Chronic fatigue, POTS, and HRV

As Dr. Bill has been working on the Body-Mind Reader, he’s been focused on people who have insufficient parasympathetic tone. Using the car analogy, this would be a person who isn’t good at putting on the brakes, and it would be manifested by difficulty thinking properly.

I’ve grown interested in the converse; namely, people who are riding the brakes all the time.

Physically, people with abnormally high parasympathetic tone are prone to dizziness and fatigue. They often pass out in the context of feeling nauseated and sweaty — all parasympathetic symptoms. We are well aware of this symptom complex. We used to call it “vasovagal,” referring to the vagus nerve, which carries parasympathetic information to the heart, blood vessels, and sweat glands. These days it’s more likely to be called Postural Orthostatic Tachycardia Syndrome (POTS) based on the body’s normal response to low blood pressure, namely an elevated heart rate (tachycardia).

What might Dr. Bill’s Body-Mind Reader tell us about people with vasovagal/POTS?

Imbalance is the key

If we think about a person who is imbalanced, with too little parasympathetic tone, we can imagine what happens to their mental state as energy in the system (stress) increases:

At high energy levels — extreme stress — we imagine the person will be in a panic attack, possibly to the point of freezing up. At lower energy levels, we imagine a state of depression associated with cognitive dysfunction. These people often complain that they can’t think straight, can’t get themselves organized, tend to have the same thoughts going around and around. I’m bad, I’m ugly, I’m no good to anyone, nobody loves me, nothing good ever happens. We might understand on a logical level that those things aren’t true; but that’s how it goes with cognitive dysfunction. The logic system just can’t kick in.

Doctors tend to focus on the amount of stimulation and energy. “Relax,” we say. Get your heart rate down. Get in your safe place and simmer down. Which is fine, panic attacks are no fun. But if you’re still out of balance, even in the low energy state, you’re still depressed. Dr. Bill hopes people can use the Reader to teach people to increase their parasympathetic tone, increase their ability to think clearly regardless of stress. “Get yourself into the green,” he says. That’s subtly different, and maybe a lot more powerful than saying, “relax.”

Now what about the person who can’t get off the brakes? Who is unbalanced the other way, with too much parasympathetic tone at any given time?

At low energy states, the patient should be thinking quite clearly. I expect most of their symptoms will be physical. Lassitude, dizziness. A tendency for the heart to race if you stand up too quickly, and sometimes even that’s not enough and you faint. At the other end of the spectrum, we actually expect them to be well-balanced, with high sympathetic and high parasympathetic tone. Solidly in the green.

Is POTS a strength?

If so, people with vasovagal/POTS should be really cool under stress. They should be the person who is saying “Calm down everybody, we can do this, let’s take it one step at a time” or something like that. Now that I’m hip to that idea, I’ve been asking people with POTS if that’s how they are. And so far, everyone has said “yes.”

The theory is, these are survivors. Many have been dealing with extraordinary stress since they were very young. And they do a hero’s job of it. The challenge they face is when the stress level goes down. They still have the system under really tight control. Maybe too tight.

What’s the answer? Well, maybe Dr. Bill might say, “get yourself into the blue.”

Could HRV biofeedback help?

Biofeedback doesn’t have to have a reason. Theoretically I could feed back anything to you. Skin temperature, sweat formation, blood pressure, heart rate. If you can see it, you can eventually learn how to manipulate it.

Sometimes we “break the ice” by having the patient do breathing exercises. Which is fair enough; the lungs are partly innervated by the voluntary nervous system, and partly by the autonomic. It’s a good place to start.

There’s breathing, and then there’s breathing. My daughter, who has a black belt in To-Shin-Do, notes during meditation that the inhale and the exhale have different qualities. “When you breathe in,” she says, “think, I’m awake! I’m alert! I’m full of energy!” On the exhale: “I’m calm, I’m centered, I’m grounded.” This carries through when she’s fighting, her kiai might emphasize the inhale, or the exhale, depending on what she’s up to. Whether she’s going for strength and explosive energy, or suppleness and fluidity. Sometimes it’s “Hey!” or “Stop!” Sometimes it’s “Easy!” or “Whoa!” (I can tell you, from experience, “Easy” is the scariest. She’s like a ghost.)

So, here’s a thought on how to use the Reader. If you have anxiety and depression, and you find yourself in the red, try breathing exercises. Focus on the exhale. Say words like “easy” or “whoa.” See if you can get yourself into the green. Do you feel calmer?

If you have POTS, and you find yourself in the dark green zone, try a slightly different breathing exercise. Focus on the inhale. Take a deep breath and shout something like “Hey!” or “Yes!” See if you can get yourself into the blue. Do you feel more energetic?

If you’re living with POTS/vasovagal, I’m interested to know what you think about this theory. If you get your hands on a Reader, I would love to hear about your experience.

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