, you may have encountered dysautonomia—a common but often misunderstood condition that frequently occurs alongside hypermobility and Ehlers-Danlos Syndrome (EDS).

What Is Dysautonomia?

Dysautonomia is an umbrella term for disorders that affect the autonomic nervous system (ANS). The autonomic nervous system controls all the things your body does automatically, without you having to think about them.

These include:

• Heart rate
• Blood pressure
• Breathing
• Digestion
• Body temperature regulation
• Sweating
• Bladder function
• Pupil dilation
• Sleep-wake cycles

Think of the autonomic nervous system as your body’s automatic operating system. When it functions properly, your body adjusts seamlessly to changes in position, temperature, stress, activity, and rest.

With dysautonomia, those automatic adjustments become inefficient, delayed, or excessive. (Cleveland Clinic)

Why Does Dysautonomia Happen?

There is no single cause of dysautonomia.

It may develop after:

• Viral infections
• Autoimmune conditions
• Concussions or trauma
• Surgery
• Pregnancy
• Genetic connective tissue disorders such as Ehlers-Danlos Syndrome
• Diabetes and other neurological diseases

Researchers continue to investigate the exact mechanisms, but many people with hypermobility disorders appear to have autonomic nervous systems that struggle to regulate blood flow, heart rate, and other automatic functions efficiently. (Dysautonomia International)

Common Symptoms of Dysautonomia

Symptoms can vary widely from person to person.

Common complaints include:

• Rapid heart rate
• Dizziness or lightheadedness
• Fainting or near-fainting
• Exercise intolerance
• Chronic fatigue
• Brain fog
• Temperature intolerance
• Excessive sweating or inability to sweat
• Digestive issues
• Nausea
• Shortness of breath
• Sleep disturbances
• Anxiety-like symptoms

Many people describe feeling as though their body is constantly working harder than it should. (The Ehlers Danlos Society)

Types of Dysautonomia

Postural Orthostatic Tachycardia Syndrome (POTS)

POTS is one of the most recognized forms of dysautonomia.

When a person stands up, their heart rate rises excessively in an attempt to maintain blood flow to the brain. Symptoms often include dizziness, palpitations, fatigue, brain fog, and exercise intolerance. (Dysautonomia International)

Neurocardiogenic Syncope (Vasovagal Syncope)

This is the most common cause of fainting. Blood pressure and heart rate suddenly drop, leading to loss of consciousness or near-fainting episodes. (Dysautonomia International)

Orthostatic Hypotension

Blood pressure drops significantly upon standing, causing dizziness, weakness, and sometimes fainting. (PubMed Central)

Inappropriate Sinus Tachycardia (IST)

Individuals experience an unusually fast heart rate even at rest or with minimal activity. (Dysautonomia International)

Other Forms

Less common forms include:

• Pure Autonomic Failure
• Multiple System Atrophy
• Autoimmune Autonomic Ganglionopathy
• Familial Dysautonomia

There are at least 15 recognized forms of dysautonomia. (The Dysautonomia Project)

The Hypermobility Connection

This is where things become especially important for massage therapists and bodyworkers.

Many people with hypermobile Ehlers-Danlos Syndrome (hEDS) or Hypermobility Spectrum Disorder (HSD) also experience dysautonomia. The Ehlers-Danlos Society notes that dysautonomia is common among people with EDS and HSD. (The Ehlers Danlos Society)

Research suggests:

• Approximately two-thirds of people with hypermobile EDS experience orthostatic intolerance.
• Among those individuals, approximately 41–49% have POTS.
• Dysautonomia is considered highly prevalent in people with hEDS and HSD. (PubMed Central)

Why?

One theory is that connective tissue abnormalities affect the blood vessels themselves. Blood vessels rely on connective tissue for support. When vessels become more compliant or “stretchy,” blood may pool in the legs and lower body when standing, forcing the heart to work harder to maintain circulation to the brain.

This may help explain why so many hypermobile individuals report:

• Racing heart
• Dizziness
• Heat intolerance
• Fatigue
• Exercise intolerance
• Brain fog

The overlap is so common that many clinicians now routinely screen hypermobile patients for autonomic dysfunction. (PubMed Central)

Managing Dysautonomia

Management is highly individualized and should always be guided by a healthcare provider.

Strategies commonly recommended include:

Hydration

Increasing fluid intake can help support blood volume.

Electrolytes

Many individuals benefit from increasing sodium and electrolyte intake under medical guidance.

Compression Garments

Compression socks or abdominal compression may reduce blood pooling.

Gradual Exercise

Recumbent biking, rowing, swimming, and carefully progressed strengthening programs are often better tolerated than upright exercise.

Pacing

Learning to work within energy limits can help reduce crashes and symptom flares.

Sleep Support

Adequate sleep is essential for autonomic regulation.

Stress Management

The autonomic nervous system is highly responsive to stress. Breathwork, mindfulness, meditation, and nervous-system regulation strategies may help.

Medical Treatment

Some individuals require medications to help regulate heart rate, blood pressure, or blood volume.

What Massage Therapists Should Know

Clients with dysautonomia may:

• Become dizzy when changing positions
• Need extra time getting on or off the table
• Struggle with temperature regulation
• Experience post-treatment fatigue
• Be sensitive to prolonged standing
• Have fluctuating symptoms from day to day

For hypermobile clients, dysautonomia may be one of the hidden reasons they feel exhausted despite appearing healthy.

Understanding this connection allows therapists to provide safer, more effective care and helps clients feel seen and understood.

Final Thoughts

For many people with hypermobility, dysautonomia is the missing puzzle piece that explains years of unexplained symptoms.

The racing heart, dizziness, fatigue, temperature sensitivity, brain fog, and exercise intolerance are not “all in their head.” They are often signs of an autonomic nervous system struggling to maintain balance.

As awareness grows, more individuals are finally receiving answers—and finding strategies that help them live fuller, more functional lives.

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Disclaimer

This article is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional regarding diagnosis, treatment, or changes to your healthcare plan. If you experience fainting, chest pain, shortness of breath, or other concerning symptoms, seek immediate medical attention.