Living with Postural Orthostatic Tachycardia Syndrome (POTS) can often feel like walking on a tightrope — some days feel manageable, while others can bring on overwhelming symptoms with little warning. Many people with POTS experience “flare-ups” — sudden periods when symptoms like dizziness, rapid heart rate, fatigue, and brain fog become worse than usual.
Understanding what triggers these flare-ups is one of the most important steps toward managing the condition. While every person’s experience is unique, there are several common causes that can make symptoms return or intensify.
In this article, we’ll break down what typically triggers a POTS flare-up, how these factors affect your body, and what you can do to prevent or minimize their impact.
1. What Is a POTS Flare-Up?
Before diving into the causes, it helps to understand what a POTS flare-up actually is.
A flare-up refers to a temporary worsening of POTS symptoms. During a flare, your autonomic nervous system — the part of your body that controls heart rate, blood pressure, and digestion — struggles to regulate itself properly. This can cause your heart rate to increase dramatically when you stand, leading to lightheadedness, fatigue, nausea, or even fainting.
Flare-ups can last for a few hours or several days. They can also vary in intensity. For some people, a flare-up may simply mean feeling more tired than usual; for others, it may mean being unable to go about daily activities.
2. Common Triggers of POTS Flare-Ups
While no two patients are exactly alike, many share common triggers that set off their symptoms. Recognizing and tracking these triggers can help you reduce flare frequency and severity.
A. Dehydration
One of the most frequent and easily overlooked triggers of POTS flare-ups is dehydration.
Water plays a vital role in maintaining blood volume and circulation. When your body lacks enough fluids, your blood volume decreases, making it harder for your body to pump blood to your brain when you stand. This leads to dizziness, rapid heart rate, and fatigue.
How to manage it:
- Aim to drink at least 2–3 liters of fluids daily.
- Add electrolyte-rich drinks (like oral rehydration solutions or sports drinks) to help your body retain fluids.
- Avoid excessive caffeine or alcohol, as both can dehydrate you.
B. Heat and High Temperatures
Many people with POTS notice that hot weather, long showers, or saunas make their symptoms worse. This happens because heat causes blood vessels to widen, allowing blood to pool in the lower body. As a result, less blood reaches the brain, increasing dizziness, weakness, and heart palpitations.
How to manage it:
- Avoid prolonged exposure to the sun.
- Take lukewarm showers instead of hot ones.
- Wear cooling vests or carry portable fans during hot days.
- Stay well-hydrated and increase salt intake slightly in warm weather.
C. Illness or Infection
Even a mild cold, flu, or viral infection can trigger a POTS flare-up. When you’re sick, your body uses extra energy to fight infection, and inflammation can interfere with your autonomic nervous system. Fever, dehydration, and bed rest can further aggravate symptoms.
How to manage it:
- Rest and hydrate generously when you’re unwell.
- Consult your doctor before taking new medications, as some can worsen POTS.
- Resume physical activity slowly once you start feeling better.
D. Hormonal Changes
Hormonal fluctuations can have a big impact on POTS symptoms, especially in women. Many patients report worse symptoms during menstruation, ovulation, or menopause. This is because hormonal shifts can affect blood volume, fluid balance, and vascular tone.
How to manage it:
- Track your symptoms across your menstrual cycle.
- Speak with your doctor about adjusting fluid and salt intake during hormonal changes.
- If needed, discuss whether certain birth control options or hormonal therapies might help stabilize symptoms.
E. Standing for Too Long
Long periods of standing can be very difficult for someone with POTS. Gravity causes blood to pool in the legs, and the heart must work harder to push it back up to the brain. This can quickly lead to dizziness, lightheadedness, or even fainting.
How to manage it:
- Shift your weight frequently or flex your leg muscles while standing.
- Wear compression stockings to improve blood circulation.
- Whenever possible, sit down or elevate your legs.
F. Lack of Sleep and Fatigue
Sleep deprivation can worsen nearly every symptom of POTS. A tired body and brain can’t regulate heart rate or blood pressure as effectively. Moreover, fatigue can make it harder to cope with existing symptoms.
How to manage it:
- Maintain a regular sleep schedule.
- Create a relaxing bedtime routine — avoid screens and caffeine before bed.
- Speak with your healthcare provider if insomnia or restless sleep persists.
G. Emotional Stress
Stress doesn’t just affect the mind — it has a strong impact on the body’s autonomic system. Emotional stress triggers the release of adrenaline and cortisol, which can increase heart rate, cause sweating, and worsen dizziness or anxiety.
How to manage it:
- Practice relaxation techniques like deep breathing, meditation, or yoga.
- Prioritize mental health — therapy or counseling can help reduce chronic stress.
- Include gentle activities like walking or stretching to release tension.
H. Dietary Triggers
Some foods and drinks can make POTS symptoms worse by lowering blood pressure or causing dehydration. Large meals can also divert blood to your digestive system, leaving you lightheaded.
Common dietary triggers include:
- High-carbohydrate or sugary foods
- Alcohol
- Excess caffeine
- Large meals instead of smaller, frequent ones
How to manage it:
- Eat smaller, balanced meals throughout the day.
- Increase salt intake if advised by your doctor.
- Keep track of foods that seem to worsen symptoms and adjust your diet accordingly.
I. Physical Deconditioning
Reduced physical activity — due to illness, pain, or fatigue — can cause muscle weakening and lower blood volume, worsening POTS over time. This creates a cycle where inactivity leads to more severe symptoms.
How to manage it:
- Start with recumbent exercises such as rowing, swimming, or cycling.
- Gradually increase intensity under medical supervision.
- Focus on consistency rather than speed or duration.
Exercise, when approached gently and progressively, can significantly improve long-term stability and reduce the frequency of flare-ups.
J. Medication Side Effects
Certain medications can unintentionally worsen POTS symptoms. These may include blood pressure-lowering drugs, diuretics, antidepressants, or stimulants.
How to manage it:
- Always discuss new prescriptions with your doctor.
- Keep a list of medications that worsen symptoms.
- Never stop medications abruptly without consulting your healthcare provider.
3. Recognizing Early Warning Signs
One of the best ways to manage a flare-up is to catch it early. Early warning signs might include:
- Unusual fatigue
- Increased heart rate upon standing
- Feeling more dizzy than usual
- Heavier brain fog
- Poor temperature tolerance
Keeping a symptom diary can help identify patterns. Over time, you’ll learn to predict when a flare is coming and take preventive steps like resting, hydrating, or adjusting your routine.
4. Practical Ways to Prevent or Minimize Flares
While not all flare-ups can be prevented, simple lifestyle adjustments can make a big difference:
- Stay Hydrated: Carry a water bottle and sip fluids throughout the day.
- Boost Salt Intake: If recommended, increase sodium to help maintain blood volume.
- Dress Smart: Avoid overheating and use compression garments.
- Plan Rest Periods: Balance activity with recovery time.
- Monitor Triggers: Use notes or an app to log daily habits and symptoms.
- Build a Support Network: Share your experiences with others who understand POTS.
Even small, consistent changes can reduce how often and how severely flares occur.
5. When to Seek Medical Help
If flare-ups become more frequent or severe, or if new symptoms develop, it’s important to contact your healthcare provider. Sometimes, a change in medication, lifestyle, or treatment plan can bring significant relief.
POTS is a complex condition, and what works for one person might not work for another. A personalized approach, guided by a medical professional familiar with Dysautonomia, is key to long-term management.
Final Thoughts
POTS flare-ups can be unpredictable and frustrating, but understanding your body’s triggers gives you more control. Whether it’s staying hydrated, managing stress, or getting enough rest, each step you take builds resilience and stability.
Living with POTS doesn’t mean giving up your goals — it means learning how to live in balance with your body. By tracking your triggers and staying proactive, you can reduce flares, regain confidence, and move closer to the life you want to live.
