The symptoms of Dysautonomia can vary from patient to patient and can be exacerbated depending on the type of Dysautonomia someone has. In general though, here are some of the common symptoms (again this is the an extremely brief list because this list could go on forever)

• Shortness of Breath
• Bradycardia/Tachycardia
• Nausea/Vomiting
• Brain Fog
• Stomach and GI Upset
• Fainting & Loss of Consciousness
• Sweat Less than Normal or Not Sweat at All
• Hypoglycemia
• Dehydration
• Dizziness
• Headaches
• GI Tract Paralysis
• Dental Issues
• Kidney Dysfunction
• Adrenaline Surges
• Inappropriate Temperature Regulation
•  Blurry Vision
• Difficulty Swallowing/Esophageal Dysmotility
• Weakness
• Brain Fog
• Chest Pain
• Balance Problems

The list could truly go on and on, but you get the idea. Anything that works automatically can be a problem that causes significant and disabling issues. If you are experiencing many of these symptoms, talk to your doctor about seeing an autonomic neurologist for testing.

For diagnosis, a neurologist who specializes in the autonomic nervous system (an autonomic neurologist) would be the best doctor to test and assess overall autonomic function via the Autonomic Reflex Screen test.

The Autonomic Reflex Screen is a series of 3 tests: the QSART, tilt table, and the Vasalva test (all done in an autonomic testing lab) and is the gold standard for autonomic testing.

There is also a separate test called the thermoregulatory sweat test which is also done but cannot be done on the same day.

These tests evaluate: cardiovagal, adrenergic, and sudomotor function (essentially different aspects of autonomic function).

autonomic function via the Autonomic Reflex Screen test.

The Autonomic Reflex Screen is a series of 3 tests: the QSART, tilt table and the Vasalva test (all done in an autonomic testing lab) and are the gold standard for autonomic testing.

There is also a separate test called the thermoregulatory sweat test which is also done, just cannot be done on the same day.

These tests evaluate: cardiovagal, adrenergic, and sudomotor function (essentially different aspects of autonomic nervous system).

The hardest part of testing, honestly, is probably finding a facility that has the equipment and the proper doctors to administer and interpret the tests.

Unfortunately, there are not many places that have both. To give you an idea, out of the whole west coast in the United States, there is only 1 clinic with certified clinicians and an autonomic lab. This clinic has 4 doctors out of the only 180 in the world that are certified. So you can see why just getting in to see a doctor about getting tested can be one of the most difficult parts!

As for the actual tests themselves, they can cause discomfort but are not hard or super painful tests. Below is a brief description of each type of test you would have done for an autonomic workup.

QSART

The QSART is a test that measures the autonomic nerves that control sweating. The test is useful in assessing autonomic nervous system disorders, peripheral neuropathies, and some types of pain disorders.

The test requires a mild electrical stimulation (it kind of feels like little bee stings) on the skin, which will stimulate sweat glands.

The QSART test measures the volume of sweat produced by this stimulation.

Tilt Table Test

In a tilt table test, you lie on a table that adjusts your body position from horizontal to vertical to simulate standing up.

The point of the test is to try to trigger your symptoms while your heart rate and blood pressure are being monitored. If you have symptoms while you’re in the upright position on the tilt table, the part of your nervous system that controls blood pressure and heart rate suddenly lowers them for a short time.

The test can tell your doctor if faulty brain signals are causing low blood pressure and is used to evaluate dysautonomia & syncope.

Vasalva

The Valsalva maneuver is a commonly used method of assessing normal or disordered autonomic control of blood pressure and heart rate. The test requires the maintenance of forced expiration against resistance for at least 7 and, optimally, for 15 seconds. This is done multiple times.

Performing the Valsalva maneuver tests the body’s ability to compensate for changes in the amount of blood that returns to the heart (preload). The changes in heart rate and blood pressure observed during this test are regulated by the autonomic nervous system.

Patients with autonomic dysfunction will therefore have changes in heart rate and/or blood pressure that differ from those expected in healthy patients.

Thermoregulatory Sweat Test

This test measures your ability to sweat in a special machine that has controlled temperature, humidity, and airflow regulation capabilities. Powder is put on your body, and the places you sweat will turn purple over time, while the places you don’t will not turn purple, making it clear where there may be issues occurring. The thermoregulatory sweat test is an important test for diagnosing certain autonomic and neurological disorders that result in abnormal body temperature regulation and sweat production.

If you sweat abnormally, a thermoregulatory sweat test, along with other tests, can identify whether the dysfunction is in your peripheral or central nervous system and how severe it is. This information helps your doctor make a diagnosis and determine whether or not you have dysautonomia as well.

There are many different reasons and ways someone could develop Dysautonomia, but there is no one cause that has been found and more research needs to be done.

Some are caused by underlying diseases and conditions while others are triggered by a virus or surgery. Not everyone finds an underlying condition for their Dysautonomia though. 

Some conditions that can be associated with Dysautonomia include: 

• Amyloidosis
• Antiphospholipid Syndrome
• Celiac Disease
• Charcot-Marie-Tooth Disease
• Chiari Malformation
• Chronic Inflammatory Demyelinating Polyneuropathy
• Deconditioning
• Delta Storage Pool Deficiency
• Diabetes
• Ehlers-Danlos Syndrome
• Mast Cell Disorders
• Mitchochondrial Diseases
• Paraneoplastic Syndrome
• Parkinson’s Disease
• Heavy Metal Toxicity
• Physical Trauma
• Surgery 
• Vitamin Deficiencies

All types of dysautonomia are different, but what they have in common is that they’re all affected by the dysfunction of the autonomic system.

Due to this, all types will cause varying symptoms with all automatic body functions.

Here is a list of some of the types of Dysautonomia (but not all of them):

• Pandysautonomia
• Autoimmune Autonomic Ganglionopathy
• Postural Orthostatic Tachycardia Syndrome
• Autonomic Neuropathy
• Holmes-Adie Syndrome
• Multiple System Atrophy
• Familial Dysautonomia
• Orthostatic Intolerance
• Neurocardiogenic Syncope
• Neurally Mediated Hypotension
• Autonomic Dysreflexia
• Baroreflex failure
• Diabetic autonomic neuropathy
• Pure Autonomic Failure

Unfortunately, there is currently no cure and the treatment is really just management of symptoms. Since there are a wide variety of symptoms as well as common comorbidities, each patient’s management plan is different and tailored to what their needs are. 

If you think you have a Dysautonomia type condition, seek help from your primary care physician and ask to be referred to an autonomic neurologist with access to an autonomic lab for testing. 

Some great Dysautonomia resources are: 

Dysautonomia International – a non-profit that seeks to improve the lives of individuals living with autonomic nervous system disorders through research, physician education, public awareness, and patient empowerment programs.

The Dysautonomia Project Book – combines current publications from leaders in the field of autonomic disorders with explanations for doctors and patients about the signs and symptoms as well as some recommendations on how to manage them and who to go to for help.