Treating Orthostatic Intolerance in Chronic Fatigue Syndrome (ME/CFS)

Standing up is a largely unconscious activity for most people. For some people, however, this simple act can be fraught with peril; causing their heart to pound and their blood pressure to drop and leaving them dizzy, nauseous and fatigued. It turns out that standing is not simple not all. Just the act of rising requires that a complex set of interactions involving the nervous system, blood vessels, muscle and heart work smoothly to keep the blood from draining from out of our upper body into our lower body.

Orthostatic intolerance is a relatively new and evolving field and different forms of OI are being uncovered. Some people exhibit immediate drops in blood pressure upon standing (dysautonomia induced OI) for others it takes more time (vasovagal faint), instead of low blood pressure some people experience increased heart rates (postural tachycardia syndrome (POTS)) and a recently discovered group has problems with carbon dioxide elimination (POSH).

Do I Have Orthostatic Intolerance?

 Tilt table tests (if done correctly) can identify different forms of orthostatic intolerance but they’re not fool proof. One rather telling study found that most of the ME/CFS patients that seemed to ‘pass’ their tilt table tests still experienced worsening symptoms during one.

For those wishing to try their own ‘tilt table’ test. Dr. Bell provides one that can be done at home. In the end, though, the symptoms are the key. For some people the answer regarding whether they have OI is painfully obvious; standing immediately brings on dizziness, heart pounding, fatigue, difficulty concentrating and more.

For others with less dramatic symptoms the issue is a bit more clouded. A yes answer to any of the following questions suggests you could have some form of orthostatic intolerance.

  • Do your symptoms tend to worsen when you stand up or have to stand still for a period of time?
  • Are you a squirmer when you’re standing in line?
  • Do you feel that you think better or talk more clearly when you’re in a seated vs standing up?
  • Does bringing one leg up when you’re sitting for some reason just feel better?
  • Are you typically exhausted after meals?
  • Do warm showers bother you?
  • Does warm weather bother you?
If you have or feel you may have orthostatic intolerance check our the ‘Perils of Standing’ series on Phoenix Rising for information on treatment, types of OI, causes and more.

The ‘Perils of Standing’ Series on Phoenix Rising




{ 3 comments… read them below or add one }

Ann December 19, 2013 at 7:03 am

Just read this article and just learned that CFS is R/T orthostatic hypotension
I fainted a tilt test study (fainted in 7 minutes)
I become lightheaded everytime I stand up since age 12 but I know how to compensate.
My question is how is this R/T CFS? I have always felt as if I am more fatigued than the average person. Also feel like I have many symptoms of ADD. Lack if motivation, disorganization , absent minded. Is there a correlation?


Chris December 22, 2013 at 9:54 pm

Hi, Ann; I have commented on this in a Comment on Andrew’s good piece on the Autonomic Nervous System–read that in conjunction with Julia Newton, “Home orthostatic training in chronic fatigue syndrome-a randomized, placebo-controlled feasibility study,” 2010. I have been doing this for about 3 months or a bit more now, and it is definitely helping my OI . But be careful–heed the warnings well, particularly as you clearly are very vulnerable. And check with your doctor before trying.


Ann March 3, 2014 at 7:13 pm

My husband had a colonoscopy, in Hospital, when he was recovering,they said he could get up and dress, he fainted. Called the Crash Cart, all his vitals dropped. Took all day for his BP to come up to normal.


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