The Symptom We Miss: Autonomic Dysfunction in Lyme Disease

Not all Lyme disease patients come in with joint pain or a rash. Some arrive with symptoms that don’t fit cleanly into any box—heart rate spikes, dizziness, temperature swings, or gut problems. What’s happening isn’t always visible, but it’s very real.

In many of these patients, the root cause is autonomic dysfunction triggered by Lyme disease. This results in a disruption of the body’s most vital control system — the autonomic nervous system, which regulates heart rate, blood pressure, digestion, and more.

What Is Autonomic Dysfunction in Lyme Disease?

Autonomic dysfunction in Lyme disease occurs when the infection affects the autonomic nervous system (ANS)—the system that regulates:

1. 1. Heart rate

   2. Blood pressure

   3. Temperature control

   4. Digestion

   5. Breathing patterns

For some Lyme disease patients, these are the only presenting symptoms. They’re the only clue that something’s wrong.

When the Body Feels “Off” but Tests Look Normal

I’ve had patients describe feeling like their body is malfunctioning—but their routine labs and physical exams come back fine.

Symptoms of autonomic dysfunction in Lyme disease often include:

1. 1. POTS (rapid heart rate with standing)

   2. Unexplained chills or flushing

   3. Night sweats

   4. Blood pressure fluctuations

   5. GI issues like bloating or nausea

   6. Breathlessness without low oxygen

These signs are easy to dismiss. But they often point to nervous system disruption caused by tick-borne infections like Borrelia, Babesia, or Bartonella.

Autonomic Dysfunction in Lyme Disease: What to Look For

Why It Gets Missed

Because autonomic dysfunction symptoms are:

1. 1. Multisystem

   2. Non-specific

   3. Often not painful

   4. And frequently dismissed as anxiety or stress

Many patients with autonomic dysfunction in Lyme disease are told they’re just burnt out—or that it’s “nothing serious.” But when we look closer, we find evidence of tick-borne infection and nervous system involvement.

When to Suspect Autonomic Dysfunction due to Lyme

Ask your patients:

1. 1. Do your symptoms change with position, temperature, or exertion?

   2. Do you feel worse in heat or after standing?

   3. Have you been told it’s anxiety—but treatments don’t help?

   4. Have you spent time in wooded or grassy areas recently?

If so, consider Lyme disease and co-infections—especially when other diagnoses fall short.

What I Do in My Practice

When I suspect autonomic dysfunction in Lyme disease, I take a layered approach:

1. 1. Start antibiotics or antiparasitics for Lyme/co-infections

   2. Support autonomic stability (hydration, salt, compression)

   3. Use symptom-guided medications (e.g., beta blockers, fludrocortisone)

   4. Focus on pacing, sleep, and vagal tone recovery

   5. Educate patients so they can track flares and triggers

Recovery takes time—but early recognition makes a real difference.

Final Thoughts: The Nervous System Doesn’t Lie

Autonomic dysfunction in Lyme disease may not show up on a CT scan or routine blood panel—but it shows up in lived experience. The key is to listen when the body says, “Something’s off,” even if the tests don’t say it yet.

In Lyme, the nervous system may speak before anything else does. We just have to listen.

References

• POTS : An autonomic disorder in Lyme disease patients

• ILADS Guidelines – Lyme Treatment