If you’re living with Postural Orthostatic Tachycardia Syndrome (POTS), you’re likely familiar with the racing heart, dizziness, and exhaustion that can accompany even basic movements like standing up. But there’s another piece of the puzzle that many patients and providers are only beginning to understand: heart rate variability (HRV).
Heart rate variability isn’t just a trendy wellness metric — it’s a powerful window into your nervous system and can provide real insights into how your body is functioning and adapting with POTS.
Let’s explore what HRV is, why it matters for people with POTS, and how you can use this data to better manage symptoms, adjust treatment, and improve your quality of life.
What Is Heart Rate Variability (HRV)?
Heart Rate Variability refers to the variation in time between each heartbeat. Contrary to what you might think, a perfectly steady heartbeat — one that ticks along at the same interval every second — isn’t actually ideal. A healthy heart speeds up and slows down naturally in response to breathing, activity, stress, and other factors. This flexibility is a sign that your autonomic nervous system (ANS) is adapting well to internal and external demands. In simple terms:- High HRV = Your body is flexible, resilient, and balanced between “fight or flight” (sympathetic) and “rest and digest” (parasympathetic) systems.
- Low HRV = Your body is under stress, overwhelmed, or stuck in sympathetic overdrive.
HRV and the Autonomic Nervous System in POTS
People with postural orthostatic tachycardic syndrome (POTS) experience dysfunction in the autonomic nervous system — the very system that controls HRV. When standing up, a healthy person’s body adjusts blood flow and heart rate to maintain balance. In someone with POTS, this regulation breaks down. As blood pools in the legs and blood pressure drops, the heart races in compensation. This dysregulation often comes with:- A lower HRV, indicating less adaptability
- An overactive sympathetic nervous system
- A delayed parasympathetic response makes it harder to calm down after stress or exertion
Why HRV Is Especially Useful for POTS Patients
For individuals navigating POTS treatment in Maryland or elsewhere, HRV offers a way to measure progress that goes beyond symptom tracking. Here’s why it’s valuable:1. HRV Can Predict Symptom Flare-Ups
Many people with POTS report “crashes” — periods of extreme fatigue, brain fog, or fainting. By monitoring HRV, some patients can identify patterns that precede these episodes. A sudden drop in HRV might signal an upcoming flare, prompting rest or hydration to prevent worsening symptoms.2. It Tracks Recovery from Activity
Exercise is often prescribed as part of POTS treatment. But overexertion can backfire, leading to post-exertional malaise (PEM). HRV gives feedback on how well your body is recovering from movement and whether your exercise plan is too intense or just right.3. It Supports Mind-Body Interventions
Interventions like breathing exercises, meditation, and cold exposure can improve HRV. Tracking HRV lets you see the physiological effects of these practices and encourages consistency.How to Measure HRV
You don’t need to visit a clinic every day to get this data. Several wearable devices now track HRV continuously or during sleep, including:- WHOOP band
- Oura ring
- Apple Watch (in Health app)
- Garmin or Fitbit trackers
- Measures HRV overnight or at rest (when data is most reliable)
- Provides trends over time, not just single-day metrics
- Integrates with your health journal or app if you’re working with a POTS doctor in Maryland
How to Interpret Your HRV
HRV is highly individual. What’s “good” for one person might be low for another. Instead of comparing your number to someone else’s, track your own trends. Look for:| HRV Pattern | What It Might Indicate |
|---|---|
| Gradual Increase | Improved nervous system regulation |
| Sudden Drop | Illness, flare-up, dehydration, or overexertion |
| Consistently Low | Chronic stress or unaddressed dysautonomia |
| High Variability Day-to-Day | ANS instability, common in early-stage POTS |
What Affects HRV in POTS?
Several factors influence HRV, especially for people managing postural orthostatic tachycardic syndrome (MD):Hydration & Electrolytes
Dehydration and low blood volume are major contributors to POTS symptoms and lower HRV. Drinking water and using electrolyte-rich beverages can help stabilize both symptoms and variability. Sleep Poor sleep reduces HRV. People with POTS often struggle with temperature regulation, night sweats, or restless legs. Improving sleep hygiene can lead to better autonomic balance. Medication Adjustments If you’re working with a POTS doctor accepting new patients in Maryland, HRV can help evaluate how well medications like beta-blockers or fludrocortisone are working. Mental and Emotional Stress Stress naturally suppresses HRV. Those with POTS often live in a state of hypervigilance due to unpredictable symptoms. Incorporating mindfulness practices can increase HRV over time.Using HRV to Guide Your Care Plan
Whether you’re just starting your POTS journey or deep into long-term management, HRV is a tool to help individualize your treatment. Ask your provider:- Can HRV be part of your regular check-ins or assessments?
- Are there trends that align with your symptom tracker?
- Could low HRV signal the need to adjust medications or activity levels?
Tips to Improve HRV Naturally
Improving HRV can help stabilize autonomic function over time, making day-to-day life more manageable. Here are practical ways to boost HRV:- Stay Consistently Hydrated — Start with salt-loading (as directed) and sip fluids through the day.
- Practice Breathwork — Try 4-7-8 breathing or alternate nostril breathing for 5–10 minutes a day.
- Use Compression Garments — These reduce blood pooling and stress on your heart.
- Sleep at an Incline — Elevating the head of your bed supports blood flow and reduces symptoms.
- Cool Your Core — Cold showers or cooling vests can reduce sympathetic dominance and improve HRV.
- Avoid Overexertion — Especially during flare-ups or heat exposure.
