POTS, Dysautonomia, and the Fight-or-Flight Response in Menlo Park, CA

When a POTS or dysautonomia fight-or-flight response seems to stay switched on, it can be hard to know what your body is asking for. Your heart may race when you stand. Heat may feel unbearable. A shower, a grocery store line, or a short walk can leave you shaky, dizzy, drained, and strangely alert.

They may still be working. They may still be parenting, answering messages, and trying to appear fine. Yet their body seems to be sounding an alarm that never fully turns off.

At Soft Reboot Wellness, we take that experience seriously. A persistent state of physiological alarm can have many explanations, including anxiety, medical conditions, medication effects, sleep disruption, trauma-related symptoms, and changes in autonomic function. POTS and dysautonomia deserve thoughtful medical evaluation, not dismissal.

POTS is more than feeling anxious when you stand

POTS, or postural orthostatic tachycardia syndrome, involves an abnormal response to being upright. A person may experience a marked increase in heart rate after standing, often alongside lightheadedness, palpitations, fatigue, tremulousness, nausea, brain fog, exercise intolerance, or near-fainting.

The autonomic nervous system makes constant, quiet adjustments to heart rate, blood pressure, temperature regulation, digestion, and circulation. With dysautonomia, those adjustments may not happen as smoothly as they should. POTS is one form of dysautonomia. Dysautonomia itself is a broader term, not a single diagnosis.

POTS has varied symptoms and contributing mechanisms (Ghazal et al., 2025). That is why a careful history matters so much. Two people may use the same word, dizziness, while living with very different patterns.

That complexity can be exhausting. It also means that a fast heart rate should not be reduced to a personality trait, a lack of resilience, or “just stress.”

When the fight-or-flight response may point beyond anxiety

Fight-or-flight is not inherently a problem. It is a survival response. Heart rate rises. Muscles tense. Attention narrows. In a brief emergency, this can be useful.

The difficulty comes when the body remains in that state, or repeatedly enters it without an obvious external threat. You may feel wired but depleted. You may wake already bracing for the day. Sleep may become shallow. Your chest may feel tight, even when your thoughts are calm.

These sensations can overlap with anxiety. They can also overlap with autonomic conditions. The clinical presentation of POTS can be broad (Lau et al., 2026), which makes timing, posture, triggers, health history, and associated symptoms more useful than assumptions based on one sensation alone.

We often encourage patients to notice the details. Does your heart rate change after standing? Do fluids, meals, heat, menstrual changes, illness, or prolonged standing make symptoms worse? Is there a difference between feeling emotionally afraid and feeling physically activated?

Those observations are not a diagnosis. They can help create a clearer conversation with the clinicians evaluating you.

The questions that help clarify the picture

Appropriate evaluation may include a primary care clinician, cardiologist, neurologist, or other specialist, depending on your symptoms and history. Orthostatic vital signs, medication review, laboratory work, cardiac assessment, and other testing may be considered when clinically appropriate.

We want to be clear about urgent symptoms. Chest pain, fainting, severe shortness of breath, a new or irregular heartbeat, or sudden neurological symptoms need prompt medical attention. Palpitations and dizziness also deserve medical assessment, especially when they are new, worsening, or interfering with daily life.

A useful evaluation often begins with questions that are simple but specific:

• When did the symptoms begin?
• What happens when you move from lying down to sitting or standing?
• Have you fainted or nearly fainted?
• Are heat, showers, meals, exertion, illness, or dehydration clear triggers?
• What medications, supplements, or substances might affect heart rate or blood pressure?
• Is there a history of hypermobility, migraine, autoimmune illness, viral illness, trauma, or chronic stress?

Hypermobility-related conditions can overlap with autonomic symptoms (Mathias et al., 2021). Still, each person needs an individual assessment. Patterns matter. So does what has already been ruled out.

Why “push through” is rarely a complete plan

When symptoms are invisible, people often try to outwork them. They drink more coffee. They skip rest. They force exercise on days when their body is clearly struggling. Or they avoid movement altogether because every symptom feels dangerous.

Neither extreme necessarily serves you. Exercise and non-pharmacological approaches have a role in POTS care (Fu et al., 2018), but the right plan depends on the person and should be guided by an appropriate medical professional.

This is where compassion becomes practical. Your body is not failing a test of willpower. It may be asking for a different pace, more information, and care that is responsive rather than punitive.

Chronic physiological alarm can narrow a life. It can make social plans feel risky, sleep feel unreliable, and ordinary errands feel like endurance events. If stress has also become part of the picture, our perspective on burnout that does not improve with rest may help put language to that depletion.

Care should match the person, not the label

At Soft Reboot Wellness, we look beyond a single symptom. We consider your medical history, present symptoms, medications, goals, and the care already in place. We also recognize that nervous system dysregulation can feel deeply personal, even when it has medical dimensions.

We offer Dual Sympathetic Stellate Ganglion Block treatments in person following individualized assessment. Stellate ganglion block is not an established treatment for POTS or dysautonomia, and evidence for its use in these conditions remains limited. It is not diagnostic, curative, or appropriate for every person with POTS or dysautonomia. If it is discussed, we consider your history, symptoms, risks, alternatives, and current medical care carefully.

We do not ask you to choose between medical evaluation and emotional support. Both can matter. The body and mind are not separate rooms.

If anxiety is part of what you are experiencing, it can help to understand how physical sensations and fear can reinforce one another. We explore this further in our discussion of anxiety and shortness of breath. The point is not to explain everything as anxiety. The point is to make room for the full picture.

When the question becomes urgent

If you are having chest pain, fainting, severe breathing difficulty, new weakness, confusion, or symptoms that feel immediately dangerous, seek emergency medical care.

If persistent physical alarm has brought you to suicidal thoughts or you feel unable to stay safe, call or text 988 for the Suicide and Crisis Lifeline (988 Suicide and Crisis Lifeline). You do not have to sort this out alone in the most difficult moment.

FAQ

Can POTS feel like panic?

It can overlap with sensations often associated with panic, including racing heart, shaking, dizziness, sweating, and breathlessness. The overlap is real. It does not mean the cause is the same. A medical evaluation can help clarify what may be happening.

Can dysautonomia cause fatigue and brain fog?

Many people with dysautonomia report fatigue, concentration difficulty, and reduced tolerance for everyday activity. Dysautonomia can also occur alongside systemic conditions (Blitshteyn, 2025), which makes a broad clinical view important.

Should I track my symptoms before an appointment?

A brief record can be useful. Note when symptoms occur, body position, heart rate if available, food and fluid intake, sleep, activity, heat exposure, and any near-fainting episodes. Do not let tracking become another source of pressure.

Is a constant fight-or-flight feeling always dysautonomia?

No. It can arise from medical, psychological, hormonal, medication-related, and situational factors. That is why evaluation matters. A label should follow careful listening, not replace it.

A quieter next step

You do not need to have the right diagnosis before reaching out. You only need to recognize that something feels persistently off, and that it deserves attention.

At Soft Reboot Wellness, we offer a calm place to talk through nervous system symptoms, chronic stress, and the questions that can accompany them. Sometimes the first step is simply letting the body’s signal be heard.

Works Cited

1. Ghazal M, et al. Pathophysiology and management of postural orthostatic tachycardia syndrome (POTS): A literature review. https://pubmed.ncbi.nlm.nih.gov/39706392/

2. Lau DH, et al. Postural Orthostatic Tachycardia Syndrome: A State-of-the-Art Review. https://pubmed.ncbi.nlm.nih.gov/41519610/

3. Mathias CJ, et al. Dysautonomia in the Ehlers-Danlos syndromes and hypermobility spectrum disorders, with a focus on the postural tachycardia syndrome. https://pubmed.ncbi.nlm.nih.gov/34766441/

4. Fu Q, et al. Exercise and non-pharmacological treatment of POTS. https://pubmed.ncbi.nlm.nih.gov/30001836/

5. Blitshteyn S. Dysautonomia: a common comorbidity of systemic disease. https://pubmed.ncbi.nlm.nih.gov/40624434/

6. 988 Suicide and Crisis Lifeline. https://988lifeline.org/

Disclaimer

This article is for educational purposes only and is not a substitute for individualized evaluation, diagnosis, or treatment from a qualified healthcare professional.