"These recent symptoms seem to be more specifically related to dysautonomia. Is there something I should be tested for?" I asked.
"No, you do not have an autonomic disorder, " he assures me.
I can tell you being up all night with night sweats and spine burning does not make me feel secure with that answer. Nor does having liable blood pressure with heart irregularities make me feel any better.
So What Is Dysautonomia?
Dysautonomia (or autonomic dysfunction) is any disease or malfunction of the autonomic nervous system (ANS). The autonomic nervous system controls a number of functions in the body, such as heart rate, blood pressure, digestive tract peristalsis, and sweating, amongst others. Dysfunction of the ANS can involve any of these functions.
A number of conditions are forms of dysautonomia: postural orthostatic tachycardia syndrome (POTS), inappropriate sinus tachycardia (IST), vasovagal syncope, pure autonomic failure, neurocardiogenic syncope (NCS), neurally mediated hypotension (NMH), orthostatic hypotension, orthostatic hypertension, autonomic instability, and a number of lesser-known disorders such as cerebral salt-wasting syndrome. Dysautonomia may occur as the result of other diseases, such as diabetes mellitus, multiple system atrophy (Shy-Drager syndrome), Guillain-Barré syndrome and a number of other conditions that may affect the nervous system.
Just taking a minute to peruse the above sources lets you know you are dealing with a life-threatening illness. So, it is clear where many fibromyalgia suffers may get confused when noting such symptoms to their specialist.
What Are the Symptoms of Dysautonomia?
The symptoms of dysautonomia are numerous and vary widely from person to person. Since dysautonomia is a full-body condition, a large number of symptoms may be present that can greatly alter a person’s quality of life. Each patient with dysautonomia is different—some are affected only mildly, while others are left completely bed-ridden and disabled.
- Excessive fatigue
- Excessive thirst (polydipsia)
- Lightheadedness, dizziness or vertigo
- Feelings of anxiety or panic (not mentally induced)
- Rapid heart rate or slow heart rate
- Orthostatic hypotension, sometimes resulting in syncope (fainting)
- Gastroparesis (delayed gastric emptying)
- Mydriasis (abnormal dilation of the pupils)
- Salt cravings
- Pallor (unhealthy pale appearance)
- Acid reflux
- Visual disturbances
- Orthostatic hypotension
- Nerve pain
- Trouble breathing
- Chest pains
Many of us suffer from at least 75% of the symptoms labeled above. Hence, it is understandable why we'd be concerned over ANS failure. Then again, it seems as if we all have a tad of any number of ANS disorders, yet, we are not labeled with the diagnosis, but just seem to exhibit varying degrees of symptoms.
How Is It Diagnosed?
Autonomic neuropathy is a possible complication of a number of diseases, and the tests you'll need depend on your symptoms and risk factors for autonomic neuropathy.
When you have known risk factors for autonomic neuropathy
If you have conditions that increase your risk of autonomic neuropathy, such as diabetes, and have symptoms of the condition, your doctor will perform a physical exam and ask about your symptoms.
If you are undergoing cancer treatment with a drug known to cause nerve damage, your doctor will check for signs of neuropathy.
When you don't have risk factors for autonomic neuropathy.
If you have symptoms of autonomic neuropathy but no risk factors, the diagnosis can be more involved. Your doctor will probably review your medical history, discuss your symptoms and do a physical exam.
Your doctor might recommend tests to evaluate autonomic functions, including:
- Breathing tests. These tests measure how your heart rate and blood pressure respond during exercises such as forcefully exhaling (Valsalva maneuver).
- Tilt-table test. This test monitors the response of blood pressure and heart rate to changes in posture and position, simulating what occurs when you stand up after lying down. You lie flat on a table, which is then tilted to raise the upper part of your body. Normally, your body narrows blood vessels and increases heart rate to compensate for the drop in blood pressure. This response may be slowed or abnormal if you have autonomic neuropathy.
A simpler test for this response involves standing for a minute, then squatting for a minute and then standing again while blood pressure and heart rate are monitored.
- Gastrointestinal tests. Gastric-emptying tests are the most common tests to check for digestive abnormalities such as slow digestion and delayed emptying of the stomach (gastroparesis). These tests are usually done by a doctor who specializes in digestive disorders (gastroenterologist).
- Quantitative sudomotor axon reflex test. This test evaluates how the nerves that regulate your sweat glands respond to stimulation. A small electrical current passes through capsules placed on your forearm, upper and lower leg and foot, while a computer analyzes the response of your nerves and sweat glands. You might feel warmth or a tingling sensation during the test.
- Thermoregulatory sweat test. You're coated with a powder that changes color when you sweat. While lying in a chamber with a slowly increasing temperature, digital photos document the results as you begin to sweat. Your sweat pattern might help confirm a diagnosis of autonomic neuropathy or suggest other causes for decreased or increased sweating.
- Urinalysis and bladder function (urodynamic) tests. If you have bladder or urinary signs and symptoms, a series of urine and bladder tests can evaluate bladder function.
- Ultrasound. If you have bladder signs and symptoms, your doctor might do an ultrasound in which high-frequency sound waves create an image of the bladder and other parts of the urinary tract.
- Treating the underlying disease. The first goal of treating autonomic neuropathy is to manage the disease or condition damaging your nerves. For example, if the underlying cause is diabetes, you'll need to tightly control blood sugar to prevent autonomic neuropathy from progressing. About half of the time, no underlying cause for autonomic neuropathy is found.
- Managing specific symptoms. Some treatments can relieve the symptoms of autonomic neuropathy. Treatment is based on what part of your body is most affected by nerve damage.
Your doctor may recommend:
- Diet changes. You might need to increase dietary fiber and fluids. Fiber supplements, such as Metamucil or Citrucel, also might help. Slowly increase fiber to avoid gas and bloating.
- Medication to help your stomach empty. A prescription drug called metoclopramide (Reglan) helps your stomach empty faster by increasing the contractions of the digestive tract. This medication can cause drowsiness and isn't advised for long-term use.
- Medications to ease constipation. Over-the-counter laxatives can help ease constipation. Ask your doctor how often you should use a laxative.
- Medications to ease diarrhea. Antibiotics can help treat diarrhea by preventing excess bacterial growth in the intestines, and over-the-counter antidiarrheal medication might be helpful.
Your doctor may suggest:
- Retraining your bladder. Following a schedule of when to drink fluids and when to urinate can help increase your bladder's capacity and retrain your bladder to empty completely at the appropriate times.
- Medication to help empty the bladder. Bethanechol (Duvoid) is a medication that helps ensure complete bladder emptying. Possible side effects include headache, abdominal cramping, bloating, nausea and flushing.
- Urinary assistance (catheterization). A tube is guided through your urethra to empty your bladder.
- Medications that decrease an overactive bladder. These include tolterodine (Detrol), oxybutynin or similar medications. Possible side effects include dry mouth, headache, fatigue, constipation and abdominal pain.
For men with erectile dysfunction, your doctor might recommend:
- Medications that enable erections. Drugs such as sildenafil (Viagra, Revatio), vardenafil (Levitra) or tadalafil (Adcirca, Cialis) can help you achieve and maintain an erection. Possible side effects include mild headache, flushing, upset stomach and changes in color vision.
If you have a history of heart disease, arrhythmia, stroke or high blood pressure, use these medications with caution. Also avoid taking these medications if you are taking any type of organic nitrates. Seek immediate medical assistance if you have an erection that lasts longer than four hours.
- External vacuum pump. This device helps pull blood into the penis using a hand pump. A tension ring helps keep the blood in place, maintaining the erection for up to 30 minutes.
- Vaginal lubricants to decrease dryness and make sexual intercourse more comfortable and enjoyable.
- Flibanserin (Addyi) for premenopausal women with low sexual desire.
Autonomic neuropathy can cause a number of heart rate and blood pressure problems. Your doctor might prescribe:
- Medications to raise your blood pressure. If you feel faint or dizzy when you stand up, your doctor might suggest fludrocortisone. This medication helps your body retain salt, which helps regulate your blood pressure.
Other drugs that can help raise your blood pressure include midodrine (Orvaten) and pyridostigmine (Mestinon, Regonol). Droxidopa (Northera) also can help raise blood pressure. Midodrine and droxidopa can cause high blood pressure when lying down.
- Medication to regulate your heart rate. A class of medications called beta blockers helps to regulate your heart rate if it goes too high with an activity level.
- A high-salt, high-fluid diet. If your blood pressure drops when you stand up, a high-salt, high- fluid diet can help maintain your blood pressure. This is generally only recommended for severe cases of blood pressure problems, as this treatment may cause blood pressure that is too high or swelling of the feet, ankles or legs and shouldn't be used in patients with heart failure.
If you sweat too much, your doctor might prescribe:
- A medication that decreases perspiration. Glycopyrrolate (Cuvposa, Robinul, Robinul Forte, others) can decrease sweating. Side effects can include diarrhea, dry mouth, urinary retention, blurred vision, changes in heart rate, headache, loss of taste and drowsiness. Glycopyrrolate can also increase the risk of heat-related illness, such as heatstroke, from a reduced ability to sweat.
- Surgery to cut the nerves in the sweat glands. It's also possible to remove the sweat glands but only in small areas of increased sweating, such as the palms.
It’s common for fibromyalgia sufferers to experience at least one or more forms of dysautonomia syndrome. We know that with fibromyalgia, there is a dysfunction in the ANS. For many with fibromyalgia, it appears as a delayed and inflated response to stressful situations. The fibromyalgia sufferer may go through a stressful situation without releasing the stress hormones that are typically produced automatically.
Once the stressful encounter is over and the sufferer is able to relax, the release of those stress hormones is triggered. The sufferer is flooded with stress hormones and experiences the anxiety and energy that others felt during the stressful situation, only the sufferer experiences it to an extreme degree long after the stress has subsided. This delayed reaction may make it appear that there is no cause for the sudden onset of severe alarm and discomfort.
Because of this, scientists have identified multiple abnormalities in fibromyalgia, including problems in the central nervous system and the autonomic nervous system. Fibromyalgia can be a result of dysautonomia or dysautonomia may be a result of fibromyalgia, we don’t really know. But there seems to be sufficient evidence to correlate the two. If you have symptoms of dysautonomia, discuss it with your physician. Diagnosis needs to be made in order to explore possible treatments that will ease your symptoms and improve your health.