What is the treatment for postural orthostatic tachycardia syndrome (POTS)?
Unfortunately, there’s no cure for POTS. Instead, healthcare providers use several strategies to manage the symptoms of POTS. Treatment is highly individualized based on your symptoms and what works best for you.
The main forms of treatment include:
- Exercise and physical activity.
- Diet and nutrition.
Medical compression stockings can also help push blood up from your legs to reduce POTS symptoms.
Exercise and physical activity
Exercise and physical activity are key to managing POTS.
Although most people with POTS have healthy hearts, your provider may recommend a cardiac rehab program. This exercise template uses the cardiac rehab model to recondition and help improve health and manage POTS. Some of the best data for treating POTS comes from cardiac rehab.
Studies show that reclined aerobic exercise, such as swimming, rowing and recumbent bicycling, has the best results. Strengthening your core and leg muscles is also helpful.
Here are important things to know as you undergo an exercise program and other physical activities. Talk with your provider for specific instructions on these exercises.
- Practice isometric exercises: These exercises involve contracting your muscles without actually moving your body. Isometrics squeeze your muscle and push your blood back toward your heart. They’re simple to do, and you can do them lying in bed or seated. It’s a good idea to do these in bed before getting up to prepare your body for sitting and standing.
- Transition slowly with your body: Go from lying to sitting on the edge of your bed. Stay there for several minutes, allowing your body to naturally adjust to the change in position. Once you’re standing, pause and wait before walking to allow your blood pressure to adjust again. If you feel lightheaded at any point, wait for a few minutes in that position to see if it resolves. If not, then return to the prior position. Moving slowly is the key.
- Begin a modest walking program: Count how many steps you can do without causing symptoms. These steps are your initial baseline. Start with walking once a day and go a little farther in time, distance or by adding steps. If you feel good, add a second walk in the day. A simple strategy for counting steps is to do 100 to 300 steps per hour during the day. Fitness trackers can monitor steps easily. Every week or every few weeks, add more steps to your daily total.
- Practice simple yoga: Practicing basic yoga with a focus on breathing may help reduce POTS symptoms.
Diet and nutrition
Managing diet and nutrition is another important aspect of managing POTS symptoms.
If you have the hypovolemic (low blood volume) form of POTS, your healthcare provider will likely recommend increasing both your fluid and salt intake to increase blood volume.
Eating a large meal can make symptoms of POTS worse, as your body redirects a lot of blood to aid in the digestion process. Because of this, providers often recommend eating several smaller meals throughout the day instead of two or three large ones.
A nutritionist or dietitian can help you with your diet. This consult can be especially helpful if you have celiac disease or other dietary sensitivities.
General guidelines for dietary changes include:
- Increase sodium in your diet from 3,000 milligrams (mg) to 10,000 mg per day.
- Drink 2 to 2.5 liters per day of fluids. Water is the best choice.
- Eat small and frequent meals instead of a few large meals.
- Eating a diet with high fiber and complex carbohydrates may help reduce blood glucose (sugar) spikes and lessen POTS symptoms.
- Keep your nutrition balanced with protein, vegetables, dairy and fruits.
- Choose beneficial salty snacks such as broth, pickles, olives, sardines, anchovies and nuts. Don’t over-rely on snack chips and crackers for salt.
- Plan grocery store shopping using a list to make sure you pick up healthy food choices and POTS care (hydration and salty supplements). If you have low stamina, have someone help you shop and carry and put away your groceries.
Medications
The U.S. Food and Drug Administration (FDA) hasn’t approved any medications for POTS treatment. But healthcare providers sometimes prescribe medications off-label to help certain POTS symptoms.
These medications include:
- Fludrocortisone (increases salt retention and blood volume).
- Pyridostigmine (may reduce tachycardia).
- Midodrine (causes widespread vasoconstriction).
- Beta-blockers (may reduce upright tachycardia).
All of these medications have potential side effects. Your provider will work with you to see if medication is right for you.
What can I do to manage postural orthostatic tachycardia syndrome?
Aside from exercise and dietary changes, other things you can do to manage POTS include frequently monitoring your pulse and blood pressure and getting quality sleep.
Monitoring pulse and blood pressure
Taking and writing down your blood pressure and pulse can provide insight into POTS and helps your healthcare provider fine-tune your treatment.
Check your blood pressure and pulse at the same time daily (in the morning and after dinner). It’s very helpful to do this for the first few months of your diagnosis. Also, check your blood pressure and pulse when you aren’t feeling well.
You can get a blood pressure monitor at most drug stores, online or at a medical supply store
Managing sleep with POTS
POTS can disrupt your sleep. As sleep is very important for overall health, you should prioritize it. These general guidelines may help you:
- Raise the head of your bed six to 10 inches to help alleviate POTS symptoms. The entire bed must be at an angle. Raising the head of the bed will increase fluid volume in your circulation in the morning. This may help you wake up more easily.
- Make sure the temperature is ideal in your bedroom to help you get proper rest.
- Try to maintain a typical sleep schedule. Go to bed consistently at a certain time and set a consistent time to wake up. The best sleep hygiene and good rest come from staying consistent with your sleep schedule every day.
- Avoid excessive daytime napping. It may make nighttime sleep less restful.
- Avoid excessive television viewing or using your phone or computer in bed. These technologies can interfere with sleep quality.
Talk to your provider if POTS is significantly disrupting your sleep.
