Are you Tired When you Shouldn’t Be?

4 min read  |  February 28, 2020  | 

In a fast-paced world where every hour is crammed with some form of activity, it’s not unusual to feel bone-tired at the end of the day.

Exhaustion is a very 21st century complaint. However, some people experience extreme fatigue that cannot be explained with the usual excuses of poor sleep or daily stress.

It’s the kind of fatigue that hits randomly, without warning, and it’s more likely to develop in young adults and women, though it could happen to anyone. The symptoms can be confusing, since they mimic those of other conditions: heart palpitations, headaches, cramps, brain fog, erratic blood pressure, lightheadedness or dizziness, sometimes even vomiting and fainting.

The culprit? Postural orthostatic tachycardia syndrome, also known as POTS.

This little-known cause of fatigue is often misdiagnosed or missed altogether. “It can happen in somebody who’s perfectly healthy without any obvious underlying conditions,” as well as someone with a more complicated health profile, explains Dr. E. Robert Schwartz

While there can be many explanations for the fatigued feeling — from medications to the more severe illnesses of fibromyalgia and chronic fatigue syndrome — POTS distinguishes itself because it affects sufferers arbitrarily. It can happen daily or less frequently, and the symptoms can last days or a few hours. Patients complain that the most straightforward task may leave them feeling drained.

People can develop POTS after a serious illness or infection, even after a traumatic head injury. Certain autoimmune diseases can also lead to a higher risk.

In his practice, Dr. Schwartz has seen both men and women, young and old, suffer from this condition. The symptoms are as varied as the causes. “You have to take a good look and evaluate their heart function, their medical history, the medicines they’re taking,” he says. “You have to approach it in a very holistic way. Every patient can be a little different.”

Many times, Schwartz has discovered that his patients who have POTS are overmedicated, resulting in dehydration and dangerously low blood pressure. (Diuretics are often to blame.) He’s also seen weekend warriors report symptoms that coincide with POTS’ typically random episodes.

Though not well known to the general public, POTS is common.

It is estimated that anywhere between one to three million people — and about 450,000 Americans — suffer from this condition. Though scientists still don’t fully understand POTS, they do know that it is caused by an autonomic nervous system that’s out of whack. (This part of the nervous system controls blood vessels and organs, as well as salivary and sweat functions. It regulates involuntary body functions, including heartbeat, breathing, and digestion.)

We do know this about POTS patients: when standing, their blood tends to collect in the lower body, forcing the heart to speed up to get the blood to the brain. In other words, a POTS patient’s blood doesn’t flow at a steady pace, and their blood pressure isn’t stable.

There’s no magic-bullet cure for the condition, and treatment options vary.

Tweaking the amount or types of medication can help. In other cases, patients are instructed to increase water intake, which helps with the blood volume. Sometimes low-intensity exercise is prescribed to maintain healthy blood circulation.

“Treatment depends on the etiology,” Dr. Schwartz explains. “It’s tailored to the patient’s symptoms and health conditions. But the good news is that POTS is highly treatable.”

Ana Veciana-Suarez, Guest Columnist

Ana is a regular contributor to the University of Miami Health System. She is a renowned journalist and author, who has worked at The Miami Herald, The Miami News, and The Palm Beach Post. Visit her website at or follow @AnaVeciana on Twitter.

Tags: blood circulation, Dr. E Robert Schwartz, Postural orthostatic tachycardia syndrome, POTS

Continue Reading