The 12 Most Overlooked POTS Symptoms — And How to Finally Get Relief

Postural Orthostatic Tachycardia Syndrome (POTS) is widely misunderstood — not just by patients, but even by many healthcare providers. While many people associate POTS with standing up and feeling faint or having a rapid heartbeat, those are only the most visible symptoms. The truth is that POTS affects multiple systems in the body, and because of that, symptoms often appear random, unrelated, or simply “in your head.”

Except they’re not.

Living with POTS can feel like your body is constantly glitching, and the frustrating part is that many symptoms slip under the radar for years before anyone recognizes what they are. This article dives deep into the 12 most overlooked POTS symptoms, why they happen, and practical ways to start finding relief.

If you’ve ever felt dismissed or misunderstood, this guide is created for you — because your symptoms are real, valid, and deserve answers.

1. Blood Pooling (and Why Your Legs Change Color)

Most people with POTS experience blood pooling, but very few know what it actually looks like. Blood pooling happens when your blood flows downward into your legs but doesn’t return to your heart efficiently when you stand.

Signs you might be experiencing blood pooling:

• Purple, red, or blotchy legs

• Heavy or “cement-like” sensation in calves

• Tingling or numbness

• Warmer or colder legs compared to the rest of the body

• Faintness after standing still

WHY IT HAPPENS

POTS involves dysfunction of the autonomic nervous system. Your veins don’t constrict the way they should when you stand, so gravity wins — and your blood gets stuck.

WAYS TO REDUCE BLOOD POOLING

• Compression stockings (20–30 mmHg or 30–40 mmHg)

• Calf strengthening exercises

• Alternating leg movements when standing

• Increased fluids + electrolytes

• Elevating legs during breaks

Blood pooling is one of the most manageable symptoms once you know what to look for.

2. Extreme Fatigue That Feels “Not Normal”

This is not regular tiredness.

This is not “I didn’t sleep well.”

POTS fatigue is systemic, overwhelming, and often disproportionate to your activity level.

WHY THIS FATIGUE IS DIFFERENT

Your body is working twice as hard to regulate:

• Heart rate

• Blood pressure

• Circulation

• Nervous system response

• Blood volume

Your body becomes exhausted doing things others find effortless — like showering, standing, or eating.

HOW TO EASE POTS FATIGUE

• Proper pacing (micro-rests during the day)

• Warm-up routines before activity

• Morning hydration protocols

• Salt loading (as medically appropriate)

• Nervous system calming exercises

• Vitamins (such as Vitamin B Complex)

A stable routine can reduce fatigue by 40–60% for many people.

3. Temperature Dysregulation

Do you overheat easily? Freeze easily? Sweat too much or not at all?

This is extremely common in POTS but rarely talked about.

WHY IT HAPPENS

The autonomic nervous system controls temperature — so when it’s dysregulated, your body can’t cool or warm itself properly.

REAL-LIFE EXAMPLES

• Feeling like you’re burning up while others are fine

• Getting cold “from the inside out”

• Sweating excessively or not sweating at all

• Heat intolerance (major flare trigger)

• Cold hands and feet even in warm weather

SYMPTOM SUPPORT

• Cooling towels / fans

• Layered clothing

• Avoid hot showers

• Hydration + electrolytes

• Avoid overheating during exercise

4. Digestive Issues (IBS, Nausea, Bloating)

Up to 70% of people with POTS experience GI problems.

COMMON POTS-RELATED GI SYMPTOMS

• Nausea

• Early fullness

• Bloating

• Abdominal pain

• Constipation or diarrhea

• Difficulty digesting large meals

THE CONNECTION

Your gut is also regulated by the autonomic nervous system — dysautonomia slows digestion, causing symptoms that mimic IBS.

SUPPORTIVE STRATEGIES

• Smaller, more frequent meals

• Increase salt earlier in the day

• Avoid heavy meals before activity

• Ginger or peppermint for nausea

• Balanced meals with protein + complex carbs + electrolytes

5. Brain Fog That Feels Completely Debilitating

POTS brain fog is not mild forgetfulness. It can feel as if your brain has been unplugged — blurry, slow, and unable to process information.

WHY IT HAPPENS

Reduced blood flow to the brain when standing or walking can impair cognitive function.

REAL IMPACTS

• Forgetting common words

• Losing your train of thought mid-sentence

• Difficulty reading or focusing

• Slower processing speed

• Feeling mentally “floaty” or confused

SUPPORT STRATEGIES

• Hydrate before cognitive tasks

• Sit instead of stand whenever possible

• Break tasks into short segments

• Breathwork to improve oxygen flow

• Improve sleep quality and circadian rhythm

6. Shortness of Breath (Especially While Standing)

Breathing difficulties with POTS often go misdiagnosed as asthma or anxiety.

WHY IT HAPPENS

When your heart rate spikes, your breathing changes — sometimes becoming shallow or rapid.

SIGNS IT’S RELATED TO POTS

• Harder to breathe when upright

• Air hunger

• Feeling like your chest is tight

• Difficulty expanding your lungs fully

WAYS TO IMPROVE BREATHING

• Diaphragmatic breathing

• Cardio reconditioning (slow + consistent)

• Improving posture

• Electrolytes before activity

• Nasal breathing as tolerated

7. Shakiness, Tremors, and Feeling “Jittery”

Adrenaline surges are a hallmark of POTS.

CAUSES

• Nervous system overactivation

• Stress

• Low blood volume

• Rapid heart rate

• Standing up too quickly

TO REDUCE SHAKINESS

• Slow position changes

• Stabilizing snacks (protein + salt)

• Meditation or grounding techniques

• Avoiding major blood sugar spikes

8. Sleep Disturbances

Oddly enough, POTS presents both fatigue and insomnia at the same time.

COMMON PATTERNS

• Trouble falling asleep

• Restless sleep

• Nighttime heart palpitations

• Waking up feeling unrefreshed

• Elevated heart rate during sleep

SLEEP SUPPORT

• Magnesium glycinate (with medical approval)

• Consistent bedtime routine

• Cooler sleep environment

• Gentle stretching before bed

• Avoid late-night large meals

9. Increased Anxiety (But Not Always “Anxiety”)

People with POTS often get mislabeled as anxious. But adrenaline surges and autonomic dysregulation cause anxiety-like symptoms — even when you’re not mentally stressed.

SYMPTOMS THAT FEEL LIKE ANXIETY BUT AREN’T

• Racing heart

• Shakiness

• Hot flashes

• Shortness of breath

• Feeling “wired”

REALITY:

It’s not psychological — it’s physiological.

SUPPORT

• Grounding exercises

• Predictable routines

• Nervous system stabilization

• Adequate hydration

• POTS-informed therapy or coaching

10. Sensory Sensitivities

Many people develop intense sensitivity to:

• Light

• Sound

• Busy environments

• Strong smells

WHY IT HAPPENS

Your nervous system is already dysregulated — additional sensory input can overwhelm it.

SUPPORT OPTIONS

• Blue light glasses

• Noise-canceling headphones

• Calming environments

• Limiting overstimulation during flares

11. Exercise Intolerance

People with POTS often feel worse:

• During exercise

• Immediately after

• Several hours later

WHY

Blood flow struggles to reach your brain and muscles effectively during activity.

THE SOLUTION IS NOT TO STOP EXERCISING

The solution is to exercise differently:

• Start recumbent

• Build slowly

• Focus on consistency over intensity

• Add salt + electrolytes before workouts

• Strength training is key

Over time, conditioning can dramatically reduce symptoms.

12. Feeling “Disconnected” or Detached From Your Body

This symptom is rarely talked about but deeply common.

WHAT IT FEELS LIKE

• You feel “floaty”

• You feel like your body isn’t yours

• You feel mentally disconnected

• You feel far away from your surroundings

WHY IT HAPPENS

Reduced brain perfusion — and chronic stress — can make you feel dissociated.

SUPPORT STRATEGIES

• Grounding techniques

• Hydration + salt

• Regulating breathing

• Gentle movement

• Treating underlying POTS symptoms

You Deserve Answers — And You Deserve Support

If you recognized yourself in these symptoms, you are not alone — and nothing about your experience is “in your head.” POTS is real, complex, and physically demanding. But it is also manageable with the right strategies, education, and support.

Many people with POTS start seeing improvement when they finally have a structured plan tailored to their body — including nutrition, nervous system support, pacing, lifestyle adjustments, and emotional guidance.

If you’re ready to take that step, I’m here to help.

Ready to Feel More in Control of Your POTS?

Book a Virtual Session and get personalized support, guidance, and tools that can help you feel better — one step at a time.