Dysautonomia is a term used to describe problems with the autonomic nervous system—the part of your body that automatically controls functions such as heart rate, blood pressure, breathing, digestion, sweating and temperature regulation. Dysautonomia in Long COVID appears to affect some people, disrupting this automatic control system and contributing to symptoms such as dizziness, palpitations, heat intolerance, fatigue and brain fog. Dysautonomia is not a disease itself, but an umbrella term for a group of conditions that affect the autonomic nervous system, with different causes, symptoms and levels of severity.
Key Takeaways
- The autonomic nervous system is your body’s automatic control system.
- Dysautonomia means this system isn’t working as efficiently as it should.
- It can contribute to dizziness, palpitations, fatigue, brain fog, heat intolerance and digestive symptoms.
- Long COVID is one of several conditions linked to autonomic dysfunction.
- Understanding dysautonomia often helps many confusing symptoms finally make sense.
Why Does My Body No Longer Feel Automatic?
Before Long COVID, you probably never thought twice about standing in a queue, taking a hot shower or walking around the supermarket. These were ordinary parts of daily life that happened without planning, pacing or worrying about how you might feel afterwards.
Then something changed.
Suddenly, standing for a few minutes felt exhausting. Your heart raced for no obvious reason. A warm room became unbearable, and a simple trip to the shops started feeling like a workout.
If this sounds familiar, the answer may not lie in your muscles or your lungs alone. It may lie in one of the most important systems in your body—one that most people have never even heard of.
Meet Your Body’s Autopilot
Your body is constantly making tiny adjustments to keep you alive and functioning normally.
Every time you stand up, it increases your heart rate slightly and tightens your blood vessels so enough blood reaches your brain. When the weather is hot, it helps cool you down. After a meal, it redirects blood towards your digestive system. Even while you sleep, it automatically adjusts your breathing, heart rate and blood pressure.
You don’t have to think about any of this because it happens in the background.
Doctors call this automatic control network the autonomic nervous system.
When it’s working well, you barely notice it exists.
When the Autopilot Starts Struggling
Imagine driving a car that has always had automatic gears.
One morning you get in, start the engine and discover someone has quietly changed it to a manual gearbox. The car still works and you can still reach your destination, but suddenly every journey takes more concentration and much more effort.
For many people, dysautonomia feels a little like that.
Your body hasn’t forgotten how to function. Instead, it struggles to make the automatic adjustments that used to happen effortlessly. Sometimes they happen too slowly, sometimes they don’t happen enough and sometimes they happen at the wrong time.
The result is that everyday life suddenly feels much harder than it should.
Why Standing Can Feel So Difficult
One of the autonomic nervous system’s most important jobs is helping your body cope with gravity.
When you stand up, around half a litre of blood naturally moves into your legs and lower body. A healthy autonomic nervous system reacts within seconds by tightening blood vessels and making the heart pump slightly faster, ensuring enough blood continues to reach the brain.
When those adjustments don’t happen properly, symptoms can appear surprisingly quickly. You might feel dizzy, light-headed, exhausted or mentally foggy. Some people notice blurred vision, while others experience a racing heart or feel as though they are about to faint.
This also explains why many people with Long COVID find standing still harder than walking.
Walking activates your calf muscles, often called the body’s “second heart,” because they help pump blood back towards your chest. When you’re standing quietly, that muscle pump isn’t doing nearly as much work, so blood can pool more easily in the legs.
For many people, this single explanation is an enormous “aha!” moment.
Why It Affects So Many Different Symptoms
The autonomic nervous system doesn’t just control your circulation.
It also helps regulate breathing, digestion, body temperature, sweating, bladder function and even how your pupils respond to light. That’s why dysautonomia can affect so many different parts of the body at the same time.
One day you notice your heart racing when you stand up. Another day it’s nausea after eating, difficulty coping with heat or overwhelming fatigue after taking a shower. At first these problems seem completely unrelated.
Once you understand the role of the autonomic nervous system, they begin to look like different pieces of the same puzzle.
Is Dysautonomia the Same as POTS?
Not necessarily.
POTS (Postural Orthostatic Tachycardia Syndrome) is one type of dysautonomia where standing causes an unusually large increase in heart rate. However, it is only one form of autonomic dysfunction.
Some people with Long COVID develop POTS. Others have orthostatic intolerance, where standing causes symptoms without meeting the full diagnostic criteria for POTS. Others experience different patterns of autonomic dysfunction altogether.
The important point is that dysautonomia is the umbrella term, while POTS is one possible diagnosis underneath it.
Long COVID Isn’t the Only Condition
Although dysautonomia became much more widely recognised during the pandemic, doctors have known about it for many years.
Autonomic dysfunction is also seen in conditions such as ME/CFS, Sjögren’s syndrome, hypermobile Ehlers-Danlos syndrome (hEDS), diabetes and certain neurological disorders.
Researchers are now exploring why these different illnesses can produce similar autonomic symptoms. They may not be the same condition, but they could share biological pathways involving the immune system, nervous system and blood vessels.
Understanding those connections may eventually lead to better treatments for many people, not just those with Long COVID.
When Everything Finally Starts Making Sense
Learning about dysautonomia doesn’t explain every symptom of Long COVID, and it certainly doesn’t mean everyone with Long COVID has autonomic dysfunction.
What it often provides is something many people have been searching for since they first became ill: a pattern.
The racing heart, dizziness, supermarket queues, hot showers, heat intolerance and overwhelming fatigue stop feeling like random problems affecting different parts of the body. Instead, they begin to make sense as different ways the same automatic control system can struggle.
Sometimes understanding what’s happening doesn’t change the symptoms.
But it can change how you understand your body—and that can be the beginning of feeling less confused and more in control.
Frequently Asked Questions
Why do I sweat differently since developing Long COVID?
Many people with dysautonomia notice changes in sweating. Some sweat much more than before, while others struggle to sweat enough, making it harder to cope with heat. This happens because sweating is controlled by the autonomic nervous system. When that system isn’t regulating the body properly, temperature control can become less reliable.
Can dysautonomia cause digestive problems?
Yes. The autonomic nervous system helps control how food moves through your digestive tract. When it’s disrupted, some people experience nausea, bloating, reflux, constipation, diarrhoea or feeling unusually full after eating. Digestive symptoms are common in Long COVID but can also have other causes, so they should always be assessed in the context of your overall health.
Why does heat make my symptoms worse?
Heat naturally widens your blood vessels to help cool your body. For someone with dysautonomia, this can make it harder to maintain blood pressure and blood flow to the brain. The result may be dizziness, fatigue, a racing heart or feeling faint, which is why many people with Long COVID find hot weather particularly challenging.
Can dysautonomia affect my bladder?
Yes. The autonomic nervous system also helps control the bladder. Some people with dysautonomia notice needing to pass urine more frequently, feeling a sudden urgency or waking several times during the night to urinate. These symptoms can have many causes, so it’s important to discuss them with your healthcare professional rather than assuming they are due to dysautonomia alone.
Can dysautonomia cause brain fog?
Yes. Brain fog has several possible causes in Long COVID, but dysautonomia may contribute by making it more difficult to maintain consistent blood flow to the brain when you’re upright. Many people notice that their thinking becomes clearer after sitting or lying down, although brain fog is often influenced by several overlapping factors.
Is dysautonomia the same as POTS?
No. POTS is one type of dysautonomia, but it isn’t the only one. Some people have orthostatic intolerance or other forms of autonomic dysfunction that don’t meet the criteria for POTS. Dysautonomia is the umbrella term for conditions affecting the autonomic nervous system.
Is dysautonomia an autoimmune disease?
Current evidence suggests that dysautonomia can sometimes be associated with autoimmune diseases, but it is not itself considered an autoimmune disease. Conditions such as Sjögren’s syndrome, lupus and autoimmune autonomic ganglionopathy can affect the autonomic nervous system, and researchers are investigating whether autoimmune mechanisms may also contribute to dysautonomia in some people with Long COVID. However, the relationship is complex and is still being studied. More on”Long COVID and Autoimmunity: What Does the Evidence Show?”
Is there a link between dysautonomia and MCAS?
Many people with Long COVID, POTS and related conditions report symptoms that overlap with Mast Cell Activation Syndrome (MCAS), and some clinicians observe that these conditions can occur together. Researchers are exploring possible connections involving the immune system, inflammation and the nervous system, but it has not yet been proven that one condition causes the other. If symptoms such as flushing, hives, itching or unexplained allergic-type reactions occur, it’s worth discussing them with a healthcare professional.
What the Evidence Says
Research consistently shows that autonomic dysfunction is common in a proportion of people with Long COVID and may contribute to symptoms including dizziness, palpitations, exercise intolerance, fatigue, brain fog and heat intolerance.
Dysautonomia is also recognised in conditions such as ME/CFS, Sjögren’s syndrome and hypermobile Ehlers-Danlos syndrome, suggesting there may be shared biological mechanisms involving the immune system, nervous system and circulation. However, dysautonomia is only one part of the Long COVID picture, and researchers are still investigating why it develops in some people but not others.
Continue Reading
- What Is POTS?
- Why Does My Heart Race When I Stand Up?
- Why Does Standing Still Feel Harder Than Walking? coming soon
- Why Does Heat Make Long COVID Worse?
- Do Compression Stockings Help Long COVID? coming soon
References
- World Health Organization. Clinical Case Definition of Post COVID-19 Condition.
- NICE. Managing the Long-Term Effects of COVID-19 (NG188).
- Raj SR, et al. Canadian Cardiovascular Society Position Statement on POTS.
- Vernino S, et al. State of the Science and Clinical Care of POTS.
- Newton JL, et al. Autonomic dysfunction in primary Sjögren’s syndrome.
- Rowe PC, et al. Orthostatic intolerance and ME/CFS.
Medical Disclaimer
This article is for educational purposes only and should not replace personalised medical advice. If you experience persistent dizziness, fainting, chest pain, severe palpitations or worsening symptoms, seek assessment from a qualified healthcare professional.