Untangling Dysautonomia: Beyond POTS and Vagal Nerve Hacks | E15

Dr. Ayla Wolf, DAOM, unpacks the complex nature of dysautonomia beyond the common POTS diagnosis, explaining how this autonomic nervous system dysfunction affects multiple body systems and presents differently in each individual.

• The autonomic nervous system makes automatic adjustments for body functions like heart rate, breathing, and digestion
• Dysautonomia refers to dysfunction of these automatic processes, affecting multiple body systems
• Common misconception that dysautonomia always means too much sympathetic (fight-or-flight) activity
• Symptoms can include cardiovascular issues like racing heart, increased heart awareness, and lightheadedness
• Digestive symptoms often include nausea, GI discomfort, and food sensitivities
• Respiratory, temperature regulation, cognitive function, and immune function can all be affected
• POTS is just one specific form of dysautonomia with clear diagnostic criteria
• Testing for dysautonomia includes pupil response tests, Valsalva maneuver evaluation, and sustained handgrip testing
• Dysautonomia can be primary, secondary (after concussion, surgery or viral illness), or co-exist with other conditions
• Proper assessment requires comprehensive testing rather than symptom-based treatment
• Vagal nerve stimulation is not a universal solution and may not help all forms of dysautonomia

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Chapters

• 0:00 Understanding Heartbeat Awareness
• 10:59 Cardiovascular Symptoms of Dysautonomia
• 18:12 Multiple Systems Affected
• 19:35 Introduction to Autonomic Basics
• 22:13 Testing and Assessment Methods
• 32:47 Beyond POTS: Complexity of Treatment
• 50:03 Interoception: Sensing Your Internal State

Transcript

Dr. Ayla Wolf DAOM, L.Ac: 0:00

And then other people can have what I call increased heartbeat awareness, where their heart feels like it's pounding in their chest, but it's not. It may not be pounding fast, so it's not necessarily that the speed is abnormal, but it's the sensation of the heart is strong.

Sophia Bouwens L.Ac.: 0:18

Welcome to the Life After Impact podcast, where we do a deep dive into all things concussion and brain injury related. We talk about all the different symptoms that can follow a brain injury, different testing methods, different types of specialists out there and different therapies available. I'm Sophia Bowens. I'm here with Dr Ayla Wolf and we will be your guide to living your best life after impact, and we will be your guide to living your best life after impact. I'm super excited about this topic today. It's a really big one and it's full of just a lot of confusion and you bring so much clarity to it.

Dr. Ayla Wolf DAOM, L.Ac: 0:58

Well, that's because it is confusing. And so whenever I had patients coming in, I kept finding that there was some type of dysautonomia, very frequently underlying a lot of their symptoms, and it had gone missed by you know so many different providers because they weren't looking for it and they weren't necessarily looking at the human physiology from that perspective. And, just like with concussions, every single person can have such a different set of symptoms with a concussion. If we even just look at it from an autonomic perspective and say if dysautonomia is present, we can also say that in every single individual that's going to look very different.

Sophia Bouwens L.Ac.: 1:42

Very different. So this episode is called Untangling Dysautonomia Beyond POTS and Vagal Nerve Hacks, so really important. Let's just start it with a brief overview of dysautonomia and the autonomic nervous system.

Dr. Ayla Wolf DAOM, L.Ac: 1:57

Yes, so our autonomic nervous system is named as such because a lot of the functions it performs are supposed to be auto, right, automatic. Automatic Meaning that we don't necessarily have to be actively trying to do things right. So when I go to stand up, my heart rate is probably going to elevate a little bit and my blood pressure is going to elevate a little bit, and those small adjustments account for the fact that gravity is trying to take my blood and pull it down towards my feet right and so, to stand up, our body makes these adjustments without us having to consciously think about it, it's just automatic. It's automatic Just like when we go to bed at night. We continue to breathe because we have specific nuclei in our brainstem that are basically that's. Their job is to keep us breathing while we're unconscious.

Sophia Bouwens L.Ac.: 2:49

And they're part of the autonomic nervous system.

Dr. Ayla Wolf DAOM, L.Ac: 2:52

Exactly, and like sweating is another example. If we are nervous, we can have kind of this like emotionally driven, you know, increased sweating response to being nervous about having to, you know, give a speech in front of a room full of people. But when we go outside and it's hot out, that sweating response is autonomic. It's our brain saying it's hot out, I need to cool my body down, and so I'm going to do that through sweating. Or if I'm a dog, I'm going to do that through panting right.

Sophia Bouwens L.Ac.: 3:21

So this complex automatic nervous system really gets broken down most simply into two different parts sympathetic and parasympathetic, or fight or flight, and rest and digest.

Dr. Ayla Wolf DAOM, L.Ac: 3:33

Yes, and even those kinds of categories are maybe also a little bit overly simplified, because there's, you know, a parasympathetic arm that goes to our pupil, that helps to actually constrict our pupil.

Dr. Ayla Wolf DAOM, L.Ac: 3:47

That's a parasympathetic response, but we don't normally associate our pupil size with resting and digesting, so that's also a bit of an oversimplification, but it does get the point across. The other thing that I like to point out is that when we talk about this idea between you know, fight or flight as being a sympathetic response, so often the sympathetic nervous system gets demonized. You know, we're all told, like we all have too much sympathetic activity, and sympathetic activity is bad and sympathetic is evil and parasympathetic is good, and that's also not true. It's not, you know, it's not the reality that it is good and that's also not true. It's not, you know, it's not the reality. And so you know, the way that I always like to frame it is that our autonomic nervous system is designed to make beat to beat adjustments in order for us to have an appropriate response in the moment. So when I'm exercising, I need a really strong sympathetic output because I'm about to go put a lot of effort into, you know, running, jumping, lifting.

Sophia Bouwens L.Ac.: 4:50

You need different blood flow, different breathing patterns, different blood pressures to adjust to that situation.

Dr. Ayla Wolf DAOM, L.Ac: 4:56

Exactly, and so we need our sympathetic nervous system. It is so important.

Sophia Bouwens L.Ac.: 5:00

It's just we don't need it overly active at the wrong times, and sometimes people can get stuck in this sympathetic dominance or this fight or flight mode, and then I think that brings us to an interesting talk about what the arm that counters that is, which is that parasympathetic response, or yeah so the parasympathetic system.

Dr. Ayla Wolf DAOM, L.Ac: 5:21

Basically, if we get into anatomy, you know, we can ask the question of what makes a nerve a sympathetic nerve versus what makes a nerve a parasympathetic nerve. And so we have what are called preganglionic fibers and postganglionic fibers. So if we look at sympathetic nerve fibers and we compare them to parasympathetic, there's a way anatomically that we're differentiating whether something is parasympathetic or sympathetic, and it's all based on the length of the nerve tracts that are either preganglionic or postganglionic. So sympathetic nerve fibers have a short preganglionic fiber and then a very long postganglionic fiber ganglionic fiber and then a very long post-ganglionic fiber, and then the parasympathetic have a very long pre-ganglionic tract and a very short post-ganglionic tract.

Sophia Bouwens L.Ac.: 6:11

So anatomically they're mirrors too.

Dr. Ayla Wolf DAOM, L.Ac: 6:14

They're opposites to each other. Yes, and so there are these anatomical differences that define whether a nerve fiber is a sympathetic or a parasympathetic. And so again, I think that when we bring it back to just anatomy and classifications based on the length of the nerve, either pre or postganglionic, again all of a sudden it's like there is not this is good and that's bad, it's just this is short and that's long right, Exactly Easy, easy easy.

Sophia Bouwens L.Ac.: 6:41

Yeah, exactly, so the vagus nerve, the longest nerve in our body, gives our brain a lot of information about what our body function is doing. One of the anatomical and functional things that fascinates me about this nerve is that its main component is to tell the brain about what is going on in the body. They go from the body to the brain. I think it's like 90% of the information in the vagus nerve goes that way.

Dr. Ayla Wolf DAOM, L.Ac: 7:08

Yeah, I think like 80% is yeah, 80% is going from the body to the brain, and that is very important, because what that means is that we have this part of the brain called the insular cortex, which is where we have what's called interoception, right? So when I ask you, sophia, how are you doing today, you know it's actually you're kind of tapping into your interoception of how am I feeling today, and a lot of that has to do with, you know, this sense of internal state. So if you were super nauseous and I asked you, how are you today, that nausea is probably going to be the first thing on your mind, right? You can probably read it on my face yeah, exactly. And so there's certain things like when I ask you, how are you today? Well, if you're, you know, overheated and you feel like you're about to pass out, that's going to be at the top of your list the driving factor, for sure.

Dr. Ayla Wolf DAOM, L.Ac: 8:00

Yeah, you're not going to say I feel great, unless you're just straight up lying to me.

Sophia Bouwens L.Ac.: 8:03

If I'm in that condition. But if I'm in a different condition, I might feel great and tell you that and I'll be able to notice in my body I have a calm heart rate, my breathing feels good, a state of balance. Dysautonomia is marked often by high anxiety and I think a lot of that is because that internal state feels really off.

Dr. Ayla Wolf DAOM, L.Ac: 8:22

Yeah, and it can be off in kind of a vague way so that when you ask somebody with dysautonomia how are you, they might just have this sense of not being well right. Maybe they feel tired, maybe they have a little bit of mild nausea, maybe they are either too hot or too cold, maybe they feel a little anxious in this kind of vague way where it's not necessarily related to any one thing that happened. It's just this kind of vague way where it's not necessarily related to any one thing that happened. It's just this kind of vague sense of restlessness.

Sophia Bouwens L.Ac.: 8:48

Yeah, like what are some of the main symptoms of this dysautonomia, what you just listed? Are there other things that come up or get categorized?

Dr. Ayla Wolf DAOM, L.Ac: 10:00

Yeah, the complexity of dysautonomia, because if we're saying dysautonomia is a dysregulation of the autonomic nervous system, well then we have to ask the next question, which is well, what are the functions of the autonomic nervous system?

Sophia Bouwens L.Ac.: 10:20

Well, that's a great question. What are the functions of the autonomic nervous system?

Dr. Ayla Wolf DAOM, L.Ac: 10:25

I think it's easiest to break it into categories of function. And then, when you break it into the categories, then you can start to look at well, what does this do? So if we look at, say, cardiovascular function, if somebody has dysautonomia and it's very much affecting their cardiovascular system, they're probably going to say that they either have a racing heart and that can be at random times. They might just be sitting on the couch and all of a sudden their heart starts racing, or they walk up their short flight of stairs, which normally would be no big deal, but all of a sudden they walk up their stairs and they feel like their heart is racing. Yeah, and then some people have heart palpitations where it almost just feels like it's skipping a beat. I always liken heart palpitations to like a submersible pump water pump in a fish tank where, like when the water gets too low, all of a sudden that pump starts cavitating.

Dr. Ayla Wolf DAOM, L.Ac: 11:18

Yeah, and like that's how I feel, like you, like, that's how I like to describe heart palpitations. And then other people can have what I call increased heartbeat awareness, where their heart feels like it's pounding in their chest, but it's not. It may not be pounding fast, so it's not necessarily that the speed is abnormal, but it's the sensation of the heart is strong.

Dr. Ayla Wolf DAOM, L.Ac: 11:39

That awareness becomes really heightened, yeah, and you know, like if you just started sprinting and you were running sprints uphill, when you stop your heart's going to be fast and it's going to be pounding and that's going to be normal, and so you wouldn't necessarily feel anxious, because you know, like I was just sprinting uphill, of course my heart is going to be pounding and it's going to be fast, but if you're sitting on the couch watching a really calm documentary and all of a sudden your heart starts racing like that it feels like it is racing like that.

Sophia Bouwens L.Ac.: 12:09

It might cause some worry.

Dr. Ayla Wolf DAOM, L.Ac: 12:10

That can definitely make people feel anxious. And then, of course, you know there's a lot of other cardiovascular symptoms, like people can actually have chest pain, they can have dizziness or a feeling of lightheadedness because when they go to stand up maybe again their heart is beating really fast or maybe their blood pressure is dropping, or, you know, people can have all these different changes in heart rate and blood pressure that can lead to dizziness and lightheadedness and even fainting. And so there's all of these kind of symptoms that come with orthostatic intolerance and the cardiovascular system not responding appropriately to somebody changing position.

Dr. Ayla Wolf DAOM, L.Ac: 12:46

And commonly people will get diagnosed with POTS for this reason, right, because of this component, yes, and so we'll circle back to POTS, because a lot of people are kind of equating dysautonomia to POTS, when really, if we look at dysautonomia as this big umbrella, pots is just one component, well-defined subcategory that falls underneath the dysautonomia umbrella, but it's not all forms of dysautonomia, and so I certainly have had actually more and more, because I think a lot of people on TikTok and YouTube are talking about POTS- it's kind of become the new popular diagnosis and so a lot of people are talking about it.

Dr. Ayla Wolf DAOM, L.Ac: 13:30

But I've definitely had patients come to me and say I think I have POTS and when I run them through a ton of autonomic testing I'm like, well, you do have something wrong with you, but it's not POTS. That's not how this is presenting.

Sophia Bouwens L.Ac.: 13:41

There's more. Let's come back to that.

Dr. Ayla Wolf DAOM, L.Ac: 13:43

Let's put a pin in that for a second because you before that there's multiple systems that this can show up in, and started with the cardiovascular system. What are other systems that this dysautonomia can show up in? So the next one is the respiratory system, and so that involves, obviously, breathing, but also the ability of our body to regulate the balance between oxygen and carbon dioxide, and so that's really important too, and when people have poor carbon dioxide regulation and that gets out of balance, that can cause a lot of symptoms too in terms of breathlessness and lightheadedness. And so when we think about this whole picture of anxiety and restlessness in the body, there's just so many things that when they're off within the autonomic nervous system, then they cause you to feel anxious and restless.

Sophia Bouwens L.Ac.: 14:33

I could see that leading into other diagnoses like fibromyalgia or Raynaud's or just ways that their circulation or oxygen delivery isn't getting places. And it's not to say that those diagnoses are always a dysautonomia. But some of what you're talking about makes me think about those conditions, because you see these vague but also really diffuse symptoms.

Dr. Ayla Wolf DAOM, L.Ac: 14:58

Well, and Raynaud's really is a, you know, a dysautonomia. There's a lot of existing disorders or diseases that really do have dysautonomia as kind of like this comorbidity or kind of coexisting with them, and so, yeah, we can get into that too. But like, for example, CRPS, complex regional pain syndrome you know, that's kind of a form of dysautonomia. And then we look at, you know, small fiber neuropathy that's present in diabetes and that's kind of a form of this dysautonomia coexisting with diabetes. We also have like Sjogren's, which is an autoimmune disorder, and so classically people have dry mouth and dry eyes. But there's kind of a whole nother aspect of Sjogren's that is maybe an atypical presentation that doesn't necessarily have the dry mouth and dry eyes as the main symptom.

Dr. Ayla Wolf DAOM, L.Ac: 15:52

It's actually people have more of like this fatigue and muscle pain and joint pain and difficulty breathing, and so there's this whole feeling wrong because this autonomic nervous system Exactly yeah, so there's a lot of, I think, disorders and diseases that people are familiar with that don't, but maybe they don't even recognize that the dysautonomia is really wrapped up in that.

Sophia Bouwens L.Ac.: 16:14

It's a component of that.

Dr. Ayla Wolf DAOM, L.Ac: 16:15

It's a component of it, exactly.

Sophia Bouwens L.Ac.: 16:17

So we have the cardiovascular, the respiratory.

Dr. Ayla Wolf DAOM, L.Ac: 16:20

Yeah, so with the respiratory symptoms, a lot of people do feel like they, you know, breathe shallowly or they have difficulty taking a full breath. They also might report that their symptoms are worse with changes in barometric pressure as a response to kind of perfusion in the body. Sure, and then I would say that one of the huge categories is digestion, and when I I mean, I taught a dysautonomia class way back in, I think, 2017, and I presented basically three cases side by side, which were all young women, who all complained of nausea and loss of appetite as like their primary complaints. And then when I examined them, it turned out that all of them had POTS, and so they basically all presented with dysautonomia. And because their main complaint was nausea, I think every other doctor they went to were just looking at it symptomatically as opposed to looking at the big picture to say, well, what's driving the nausea?

Sophia Bouwens L.Ac.: 17:21

Functionally what's going on? So POTS can be this orthostatic imbalance you feel, but it shows up as many other things too. But it is a clearly defined diagnosis, which is not the case for all dysautonomias.

Dr. Ayla Wolf DAOM, L.Ac: 17:34

No, and that's what's confusing to people is, you know, you can have POTS and then you can have, say, somebody gets a concussion and maybe they don't develop POTS but maybe they develop dysautonomia that manifests in a completely different way in terms of like migraine headaches and orthostatic intolerance, where when they go to stand up again, they feel lightheaded, their maybe headaches get worse, they then have nausea. So you can have these other dysautonomia symptoms that come on after a concussion that don't necessarily fit into a classic POTS diagnosis, that don't necessarily fit into a classic POTS diagnosis, and so they are almost a bit more vague. You know it's a more vague presentation of dysautonomia, but it's just as important nonetheless to identify and there's ways of doing that.

Sophia Bouwens L.Ac.: 18:21

There's a lot of complexities in this. So the gastrointestinal symptoms you described make sense, because we hear about this as rest and digest, so, of course, digestion. Are there other symptoms or systems that we see we're commonly with?

Dr. Ayla Wolf DAOM, L.Ac: 18:35

Yeah, and I mean going back to digestion real quick. You know I mentioned nausea as being a big one, but a lot of people you know will report that after they eat they might actually feel like they have tachycardia or their heart is beating. Or we know that a lot of people with dysautonomia can actually have pooling of blood in their pelvic cavity, Because when you do eat, your blood goes to your stomach to help you rest and digest, right, but then when you start to get up and move around and do other things, it's almost like your autonomic nervous system is still stuck in rest and digest and it's not controlling blood flow properly and so you can have this kind of pooling of blood in the abdominal cavity. That feels uncomfortable and causes these other symptoms too, Because if your blood is pooling down below, that means it's not getting to your brain and that's going to cause problems as well.

Dr. Ayla Wolf DAOM, L.Ac: 19:24

So, but I mean people can have I mean vomiting and, like you know, really bad nausea plus vomiting. They can have changes in bowel movements, a lot of bloating, People can have food sensitivities and just like general sense of abdominal pain or abdominal tension, and then some people also report that they will start choking on, like if they have to swallow pills, they'll start choking on pills and actually have kind of a loss of the gag reflex. Yeah, choking on pills and actually have kind of a loss of the gag reflex. So there's a lot of other symptoms too. That, of course, each of these symptoms by itself doesn't necessarily mean oh, you have dysautonomia.

Sophia Bouwens L.Ac.: 19:59

But if I hand somebody a list of, say, 100 symptoms and they're checking every single box in my questionnaire I start to, then you know, it makes some sense, right, and I think a lot of people have a form of dysautonomia or there's some dysautonomic regulation, so it can happen on its own. It can happen as a response to trauma, some disruption, a concussion, or it can happen as part of something else going on.

Dr. Ayla Wolf DAOM, L.Ac: 20:25

Yeah. So we can kind of break it up into either like a primary type so, for example, multiple systems atrophy is a neurodegenerative disorder that is a primary form of dysautonomia. Then we have these secondary forms of dysautonomia that are a result of, say, a concussion, or I mean POTS, for example, can actually come on as a result of a surgical trauma. I've had a patient that that was the case for her. And then we can also now have, you know, POTS, I think has become more popular because it has become a side effect of COVID, and so you can have post-viral dysautonomias, you can have post-surgical dysautonomia, you can have dysautonomia as a result of a brain injury. So those would all be secondary types. And then there's, you know, the idiopathic dysautonomias, where they just are not quite sure what's driving the process, and then those kind of coexisting ones that we already talked about.

Sophia Bouwens L.Ac.: 21:22

Right. So this is an interesting thing because I think a lot of times people will break it down and say well, dysautonomia means that your sympathetic nervous system is in overdrive, so we need to stimulate your parasympathetic or your vagus nerve to get you into better balance, right? So there's all these vagal hacks to help with these dysautonomias. Why might that not be the full picture?

Dr. Ayla Wolf DAOM, L.Ac: 21:45

Because in some cases people aren't having a proper sympathetic response. It's not that their sympathetic nervous system is stuck in overdrive. For some people it's the exact opposite. Their sympathetic is not responding appropriately. It's actually they don't have enough sympathetic output. And then so in some cases the parasympathetic nervous system is not necessarily the problem. It's not the thing that isn't working. The problem, it's not the thing that isn't working. And so to try to simplify dysautonomia, to say that it's always too much sympathetic activity and not enough parasympathetic, that's just simply not true, and so we can't say that that is the case for everybody and we can't jump to that conclusion for anybody. And so just simply doing vagal nerve stimulation is not the solution, it's not the appropriate response. Because if you haven't had all the proper tests done to see, do I have the right sympathetic output, you know what is my parasympathetic nervous system doing. You know those tests are important to be able to understand what category each individual person falls into, to then know what is the appropriate treatment.

Sophia Bouwens L.Ac.: 22:55

And so some of these conditions, like POTS, have clearly defined testing and parameters. What might be some other types of testing that we would do to gauge the autonomic nervous system functioning or not functioning well?

Dr. Ayla Wolf DAOM, L.Ac: 23:08

We can look at the pupils and we can look at how the pupils respond to light in terms of what is the rate of constriction of the pupil when you flash a light in the eye, and then also how long does it take for the pupil to dilate again. So we call that the 75% recovery time of what was the original pupil size. What did it constrict down to? And then how long did it take to then get back to 75% of the original size? And so we have these very well-established parameters to say we know how the pupil constriction is mediated as a parasympathetic response, and we know that dilation is a sympathetic response. And so we can look at the pupil to just say what does the orchestration of the autonomic nervous system look like with this one reflex which is so powerful?

Sophia Bouwens L.Ac.: 24:01

And how are these partners dancing and who might be misstepping and where?

Dr. Ayla Wolf DAOM, L.Ac: 24:05

Exactly.

Sophia Bouwens L.Ac.: 24:05

Yeah, gives us insight into the pupil dilation and constriction.

Dr. Ayla Wolf DAOM, L.Ac: 24:09

So that's one of them. And then you can also look at a Valsalva maneuver. So if somebody is, you know, holding their breath and bearing down, like right when you sneeze, you have that internal pressure right. So when we do a Valsalva maneuver, there's also this kind of response by the heart rate and the blood pressure in response to that increased pressure. And so Valsalva is another way of looking at, you know, is the system responding appropriately?

Sophia Bouwens L.Ac.: 24:37

So checking all these measures. That part of the nervous system governs, right. So blood pressure pupil dilation.

Dr. Ayla Wolf DAOM, L.Ac: 24:44

I would say that the other kind of bedside test that's really valuable for understanding, if there's enough sympathetic output, is looking at this five-minute sustained hand grip test where you find somebody's max grip strength. You take 30% of that and then they have to hold that for five minutes.

Sophia Bouwens L.Ac.: 25:03

I love that test. I think there was a paper that you got really excited about when you first brought that to my attention how they had correlated it really strongly with dysautonomia.

Dr. Ayla Wolf DAOM, L.Ac: 25:16

So this has been around for a long time, but I almost feel like it didn't get popular enough, and part of the problem is again, like our modern medical system really relies on lab work and imaging right, and so they don't often throw in a lot of these. You know, bedside tests that take five minutes, where you're having to look at blood pressure and heart rate over and over again and make somebody grip this thing right.

Sophia Bouwens L.Ac.: 25:41

And also if you have a 15-minute increment with someone and you're going to have them sit there for five minutes, it's like a third of your time with them and you have so much to get through.

Dr. Ayla Wolf DAOM, L.Ac: 25:49

Right, yeah, and so that's where you know. I think if medicine got better at doing more screenings to like. There's the Compass 31 questionnaire. For example, one of my teachers he basically just said you know, I have all my patients fill out the Compass 31. And if they don't score very high on this, then I know that I don't necessarily need to spend an hour assessing their autonomic nervous system. If they can actually go through this questionnaire, and they don't, they don't have very many of these symptoms, right, and so you know, for me. That's why I also love my symptom checklist, which is maybe, you know, a lot more than the compass, but I love to gather information. Yes, you do so. Yeah, it's that same concept of like. If we just did more screenings, you know, this would probably get caught more.

Sophia Bouwens L.Ac.: 26:37

And be better treated, because we can maybe see how and where the complexities are happening right.

Dr. Ayla Wolf DAOM, L.Ac: 26:44

Yes, and because it is so complex and there can be a lot of different drivers for you know, like what is causing the dysautonomia, treatment is definitely not straightforward and it's not easy and it's not simple, it's really complex stuff, which is why I think a lot of people just kind of like they're like goes. So we have the cardiovascular system, the respiratory system.

Sophia Bouwens L.Ac.: 27:11

We have the digestive system. Are there other systems that you would name or involve?

Dr. Ayla Wolf DAOM, L.Ac: 27:18

Yeah, one of the things that is also, I think, important to differentiate is that you know I mentioned the autonomic nervous system is in charge of these beat to beat adjustments, but it also has, like long term control over our immune system and also our circadian rhythms. And so a lot of times when people have dysautonomia, they also have immune system imbalances. There's a lot of kind of coexisting autoimmunity that can happen with dysautonomia and even just beyond that. People can have frequent colds and flus, or they might even have mild fevers, they can have chronic fatigue or even unexplained vertigo. That might actually be associated with some kind of autoimmune imbalance because of the dysautonomia. So it can get pretty complex in that regard. And then, because of the fact that it is involved in their circadian rhythms, a lot of people also have very poor sleep because the circadian rhythms are affected.

Dr. Ayla Wolf DAOM, L.Ac: 28:14

And then we mentioned sweating too, and so, again, the sympathetic nervous system is responsible for sweating. So some people might say they sweat way too much. Other people might say they can't sweat at all. A lot of people say that they have heat intolerance. Right, if you can't sweat, if you can't vent your heat, then you're going to have a lot of heat intolerance.

Sophia Bouwens L.Ac.: 28:35

You can't stand heat. Yes for sure.

Dr. Ayla Wolf DAOM, L.Ac: 28:37

And so that's where you know a lot of people are talking about. You know the use of saunas being so helpful as well, and you know usually I pay attention and even like 20 years ago when I was first learning Chinese medicine, you know they would teach you. It's like you're feeling your patient's pulses. But how do their hands feel? Are their hands super clammy and wet? Are they super hot? Are they super cold? I mean just like the temperature of somebody's hands and the moisture content can tell you a lot.

Sophia Bouwens L.Ac.: 29:06

And I think that Chinese medicine tunes into the autonomic nervous system way more than we realize.

Dr. Ayla Wolf DAOM, L.Ac: 29:11

Yeah, I mean the language of Chinese medicine. It really is a language of function and balance. I mean that's really what it is. It's a language of what are the different functions and the original word for sympathetic the reason why they called it the sympathetic nervous system is that that word actually came from people back in I don't know the 1800s, saying you know, we think there's this nervous system that is sympathetic to the other organs.

Dr. Ayla Wolf DAOM, L.Ac: 29:38

Like these organs are sympathetic to each other. Yeah, they pay attention to conditions. Yeah, the organs are like paying attention to what is happening with the other organs, and so we have this nervous system. That's like communicating between the internal organs and sympathizing with them.

Sophia Bouwens L.Ac.: 29:52

That's where it came from and the dysautonomia is the difficulty in the sympathizing and adjusting. It's a difficulty with the sympathizing.

Dr. Ayla Wolf DAOM, L.Ac: 29:59

Yes, the hardest like not sympathizing appropriately with what's happening with the kidneys and the blood pressure.

Sophia Bouwens L.Ac.: 30:06

What else needs to happen.

Dr. Ayla Wolf DAOM, L.Ac: 30:07

Yeah.

Sophia Bouwens L.Ac.: 30:08

Okay, so there's so many different symptoms. Are there more even that you would note?

Dr. Ayla Wolf DAOM, L.Ac: 30:13

Yeah, so a lot of the peripheral nerves are involved, because obviously our peripheral nerves are bundles of sensory, motor and autonomic fibers.

Sophia Bouwens L.Ac.: 30:22

And peripheral, being the ones far away from the center of our body.

Dr. Ayla Wolf DAOM, L.Ac: 30:26

The nerves that don't directly go into the brain or the central nervous system.

Sophia Bouwens L.Ac.: 30:29

Outside of the central nervous system. Yeah, on the outside.

Dr. Ayla Wolf DAOM, L.Ac: 30:32

And so because of that, a lot of people can have numbness and tingling. And the key there is a lot of times it moves around, so like, if you've got carpal tunnel, your numbness and tingling is really in one place. It stays in the same place.

Dr. Ayla Wolf DAOM, L.Ac: 30:48

A lot of people with dysautonomia can actually have numbness and tingling that moves around and doesn't necessarily follow a clear pattern, but people can complain about generalized weakness, about kind of random muscle soreness or joint pain. That doesn't seem to really make sense. A lot of people will say that they feel shaky or they have this sense that they're like internally they're kind of shaking and sometimes I can feel that and sometimes I can't. You know, somebody says that they feel like they're shaky and sometimes they hold out their hand and you can literally see their hand shaking. Sometimes you can't see the shaking, but when you put your hands on their feet, for example, all of a sudden you can just feel the whole body is vibrating. So the shakiness is real. So that's a common thing.

Dr. Ayla Wolf DAOM, L.Ac: 31:33

And then a lot of times you know, especially with concussions, exercise intolerance is a form of orthostatic intolerance, because usually you're upright right but obviously there's a lot of exercise that can be done on your back or in other different positions, upside down, whatever but exercise intolerance is again the inability to have the right autonomic response to the fact that you are now using your muscles and you're trying to exert energy in a way where you need to shunt blood to your muscles, and so if your body is failing to do that appropriately, people are going to have things like, you know nausea, headaches, lightheadedness, dizziness, fatigue, maybe tachycardia, and so the exercise intolerance one I would say in the world of kind of sports concussions is huge, because if you're an athlete and you can't do your sport.

Sophia Bouwens L.Ac.: 32:25

That's a problem.

Dr. Ayla Wolf DAOM, L.Ac: 32:27

And so exercise intolerance is kind of a big you know. I would say it's well described as far as a form of dysautonomia. We also have the Buffalo treadmill test, which is a very, you know now, well-established means of kind of categorizing that. So that's another important one too sure are there others.

Sophia Bouwens L.Ac.: 32:48

I mean this. The list goes on, doesn't it?

Dr. Ayla Wolf DAOM, L.Ac: 32:50

there's so many well, I mean, I think, those that you can definitely have, um, urinary functions, so different changes in bladder control. A lot of people that I work with with dysautonomia they say that they have to go to the bathroom like all the time. Frequent urination, right, um, and then some people might say they actually have difficulty like initiating urination too. So changes in bladder function, changes in bowel function, and then there are cognitive and emotional symptoms too, like we mentioned, a lot of times people feel a sense of agitation, restlessness, anxiousness.

Dr. Ayla Wolf DAOM, L.Ac: 33:25

You know, I know for me I had maybe some mild dysautonomia with all of my different concussions, but one of the things I really felt was that if I ever had to wait in line, I would start to get very anxious and restless. And I think for me that was a bit of this like orthostatic intolerance, where I had to stand upright in a line, not moving, and so I would constantly be like shifting my feet and I'd feel agitated the longer I had to stand there. And so I think, you know, for me there was a long period of time where I didn't understand why I was so restless and agitated and anxious and uncomfortable in my own body, and it was probably because I had dysautonomia, and I just didn't know it at the time.

Sophia Bouwens L.Ac.: 34:09

It was just coming out as this like restlessness or irritability, so it could be seen as different.

Dr. Ayla Wolf DAOM, L.Ac: 34:15

And obviously, you know, the autonomic nervous system is supposed to send blood to the area that needs it the most, and that's true for the brain as well. So if we're trying to perform cognitive activities that require us to shunt blood to our frontal lobe and our autonomic nervous system is failing to do that, well then we're going to have brain fog and difficulty focusing and concentrating. People can even have blurry vision as a result of dysautonomia because of blood flow issues. So there's tons of you know, like cognitive and emotional things that are associated with it as a result of the autonomic nervous system failing to shunt blood to where it's needed in the moment.

Sophia Bouwens L.Ac.: 34:56

So this is one of the reasons I was so excited to dive into this conversation. I think we just scratched the surface too. It's such a big one and it's really misunderstood because it is very complex and it gets oversimplified incredibly into this rest and digest, imbalance, fight or flight and then over put into like, well, we just need to stimulate your vagus nerve and you're going to be OK. I wonder we'll maybe do some more episodes on different caveats of this. But are there main takeaways that you want our audience members to know from this initial conversation? But are there main takeaways that you want our audience members to know from this initial conversation?

Dr. Ayla Wolf DAOM, L.Ac: 35:28

Yeah, I would say the main takeaways are kind of what you described is that dysautonomia is actually very complex and it does not automatically mean that the parasympathetic system needs to be stimulated or like that, vagal nerve stimulation is the answer to everything, because it's not so. That's a huge takeaway is that people really need to get properly assessed and evaluated to understand exactly how the dysautonomia is manifesting for that individual person and they need to be able to work with a provider who understands how to also then triangulate other issues that might be driving the dysautonomia, then triangulate other issues that might be driving the dysautonomia. So you know, the ocular motor system. If there's imbalances there that can drive dysautonomia. If there are vestibular imbalances, the vestibular system fires so heavily into the brainstem If that system is sending you error messages. It's the equivalent of living in a house with a fire alarm going off.

Sophia Bouwens L.Ac.: 36:27

All the time.

Dr. Ayla Wolf DAOM, L.Ac: 36:33

And so we have to recognize that when there are problems with the functioning of the vestibular system, the cerebellum, the you know the frontal lobes, the ocular motor system, the immune system, all of these things can drive dysautonomia. And so we have to look at it from a very individualized perspective to say what is going on with this one particular person and what are what's the best path forward in terms of, you know, addressing some of the drivers for that individual. And and then what do we need to do to not only manage their symptoms but then also treat the problems?

Sophia Bouwens L.Ac.: 37:02

The driving cause yeah Right, yeah Bigger picture.

Dr. Ayla Wolf DAOM, L.Ac: 37:06

So that's, that's kind of like. The big takeaway is that this is way more complex than TikTok would make you think right Absolutely, and that vagal nerve stimulation is not the answer to everything. And then I would say, like next time we can actually do a deeper dive into POTS because there's a lot of fascinating data on POTS.

Dr. Ayla Wolf DAOM, L.Ac: 37:27

Has really predictable measures, we know yeah, I mean, the one good thing about like awareness around it growing is the fact that up until now, a lot of people that suffer from pots often have to go for many, many months to years before they get the right diagnosis, and so I'm hoping that now that just everybody is kind of more aware of it, that maybe the actual screenings will happen better or more frequently and that people won't have to wait three or four years before somebody figures out that that's what they're dealing with.

Sophia Bouwens L.Ac.: 37:58

Well, let's dive into that next episode we do, just on exactly what those screenings are and some of these complexities with POTS, to understand even more this dysregulation of this autonomic nervous system. Perfect, yeah, let's do it All right, stay tuned.

Dr. Ayla Wolf DAOM, L.Ac: 38:17

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