What to do when you can't avoid a trigger

These are things to either avoid if possible. If you can't avoid them, then the challenge is to figure out things to do that will help control how much they affect your orthostatic problem.

Stressors that don't last long

Most of the stressors listed here are "short-acting". That means they affect you at the time but the effect on the orthostatic symptoms goes away when the stressor goes away. For example, if you are standing up and get symptoms, the symptoms usually go away when you lie down.

How long a stressor will affect you

Some of the stressors have a longer effect. The effect may last for hours and even a day or two. The ones that last longer are 1) not getting enough fluids/salt (getting dehydrated), 2) getting hot, 3) certain medications and 4) menstrual cycle.

If the problem is fluids - it will last until you get more fluids in. Sometimes, it will take another 24 -48 hours for your body to readjust fluids, especially if you needed more than1 liter of IV fluids.

If you get hot, the effect on your orthostatic symptoms will last until your body cools down (or longer).For example, getting hot during exercising may only last until you cool off.

If you are hot for a longer period of time, the effect will last for hours.

If you are doing more bedrest - or lying flat in bed to read or watch TV, the effect will last longer. Check out "Manage Bedrest Better".


What to do when you have to do something that is an orthostatic stressor:

Because we live & do things standing up, it is impossible to avoid doing many things on these lists. For example, we have to go to the bathroom! We have to go outside when the temperature is high. We need to do some activity for our recovery program.

There are things that can be done that will limit how much these things will affect the orthostatic problem. For some of them, if you know you will be doing them, you can take steps to control the orthostatic stress. Use as many of these as you need to get under control.


Things you can do to reduce how much a trigger affects you:

    —  Compression Garments

    —  The Water Trick

    —  Energy Savers

    —  Tricks to Avoid Getting Dizzy.


Triggering a Flare-Up

If the "stressor" lasts longer than a few hours and your worse symptoms last into the next day, you may be starting a "flare-up" when you are getting more symptoms or what you usually do isn't working as well as it used to. For more information about what to do when a "flare-up" happens, go to "Handling Flare-Ups".

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  2. Freeman, Roy. Neurogenic orthostatic hypotension.NEJM 2008;358(6):615-624. Abstract #90
  3. Medow MS, Stewart JM, Sanyal S, Mumtaz A, Stca D and Frishman WH. Pathophysiology, Diagnosis, and Treatment of Orthostatic Hypotension and Vasovagal Syncope. Cardiology in Review 2008;16(1):4-20. Abstract. #103
  4. Low PA, Sandroni P, Joyner and Shen W. Postural Tachycardia Syndrome (POTS). J Cardopvasc Electrophysiology 2009; 20:352-358.  Abstract.  Article PDF
  5. Rowe, Peter.  General Information Brochure on Orthostatic Intolerance and Its Treatment. June 2010. Accessed from http://www.cfids.org/webinar/cfsinfo2010.pdf. Accessed May 28.2012.
  6. Rowe, Peter. Managing Orthostatic Intolerance. Webinar. September 1, 2010. Hosted by CFIDS Association of American. Accessed June 1, 2012.  Written material.  Slides PDF.   Video.

Author: Kay E. Jewell, MD
Page Last Updated: July 8, 2012