Dysautonomia is a dysfunction of the autonomic nervous system (ANS), which controls automatic bodily functions like heart rate, blood pressure, and digestion. In Long COVID, the virus appears to damage or interfere with the proper functioning of the ANS, particularly by causing an overactive sympathetic (“fight-or-flight”) response and an underactive parasympathetic (“rest and digest”) response. This autonomic imbalance contributes to many Long COVID symptoms including fatigue, brain fog, irregular heart rate, dizziness, and digestive problems.

Common dysautonomia symptoms include dizziness when standing up, rapid or irregular heartbeat, fatigue, brain fog, digestive problems, and temperature regulation issues. You might also experience headaches, trouble sleeping, tingling sensations, coat hanger pain (pain in head, neck and shoulders), shortness of breath, cold hands or feet, anxiety, and sensory changes like abnormal taste and smell. If you’re experiencing multiple symptoms across different body systems that worsen with physical exertion, dysautonomia may be a contributing factor.

Several treatments that target dysautonomia have shown promise, including Stellate Ganglion Block (SGB), Vagus Nerve Stimulation (VNS), and Epipharyngeal Abrasive Therapy (EAT). SGB has been particularly effective for symptoms like brain fog, smell/taste disturbances, and chronic fatigue. Medications that may help include beta blockers, fludrocortisone, and pyridostigmine. Treatment is highly individualized and often requires a combination approach targeting multiple aspects of the condition.

This symptom is called Post-Exertional Malaise (PEM), which is common in Long COVID-related dysautonomia. When you have dysautonomia, your body struggles to properly regulate energy distribution and recovery after activity. Your autonomic nervous system doesn’t “refuel” properly after exertion, leading to a crash that can last for days, weeks, or even longer. This is why carefully paced, gradual activity rather than pushing through fatigue is recommended for recovery.

Recovery from Long COVID dysautonomia typically takes several months, and improvement usually happens gradually rather than immediately following treatment. The book notes that recovery is unlikely to occur within hours, days, or even weeks. Many patients see progressive improvement with appropriate treatment, but patience and consistency are essential. The timeline varies significantly between individuals, depending on severity, pre-existing conditions, and how promptly treatment is initiated.

Yes, dysautonomia can explain the diverse, seemingly unrelated symptoms you’re experiencing. The autonomic nervous system controls many automatic functions throughout your body, including heart rate, blood pressure, digestion, temperature regulation, and more. When this system malfunctions, it can cause widespread effects across multiple body systems. This is why Long COVID is often described as a “multi-car pileup” – while there’s a common cause (autonomic dysfunction), each person experiences different symptoms requiring individualized treatment approaches.