The Supersyndrome | Part 3

The Link Between Hypermobility & Dysautonomia

Dr. Aaron Hartman

February 21, 2023

Hypermobility and Dysautonomia

What is Dysautonomia?

Dysautonomia is basically a dysregulation between the fight or flight (sympathetic) nervous system and the rest and digest (parasympathetic) nervous system. It’s a sympathetic overdrive and a parasympathetic underdrive.

Symptoms of Dysautonomia Include:

  • Dizziness
  • Lightheadedness
  • Fast heart rate
  • Low blood pressure
  • Edema
  • Slow gut transit

To understand the four phases of dysautonomia, we need to have a basic understanding of the vagus nerve. So, let’s begin there.

What is the Vagus Nerve?

Hypermobility and DysautonomiaThe vagus nerve runs from the brain to the organs, the GI tract, and various other areas of the body. It helps control the heart rate and regulates digestion. The body uses the vagus nerve to transmit information both ways, so this nerve also tells the brain what is going on in the organs. Your vagus nerve is the main rest and digest, calming nerve. When we take deep breaths through the belly, we are activating the vagus nerve. In medical school, I learned that, when people have a fast heart rate, giving a carotid massage can slow it down, because the massage activates the vagus nerve.

Now that we understand the basic function of the vagus nerve, let’s talk about the four phases of dysautonomia, which is a vagal tone dysfunction.

Four Phases of Dysautonomia

Hypermobility and Dysautonomia

Phase I

The first phase of dysautonomia is just a pure vagal tone dysfunction. This generally starts in the brain, sometimes with a concussion, head injury, or a traumatic event. In this case, blood pressure might be slightly low with a slightly higher pulse rate. The person might be experiencing mild anxiety. Some people remain in this phase one to four months and even never progress. Others do progress if additional stressors add burden to the body, such as living in a moldy building, gut issues, or nutrient deficiencies. Even triggers like tick bites can escalate dysautonomia from phase one to phase two.

Phase II

Phase two is basically relative hypovolemia, which just means low volume. As blood begins to pool in the feet, the person can experience mild edema, and their feet might look a little mottled. The kidneys respond to an increase in fluid, while the brain tries to get more blood flow. So the person would experience a higher heart rate, low blood pressure, and frequent urination. It’s almost like half of the body is not communicating with the other half. I’ll hear these patients say that they drink lots of water, but it goes right through them. That’s when I pause to consider whether they could have dysautonomia, perhaps related to hypermobility. When this low volume status is exacerbated, lower blood flow to the brain, gut, heart, and other organs results. Brain fog and poor sleep then follow. If there is an underlying pain syndrome, it can get worse, because of decreased blood flow to the muscles. Muscles fatigue more easily and can become somewhat achy in this phase.

Phase III

The next stage is metabolic dysfunction. It seems logical that the metabolism would slow down as a result of low blood flow. Blood pressure and blood sugar become more difficult to regulate. Mast cell activation syndrome (MCAS), metabolic syndrome, or even mitochondrial dysfunction can result. These patients are much more sick and experience a whole host of systemic symptoms.

Phase IV

This phase can begin 12 to 24 months after the first phase of dysautonomia. In phase four, some of the early hypermobility becomes worse and much more problematic. Loose joints become even more loose because connective tissue is not being repaired quite as well. The autonomic nervous system continues to malfunction and is so suppressed that these patients have difficulty in recovering from minor illness or anesthesia.

What about POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia, which I see frequently in my clinic.

There is a simple test you can do yourself to see if you might have POTS. It’s called the NASA Lean Test, and you can Google it and do it at home! Basically, you check your blood pressure and pulse after lying down for a few minutes. Then you sit up and check it again a couple of times. Then you stand against a wall and recheck it. If there is a significant change in blood pressure and/or pulse as your positioning changes, you may have POTS. There are other ways to assess for POTS as well, but this is a simple test that anyone can do at home.


These are the four stages of dysautonomia that I look for. They help me to gauge the seriousness of a patient’s illness and how aggressive I should be with interventions. There are many strategies I use when treating dyautonomia. I often use IV fluids, nutritional interventions, mind-body therapy, stress reduction, trauma therapy, gut protocols, sleep-wake cycles, and pain treatment if necessary.

One underlying common factor that I so often see along with dysautonomia is hypermobility. My goal in this post is to bring awareness to the link between hypermobility and dysautonomia.

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