Why Do I Feel Worse in the Morning? Understanding Morning POTS Symptoms

The Morning Struggles of Someone with POTS

Getting out of bed is harder than it should be for someone living with POTS. You may have noticed it and have been wondering why. Logic says that people should feel better after a full night of sleep. Instead, you experience palpitations and nausea.

So there is a high chance you are asking: "Why do I feel worse in the morning, and what can I do to make things better?" That is the knowledge I want to impart to you through this post. Continue reading to learn about POTS symptoms and how to make your mornings lighter.

From Lying Down to Standing Up

The main thing about POTS is that it causes your heart to beat faster when you switch from sitting or lying down to standing up. Sleeping means you are lying flat in your bed for hours. Then, in the morning, you need to get out of that bed.

When you stand up, your blood pools in your lower body due to gravity. A healthy nervous system will prevent that by signalling your blood vessels to tighten up. Effectively, the brain helps send your blood back up your upper body.

POTS delays that response or makes the brain signals misfire, so your blood still pools in your lower body. As a result, your brain is not receiving enough oxygen. It then sends adrenaline to make your heart beat faster so your blood can go back up faster.

In simpler words, your brain panics, and its stress response is the cause of your dizziness and palpitations in the morning.

Coping Strategy

Make getting out of bed a gradual transition. From lying down, slowly shift to a sitting position. You can prop yourself up on pillows for this transition. 

If it's possible, get dressed while you are still in a sitting position. If you're using compression garments, this is also the time to put them on. Furthermore, I recommend briefly meditating before standing up.

Low Blood Volume Due to Dehydration

You are not drinking water while you are sleeping. Contrary to that, loss of fluids continues even when you are asleep. You breathe, and you sweat, especially on warm nights.

That affects your low volume. Low water intake means there is less fluid circulating through your blood vessels. If you don't have POTS, that would not matter.

However, for someone with POTS, changes in your blood volume have a bigger effect on you. It becomes more difficult for your cardiovascular system to ensure blood gets to your brain. To keep up, your heart has to pump faster and harder. As I have mentioned above, this can cause dizziness.

Coping Strategy

Before you go to sleep, put a tumbler of water on your nightstand. Water with electrolytes is better if you have been cleared for them. Drink this when you wake up to rehydrate your body.

If you are taking any medications, put them on your nightstand too. Doing so lets you access things you need without standing up first.

Adrenaline Surges

Your body naturally releases a surge of adrenaline every morning. It does that to:

• Wake you up (along with cortisol, the stress hormone)
• Liberate stored sugars to correct blood sugar levels
• Make your heart beat faster to push blood back up to your upper body (for someone with POTS)

POTS makes your nervous system hypersensitive. That makes this adrenaline surge feel unnatural and unsettling. It can cause:

• nausea
• breathlessness
• sweating
• chills
• panic attacks

This can feel like anxiety.

Coping Strategy

Lie down flat with your legs raised above heart level. This helps blood that has pooled in your legs move back toward your heart.

Lying down also removes the strain of standing upright, so your heart and blood vessels don't have to work as hard to keep blood flowing to your brain.

I also recommend breathing exercises when you feel the effects of an adrenaline surge. Count to four when you inhale, and count to six or eight when you exhale. It can help you get past the challenge of air hunger.

Additionally, tell yourself that it is an adrenaline surge and it will pass. Naming it will help prevent a second surge of adrenaline and the fear that it brings.

POTS Morning Support in Melbourne and Online

If you are searching:

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POTS specialist Melbourne

I offer chiropractic neurological consultations focused on autonomic regulation and practical strategies for managing POTS symptoms.

Sessions are available:

• Face to face in Melbourne

• Online across Australia

• Online worldwide

If you would like personalised guidance focused on improving regulation, managing your morning routine, and building greater tolerance for being upright, I invite you to book a consultation.

Your mornings can become more manageable with the right strategies and gradual progression.

Frequently Asked Questions

Can POTS cause brain fog in the morning?

Yes. Some people with POTS experience difficulty concentrating, remembering things, or thinking clearly. These symptoms can be more noticeable in the morning when your body is adjusting to being upright.

Should I exercise in the morning if I have POTS?

Exercise can be helpful for some people with POTS, but the appropriate type and intensity depend on the individual. A healthcare professional can help you determine a safe starting point.

Can eating breakfast make morning POTS symptoms worse?

For some people, symptoms can increase after eating. Digestion requires increased blood flow to the digestive system, which may temporarily make it harder for someone with POTS to maintain blood flow elsewhere.

Research Articles:

Sheldon R S, Grubb B P, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12(6):e41 to e63.

Raj S R, Biaggioni I, Yamhure P C, et al. Renin-Aldosterone Paradox and Perturbed Blood Volume Regulation Underlying Postural Tachycardia Syndrome. Circulation. 2005;111(13):1574 to 1582.

Stewart J M, Medow M S, Glover J L, Montgomery L D. Regional Blood Volume and Peripheral Blood Flow in Postural Tachycardia Syndrome. American Journal of Physiology-Heart and Circulatory Physiology. 2004;287(3):H1319 to H1327.

Thieben M J, Sandroni P, Sletten D M, et al. Postural Orthostatic Tachycardia Syndrome: The Mayo Clinic Experience. Mayo Clinic Proceedings. 2007;82(3):308 to 313.

Shibata S, Fu Q, Bivens T B, Hastings J L, Wang W, Levine B D. Brain Fog in Postural Tachycardia Syndrome: An Objective Cerebral Blood Flow and Neurocognitive Analysis. Journal of Neurology. 2018;265(8):1902 to 1910.

Bourne K M, Stiles L E, Raj S R. Do Meals Affect Heart Rate and Symptoms in Postural Orthostatic Tachycardia Syndrome? Clinical Autonomic Research. 2022;32(1):65 to 67.