Understanding POTS and Orthostatic Hypotension

How Your Balance System and Autonomic Nervous System Are Connected

Have you ever stood up and suddenly felt lightheaded, dizzy, or even like you might faint? For some people, this isn’t just a momentary sensation—it’s a sign of a deeper issue involving how the body regulates blood pressure and heart rate. Two conditions that commonly cause these symptoms are Postural Orthostatic Tachycardia Syndrome (POTS) and Orthostatic Hypotension (OH).

At Healing Vertigo, we often see patients with these diagnoses who also experience dizziness, imbalance, and motion sensitivity. One surprising connection between these symptoms lies in the vestibular system—your inner ear’s balance center. More specifically, something called the vestibulosympathetic reflex (VSR) plays a key role in how the body manages changes in posture.

Let’s explore what’s happening, and how vestibular therapy can support recovery.

What are POTS and Orthostatic Hypotension?

Both conditions fall under a category called orthostatic intolerance, meaning your body has trouble adjusting to upright posture.

POTS involves an exaggerated increase in heart rate (often by 30+ bpm within 10 minutes of standing) without a significant drop in blood pressure. People often feel dizzy, shaky, fatigued, or experience “brain fog” upon standing.
Orthostatic Hypotension (OH), on the other hand, is defined by a drop in blood pressure upon standing, which can lead to lightheadedness, fainting, and visual disturbances.

Though these conditions are different, both involve dysfunction in the autonomic nervous system - which controls involuntary functions like heart rate, blood pressure, and digestion.

understanding bppv, understanding vertigo, benign paroxysmal positional vertigo, inner ear anatomy, vestibular system anatomy, bppv pathophysiology, bppv anatomy

The Missing Link: Your Balance System and the VSR

You might wonder—what does the inner ear have to do with your heart rate and blood pressure?

The answer lies in a reflex called the vestibulosympathetic reflex (VSR). This is a communication pathway between the vestibular system (which helps detect motion and head position) and the sympathetic nervous system (which helps regulate things like blood pressure during posture changes).

Here’s how it works in a healthy system:

When you move from lying down to standing, the otolith organs in your inner ear (the utricle and saccule) detect this change in gravity and position.
Through the VSR, this information helps trigger sympathetic nervous system activation, which tells your blood vessels to constrict and your heart rate to adjust—helping maintain steady blood flow to your brain.

But in conditions like POTS and OH, this reflex doesn’t work properly. The vestibular system may either overreact (as in POTS, leading to excessive heart rate increases) or under-respond (as in OH, leading to insufficient blood pressure regulation).

Dysfunction in the VSR can also contribute to feelings of dizziness, lightheadedness, and poor balance when upright—even if the inner ear itself is structurally healthy.

How is POTS or OH Diagnosed?

Diagnosis typically involves a combination of clinical history and tests that measure cardiovascular responses to posture:

POTS is diagnosed when there’s a heart rate increase of 30+ bpm (or 40 bpm in teens) within 10 minutes of standing, without a significant drop in blood pressure.
Orthostatic Hypotension is diagnosed by a drop in systolic BP of 20 mmHg or more, or diastolic BP of 10 mmHg or more within 3 minutes of standing.

Additional tests may include tilt table testing, blood volume analysis, and evaluation for underlying causes.

How Vestibular Therapy Can Help

Even though POTS and OH originate in the autonomic system, vestibular therapy plays an important role—especially when symptoms include dizziness, imbalance, and sensory sensitivity. By targeting the vestibular-autonomic connection through carefully guided movement, therapy can help regulate the VSR and reduce symptom flares.

Here’s how:

Improve VSR Function Through Motion-Based and Otolith Training

Gentle, graded exposure to postural and head movements can help retrain the vestibulosympathetic reflex, improving the body's ability to adjust to standing and movement over time.

Balance and Gait Retraining

If you feel unsteady on your feet, we work on strengthening your balance and improving postural control—especially important in cases of frequent pre-syncope or fainting.

Visual-Vestibular Integration

We address visual motion sensitivity (e.g., dizziness in crowds or busy environments) by retraining how your eyes and inner ear coordinate movement.

Graded Exercise Programming

We develop safe, individualized exercise plans that account for fatigue, orthostatic intolerance, and pacing—an important foundation of POTS/OH recovery.

Education and Empowerment

We help you understand how your body is reacting, and give you tools to manage symptoms confidently—such as posture strategies, breathing techniques, and hydration tips.

Real Help for a Real Condition

If you’ve been told “it’s just anxiety,” or if your symptoms are dismissed because your tests appear normal—please know that your experience is valid. Conditions like POTS and orthostatic hypotension are real, complex, and treatable.

At Healing Vertigo, we believe in treating the whole person. That means addressing the vestibular and autonomic components of your symptoms with compassion, evidence-based care, and individualized support.

Join our Community!

We would love to stay connect with you! Subscribe to get access to my latest content, BPPV Masterclass, and early invites to our vestibular workshops.

POTS and OH Treatment Near Me

If you're struggling with dizziness, lightheadedness, or imbalance when upright, vestibular therapy might be a missing piece in your recovery. Book an assessment today or reach out with questions—we’re here to help you feel steady and supported again.

Book an Appointment

Disclaimer: This advice is not meant to be a substitute for advice from a medical professional regarding diagnosis, prognosis, or treatment. Always seek advice from your physician, physiotherapist, or other qualified healthcare provider with questions you may have regarding a healthcare condition. The information of this website and email, including but not limiting to text, graphics, videos, images, and other materials are for informational purposes only. Reliance on the information on this website and email is soley at your own risk.