When Symptoms Don’t Seem to Fit: Exploring the Autonomic Nervous System

Understanding dysautonomia, perimenopause, long COVID, and POTS—and four gentle ways to support nervous system regulation.

October 26, 2026 · By Dr. Kirstin Sweet, ND

Have you ever experienced symptoms that seem completely unrelated? Perhaps your heart races when you stand, you're exhausted despite sleeping, your digestion has changed, or your temperature seems impossible to regulate. You may have been told your laboratory results look normal, or that you're simply stressed.

What if another piece of the puzzle is worth exploring? Your autonomic nervous system quietly coordinates many of the functions keeping your body running. Understanding it may help explain why symptoms sometimes appear across different body systems.

What is dysautonomia?

Your heart beats, your blood vessels adjust when you stand, and your digestive tract moves food along—all without conscious effort. These processes are regulated in part by the autonomic nervous system (ANS). Dysautonomia is an umbrella term for disorders of this automatic regulation, not one single disease.

Depending on the condition, symptoms can include dizziness on standing, palpitations, fatigue, brain fog, digestive changes, temperature intolerance, unusual sweating, exercise intolerance, or disturbed sleep.

The vagus nerve and your body's changing needs

The vagus nerve travels from the brainstem through the neck and into the chest and abdomen. It helps carry signals involved in heart, digestive, and other functions.

One familiar analogy describes the sympathetic nervous system as a gas pedal, preparing us for activity and challenge, and the parasympathetic nervous system as a brake, supporting rest and digestion. The vagus nerve is an important parasympathetic pathway. In reality these systems cooperate in complex ways; neither is inherently bad.

What does “vagal tone” mean?

Vagal tone broadly describes aspects of vagal influence, especially on cardiovascular regulation. Some measures of heart rate variability (HRV) can reflect parasympathetic influences on the heart, but a wearable HRV number cannot directly measure your entire vagus nerve or diagnose dysautonomia. [1]

Three different conditions, overlapping questions

Perimenopause: hormones affect more than reproduction

Changes in estrogen signaling during the menopausal transition influence temperature regulation, sleep, and cardiovascular and autonomic function. Hot flashes, palpitations, disrupted sleep, and mood changes may overlap with autonomic symptoms. Perimenopause itself is not dysautonomia, but considering hormonal, metabolic, cardiovascular, and nervous system factors together can be useful. [2]

Long COVID: when recovery takes longer

Some people experience persistent fatigue, brain fog, palpitations, dizziness, or exercise intolerance following COVID-19. Autonomic dysfunction—including orthostatic intolerance and sometimes POTS—has been identified in a subset of patients. Long COVID is complex, however, and cannot simply be reduced to a body stuck in fight-or-flight mode. [3]

Some patients experience post-exertional malaise: symptoms worsen after physical or cognitive exertion. In those circumstances, pushing through fatigue or beginning a conventional exercise program can worsen symptoms. Activity plans must be individualized.

POTS: when standing becomes a challenge

Postural Orthostatic Tachycardia Syndrome (POTS) involves symptoms of orthostatic intolerance and an excessive sustained rise in heart rate upon standing. In adults, a heart-rate rise of at least 30 beats per minute within 10 minutes is one diagnostic criterion, but diagnosis requires additional evaluation and exclusion of other explanations. [4]

Blood pooling, altered blood volume, vascular regulation, and increased sympathetic activity in some individuals can contribute. It is not the same mechanism for every patient. Standing in line, showering, or preparing a meal can become difficult.

Other ways autonomic regulation may show up

Digestive disturbances, altered sweating, temperature sensitivity, migraines, and some autoimmune conditions may involve autonomic pathways. That does not mean every symptom is caused by dysautonomia. The goal isn't to force every symptom into one label; it's to understand the individual and the relationships among their symptoms.

Four gentle practices for nervous system regulation

These techniques may support relaxation and body awareness. They are not substitutes for diagnosing or treating dysautonomia, and not every technique will suit every person.

1. The physiological sigh

1. Inhale comfortably through your nose.
2. Before exhaling, take a small second inhale.
3. Exhale slowly through your mouth.
4. Return to natural breathing and notice how you feel.

A randomized study of daily structured breathing practices found improvements in mood and respiratory rate with cyclic sighing. This does not establish that a single sigh treats an autonomic disorder. [5]

2. Gently lengthen your exhale

While seated comfortably, try inhaling for about four seconds and exhaling for about six, for one or two minutes if comfortable. Keep your breathing smooth and unforced. Research suggests slow breathing can influence heart rate and HRV, although the response varies. Stop if you feel dizzy or uncomfortable. [6]

3. Gentle eye-gaze exercise: Rosenberg-inspired

I learned an eye-gaze exercise during clinical training while navigating complex health symptoms myself. I still return to it when I feel out of balance, and patients have also told me they find it helpful.

Stanley Rosenberg describes a similar sustained eye-gaze practice in Accessing the Healing Power of the Vagus Nerve. [7]

1. Sit or lie comfortably with your head supported and facing forward.
2. Without moving your head, gently look to the right for up to 30 seconds, breathing naturally.
3. Return your eyes to center and relax.
4. Repeat while looking left. A sigh, swallow, or yawn may occur but is not required.

These practices are sometimes called vagus nerve “resets,” but there is not adequate evidence that they directly reset vagal function or treat dysautonomia. Avoid strain and stop with dizziness, visual discomfort, or other unpleasant symptoms.

4. Gentle ear massage inspired by Qigong

Another practice I enjoy comes from Qigong, a traditional Chinese approach incorporating mindful movement and breath.

1. Bring your hands toward your ears.
2. Separate your index and middle fingers on each hand to form a V.
3. Place each ear between those fingers, with one finger in front and one behind.
4. Gently move your hands up and down, massaging around the ears.
5. Continue for 30–60 seconds, using light pressure and breathing naturally.

Some regions of the external ear have sensory connections involving the vagus nerve, and researchers have studied specific forms of auricular stimulation. However, those studies do not establish that this particular self-massage directly stimulates the vagus nerve or treats dysautonomia. [8] Avoid painful, swollen, or irritated areas.

Small practices, greater awareness

These exercises are invitations to notice—not tests to pass. Perhaps your shoulders relax or breathing feels easier; perhaps a technique isn't helpful today. Your response matters. Sleep, illness, hormonal changes, hydration, and stress can all influence how you feel.

Looking beyond individual symptoms

One of the things I appreciate about naturopathic medicine is the opportunity to consider how hormones, metabolism, sleep, nutrition, cardiovascular health, and the nervous system influence one another. Sometimes symptoms need separate evaluations; other times recognizing relationships opens a more useful conversation.

That doesn't mean every symptom has one root cause or that lifestyle changes can resolve every condition. It means asking better questions, recognizing patterns, and developing an individualized plan.

Research & further reading

1. Laborde S, Mosley E, Thayer JF. Heart Rate Variability and Cardiac Vagal Tone in Psychophysiological Research. Front Psychol. 2017. Read.
2. Autonomic nervous system dysfunction throughout menopausal transition: A potential mechanism underpinning cardiovascular and cognitive alterations during female ageing. J Physiol. 2024. Read.
3. American College of Cardiology. 2022 Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults. JACC. Read.
4. Raj SR, et al. Diagnosis and management of postural orthostatic tachycardia syndrome. CMAJ. 2022. Read.
5. Balban MY, et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Rep Med. 2023. Read.
6. Laborde S, et al. Effects of voluntary slow breathing on heart rate and heart rate variability: A systematic review and a meta-analysis. Neurosci Biobehav Rev. 2022. Read.
7. Rosenberg S. Accessing the Healing Power of the Vagus Nerve. North Atlantic Books; 2017. This describes a practice, not a clinical trial of efficacy.
8. Butt MF, et al. The anatomical basis for transcutaneous auricular vagus nerve stimulation. J Anat. 2020. Read.

Educational note: This article is general education, not a diagnosis or individual treatment plan. New palpitations, dizziness, fainting, or significant exercise intolerance warrant medical evaluation. Seek emergency care for chest pain, severe breathing difficulty, or concerning fainting. POTS and other autonomic conditions may require specialized testing and coordinated care. Telehealth appointments are available only when you are physically located in a state where I am licensed to practice. I am currently licensed in Oregon.