Dysautonomia is disorder of the autonomic nervous system (which regulates heart rate, blood pressure, body temperature and digestion etc). Postural Orthostatic Tachycardia Syndrome (POTS) is a is a form of dysautonomia, and is disorder of the autonomic nervous system that affects heart rate regulation and circulation. For the purposes of this page we will now refer to POTS, but rest assured that at Breathing Works we are experts in the management and treatment of both POTS and Dysautonomia.
When a person with POTS stands up, their heart rate increases excessively—usually by more than 30 beats per minute in adults (or exceeding 120 bpm)—without a significant drop in blood pressure. This exaggerated response can cause symptoms of dizziness, palpitations, fatigue, shortness of breath, chest discomfort, and sometimes fainting. POTS commonly affects young women, but can occur in anyone, often following illness (COVID -19 or post viral infection etc), or trauma (concussion etc), or others triggers such as growth spurts or after prolonged inactivity. Because it impacts multiple systems, management requires a holistic approach focused on restoring autonomic balance and physical conditioning, and often requires multiple health professionals to treat and manage your symptoms, including Doctors, Cardiologists, Physiotherapists, Exercise Physiologists, and Psychologists, Dieticians, and work and school support people.
The Autonomic Nervous System and POTS
The autonomic nervous system controls vital functions such as heart rate, blood pressure, and breathing. In POTS, the system becomes dysregulated, often with increased sympathetic (“fight or flight”) activity and reduced parasympathetic (“rest and digest”) tone. This imbalance leads to poor blood distribution on standing and contributes to many symptoms. While medication may be prescribed in some cases, conservative management remains the first-line and often most effective approach for improving quality of life and long-term outcomes.
Breathing Retraining and Breathing Works
Research has shown that many people with POTS develop breathing pattern disorders and, including shallow chest breathing, mouth breathing, or chronic over-breathing (hyperventilation). These patterns lower carbon dioxide (CO₂) levels in the blood, causing vasoconstriction (narrowing of blood vessels), reduced brain perfusion, and increased symptoms such as dizziness, shortness of breath, and anxiety. Breathing retraining focuses on restoring efficient, calm, and physiologically appropriate breathing patterns that support autonomic regulation and circulation.
Breathing Works, has developed a POTS and Dysautonomia program, grounded in physiotherapy-based rehabilitation, in Auckland, New Zealand. Rest assured that treatment is always individualised, and meets clients at their own level. We help by addressing respiratory control and physiology, improving pacing, awareness and mindfulness, and build specific physical rehabilitation programs to help individuals normalise breathing patterns and improve overall autonomic stability.
Breathing retraining: At Breathing Works, we will assess and manage any aspects of dysfunctional breathing which may be contributing to your POTS presentation and symptoms. This may also include Inspiratory Muscle Training to strengthen your breathing muscles. It will also usually include an Active Stand Test with Capnography to assess dysfunctional Heart rate, blood pressure and CO2 levels.
Our Breathing Works method has shown positive outcomes for individuals with POTS, anxiety, long COVID, asthma, and chronic fatigue, helping regulate the autonomic nervous system and reduce symptom burden.
Other Conservative Management Strategies for POTS
4. Hydration: Increasing water intake (2–3 litres daily) can expand blood volume and support circulation.
4. Compression Garments: Waist-high compression garments and stockings help reduce blood pooling in the lower limbs, improving venous return.
4. Exercise and Reconditioning: We aim to provide a gradual, structured exercise program that meets clients at their level—usually starting with recumbent activities such as core exercises or strength training, then moving to cycling, or swimming— this strengthens muscles and blood vessels, improving tolerance to upright positions. Often structured Exercise Physiology can be very beneficial with POTS, when entered into at the right stage of rehab.
4. Pacing, Sleep and Stress Management: Prioritising activity pacing, adequate sleep, and incorporating relaxation techniques, such as mindfulness can complement breathing retraining by enhancing parasympathetic activation.
4. Dietary Adjustments: Smaller, frequent meals and a balanced diet with adequate electrolytes help prevent post-meal symptoms and energy fluctuations.
4. Medical and Cardiologist input: This is usually essential to help manage symptoms and trial medications to help with POTS.
Conclusion
POTS Physiotherapy and conservative management of POTS at Breathing Works can help to form a foundation for recovery and long-term symptom control. By learning to breathe efficiently and regulate autonomic responses, individuals with POTS can experience improved brain blood flow, reduced dizziness, and greater energy stability. The integration of Breathing Works principles within a holistic rehabilitation plan empowers patients to rebuild resilience and regain control over their daily lives. Book a session at Breathing Works today to start your recovery journey.