Do you find it difficult to relax?

Dysautonomia

Which explanations are relevant to you?

Dysautonomia refers to dysfunction of the Autonomic Nervous System (ANS).

Think of the ANS as your body’s autopilot. It regulates essential functions like heart rate, breathing, digestion, and temperature.

It constantly adjusts internal systems to keep the body in balance—whether you’re resting, digesting, sleeping, or facing a challenge.

It has two key branches that work in tandem:

Sympathetic Nervous System (SNS) – the body’s “fight, flight, or freeze” response.
Parasympathetic Nervous System (PNS) – the “rest, digest, and restore” mode.

The role of The Sympathetic Nervous System (SNS)

The SNS activates when the body detects a threat or stress. It gets us ready for action—whether that means running from danger or rising to meet a challenge.

From an evolutionary perspective, it made sense to be easily startled. A deer that runs every time it hears a rustle survives the one time it’s actually a predator. Our bodies have inherited that same “better safe than sorry” approach.

Today, however, the threats are different—emails, deadlines, traffic. But the body responds in the same way: with a rapid heartbeat, sweating, shallow breathing, overactive bladder and urgent bowel movements.

The role of The Parasympathetic Nervous System (PNS)

The PNS counterbalances the SNS. Its job is to bring the body back into a calm, restorative state. The vagus nerve—the longest nerve in the PNS—plays a key role, sending calming signals to the heart, lungs, gut, and other organs.

The vagus nerve is also key in regulating the amount of inflammation in the body (calming down inflammation) and in taking regulating what sensory information reaches the brain (one of the key pathways for interoception).

The role of the ANS in brain body communication

The ANS is a communication network that sends fast electrical signals between the brain and the body.

It helps adjust our internal state as we move through cycles of activity, rest, digestion, and sleep.

The ANS is involved in 2-way communication between the body and brain. The bottom-up signals carry information about the general metabolic and inflammatory condition of the body, along with as sensory information to the brain.

The top-down signals work largely in anticipation of future bodily needs: adjusting the bodily responses in line with what the brain thinks is about to happen. This means that symptoms that come from the ANS may not always be a reflection of real damage or danger. Instead symptoms can be a reflection of what the brain predicts is going to happen. This process can be part of how the predictive brain causes symptoms.

Showing symptoms of SNS activation and PNS activation

Notice which branch of the ANS is active

Dynamic Balance

Just like a car needs both gas and brakes, in the body the SNS and the PNS need to work together in balance.

When the two branches get out of balance, many systems of the body start to get dysregulated. This is why dysautonomia causes variable symptoms in many different parts of the body.

The typical pattern of dysautonomia causing symptoms:

ANS dysfunction can show up in many different ways. Everyone has a unique pattern in how their parasympathetic and sympathetic nervous systems interact and influence the symptoms they experience.

However, research shows that there is a typical general pattern of dysautonomia in stress-related conditions, such as burn out, and also in functional somatic symptoms.

This pattern can lead to a variety of symptoms across different systems:

Gastrointestinal symptoms: Difficulty digesting food, bloating, and irregular bowel movements, often due to poor PNS activation and reduced digestive function.
Sleep disturbances: Due to low PNS tone, which affects the body’s ability to relax and restore during sleep.
Fatigue and mental fog: A combination of high SNS activity (leading to mental and physical exhaustion) and low PNS activity (impairing synchronized heart and brain rhythms) makes it difficult to concentrate.
Temperature regulation problems: With a compromised autonomic response, people may have difficulty adjusting to temperature changes or regulating their body temperature effectively.
Urinary issues: The bladder wall needs to relax for us to urinate. High SNS tone can lead to urinary urgency, frequency or pain (spasm). Poor PNS tone can contribute to difficulty emptying the bladder and even lead to urinary retention in extreme cases.
Cardiovascular issues: Including rapid heart rate, palpitations, and fainting/dizziness.

The most commom pattern of dysautonomia is caused by a sum of the two (connected) problems:

High baseline stress (High SNS, Low PNS) and
A blunted response to stress when needed.

In simpler terms, the body is stuck in a hyper-aroused state even when it should be relaxed. The sympathetic nervous system (SNS)—which controls the “fight or flight” response—is overactive, while the parasympathetic nervous system (PNS)—which governs “rest and digest” functions—is underactive.

Dizziness when standing: An example

A good example of how this imbalance can lead to symptoms is orthostatic hypotension—a condition in which there is a significant drop in blood pressure when standing up, causing dizziness, lightheadedness, or even fainting. This can arise from the typical dysautonomia pattern of lower parasympathetic activity and higher sympathetic activity at rest, combined with a blunted response when a stress response is needed.

Normally, when we stand up, gravity causes blood to pool in the lower part of the body, which temporarily reduces the amount of blood returning to the heart. The autonomic nervous system compensates for this by activating the sympathetic nervous system (SNS), causing blood vessels to constrict and the heart rate to increase, thus maintaining adequate blood flow to the brain.

In someone with a blunted stress response, however, this compensatory response may be impaired. The blunted stress response means that, when standing, the body may not respond adequately by constricting blood vessels and increasing heart rate as it should, resulting in a drop in blood pressure and the characteristic dizziness or lightheadedness of orthostatic hypotension.

One route to symptom persistance

Over time the lower activity of the PNS creates a feedback loop, which can be one route by which symptoms become persistent.

A constant state of low level arousal (SNS dominance) means too little time is spent every day in a state of physiological rest, where repair and recovery take place.

Since the body isn’t able to fully rest and repair, low grade inflammation remains activated at the level of the tissues longer than necessary.

Active inflammation continues to stimulate the body’s stress responses (including the SNS), which reinforces the cycle of dysfunction.

Explore interactions

Bodily stress.

Learn More
Dissociation.

Learn More
Dysfunctional breathing.

Learn More
Co-regulation.

Learn More
Hormones.

Learn More
The neuroimmune system.

Learn More

Rebalance the ANS by practicing the shift into physiological rest.

Why

Although we don’t have direct control over the ANS, it responds to what is going on in and around the body. This means there are lots of ways we can influence the ANS and bring the two branches back in balance.

Regularly taking actions that rebalance the two branches of the ANS is not just about managing anxiety. Practicing the shift into physiological rest trains the neural pathways the body needs to find its way back into balance automatically, throughout the day. It keeps the vagus nerve toned and the autopilot flexible and effective.

Short guide: Rebalance the ANS

Step 1. Turn down an overactive SNS

If you have a lot of restless energy in the body when you try to relax, this step is necessary.

If instead you feel exhausted, skip this step and move to Step 2.

Reduce stimulants. We might stimulate the SNS through substances (like caffeine and sugar) or mental activity (like videogames or frightening movies).
Active Mindfullness Make space to tune in with the present reality. If you are very restless, it will be difficult to sit still and medititate. Instead try taking a walk where you pay attention to sights and sounds around you, do something creative with your hands, or make time to play with a pet.
Move the body Shaking or moving the body is a powerful way to reset the SNS.

Note of Caution

Exercise can initially activate the SNS.

This means:

-It is a bad idea to schedule vigorous movement too close to bed. It can get in the way of the switch to physiological rest (SNS->PNS) needed for a good night’s sleep.

-Take care to be gentle and move with awareness if you have symptoms that are triggered by exercise.

Step 2. Train the PNS (vagal nerve) to activate more easily

When the PNS is in the driver’s seat, healing, restoration and repair naturally happen.

There are some specific things we can do to train the PNS to kick in more easily. When we train and tone the vagal nerve, automatic vagal reflexes become stronger, and the body will start to restore balance more automatically throughout the day.

Examples include:

Breathing exercises which focus on lengthening the exhale
Cold water (swimming or cold shower)
Singing or chanting
Laughing and socializing
(Self) touch, massage or orgasm
Postures where blood flow to the heart is maximized. (For example lying with the legs raised higher than the heart)
Spending time in nature
Gentle movement
Listening to relaxing music/ sounds.

Remember, you don’t need to do all these things! You just need to find a few ways that work for you, that you can practice regularly (ideally on a daily basis).

The better the ANS is at moving from one state to the other, from tense to relaxed (and back again), the fewer symptoms of dysautonomia you will experience.

There are additional benefits: the body will be better equipped the body to automatically regulate bodily stress. This brings benefits for inflammation and autoimmunity related symptoms, helps reduce worry and overthinking, improve attention and fatigue, and helps with emotion regulation.

Skills guide: Design your own physiological rest.

It helps to be physiological about rest.

Professional Support

If you are struggling to settle into physiological rest, it is a good idea to ask for some help and guidance. Therapists, including psychologists and physiotherapists, can guide you to find a way to relax the body.

High levels of sympathetic activity are often related to anxiety. If this is true in your case, you might benefit from treatment of anxiety involving a mental health specialist such as a psychiatrist. Just remember: don’t leave out the body.

Activating the parasympathetic nervous system might feel exhausting at first. For some people the body has grown to depend on stress for its energy. When this stress ‘boost’ is removed, you feel depleted. However, your body needs physiological rest to begin to restore its reserves.

If you experience exhaustion when you relax, use this to your advantage and practice shifting into physiological rest at night before you go to bed. Then if you fall asleep, there is no problem! The benefits will build as the PNS gets toned which will help sleep improve.

Which explanations are relevant to you?

Your unique symptoms

Do you find it difficult to relax?

Dysautonomia

The role of The Sympathetic Nervous System (SNS)

The role of The Parasympathetic Nervous System (PNS)

The role of the ANS in brain body communication

Dynamic Balance

Flexibility to shift PNS <–> SNS

The typical pattern of dysautonomia causing symptoms:

High baseline stress (High SNS, Low PNS) and

A blunted response to stress when needed.

Dizziness when standing: An example

One route to symptom persistance

Explore interactions

Bodily stress.

Dissociation.

Dysfunctional breathing.

Co-regulation.

Hormones.

The neuroimmune system.

Rebalance the ANS by practicing the shift into physiological rest.

Why

Short guide: Rebalance the ANS

Step 1. Turn down an overactive SNS

If you have a lot of restless energy in the body when you try to relax, this step is necessary.

Note of Caution

Step 2. Train the PNS (vagal nerve) to activate more easily

Professional Support

Do you find it difficult to relax?

Dysautonomia

The role of The Sympathetic Nervous System (SNS)

The role of The Parasympathetic Nervous System (PNS)

The role of the ANS in brain body communication

Dynamic Balance

Flexibility to shift PNS <–> SNS

The typical pattern of dysautonomia causing symptoms:

High baseline stress (High SNS, Low PNS) and

A blunted response to stress when needed.

Dizziness when standing: An example

One route to symptom persistance

Explore interactions

Bodily stress.

Dissociation.

Dysfunctional breathing.

Co-regulation.

Hormones.

The neuroimmune system.

Rebalance the ANS by practicing the shift into physiological rest.

Why

Short guide: Rebalance the ANS

Step 1. Turn down an overactive SNS

If you have a lot of restless energy in the body when you try to relax, this step is necessary.

Note of Caution

Step 2. Train the PNS (vagal nerve) to activate more easily

Professional Support

Our Stories.

Terence’s Story.

Maria’s Story.

Related Resources.

Skills guide: Finding your way into physiological rest.

Dysautonomia International.