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:
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Heart rate
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Blood pressure
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Temperature control
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Digestion
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Breathing patterns
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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:
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POTS (rapid heart rate with standing)
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Unexplained chills or flushing
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Night sweats
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Blood pressure fluctuations
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GI issues like bloating or nausea
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Breathlessness without low oxygen
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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
| Symptom | System Affected | Notes |
|---|---|---|
| POTS | Cardiovascular | Often misdiagnosed as anxiety |
| Temperature swings | Thermoregulation | Not always accompanied by fever |
| GI dysmotility | Digestive | Can mimic IBS or food sensitivities |
| Air hunger | Respiratory | Described as “not enough oxygen” |
| Lightheadedness or presyncope | Orthostatic | May worsen with heat or exertion |
| Frequent urination or retention | Urogenital | Can mimic bladder or pelvic disorders |
Why It Gets Missed
Because autonomic dysfunction symptoms are:
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Multisystem
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Non-specific
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Often not painful
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And frequently dismissed as anxiety or stress
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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:
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Do your symptoms change with position, temperature, or exertion?
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Do you feel worse in heat or after standing?
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Have you been told it’s anxiety—but treatments don’t help?
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Have you spent time in wooded or grassy areas recently?
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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:
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Start antibiotics or antiparasitics for Lyme/co-infections
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Support autonomic stability (hydration, salt, compression)
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Use symptom-guided medications (e.g., beta blockers, fludrocortisone)
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Focus on pacing, sleep, and vagal tone recovery
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Educate patients so they can track flares and triggers
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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.
Dr. Cameron,
I am a 63 YO retired and disabled US Air Force 23 year Veteran. I believe I may have become infected decades ago and am currently about 6 weeks into a wholly holistic treatment plan as I have a clueless Twin Ports VA clinic in Superior Wisconsin as my Primary Care team. I just recently in the last year became aware of the Borrelia bacteria and now I am reading your latest articles about Babesia, or Bartonella and my heart is sinking. I have had every single symptom on the charts in the last 20 years. My VA doctors have no clue, no diagnosis, and there primary objective seems to be to remove me from getting any Opioid medications. I have known all along that something was wrong inside of me but even intensive blood testing showed nothing. I have so much more to share but this would become a novel. Please make contact with me so I can get someone on my side against the Minneapolis VA medical system. I am on my 7th or eighth provider since I moved back to my Hometown in Nov 2016 to get sober from alcohol and own my first house. I stopped alcohol 12 Feb 2017 for good after multiple rehabs failed over my career and beyond. Thanking our Creator for leading me to your articles and additional information I need in this war for my physical body and mind.
Sincerely,
Richard A Celusta, MSgt USAF Retired
(320) 761-7726
I am glad our Creator has gotten you this far. I grew up in Minnesota but now practice in New York. You should call my office with your question.
I find both articles on the autonomic nervous system and how to treat patients who have had treatment for Lyme previously pertinent to my situation. I was an avid hiker after retirement from 33 years of critical care nursing. I got my first EM rash after moving back to East TN. After a 2020 COVID episode I developed symptoms that caused me to suspect Lyme. My tests came back as TBRF. This last year I was bitten by multiple Lone Star ticks and developed Alpha-gal syndrome. I have been following a strict diet, aware of my triggers and my IgE was coming down. Unfortunately, I received yet another tick bite that became infected while working in the yard. I am two weeks past the bite and my AG symptoms have become worse than previously. Would you recommend antibiotic treatment, as the wound has healed with antibiotic creams, or would the drugs cause me further symptoms? I am pretty sure I have developed the POTS symptoms since this latest bite, as my heart rate fluctuates from 50 to 130 by just getting up from bed or going up to the second floor. Heat intolerance as I used to hike in this, but no more! My BP is hard to manage with the AG reactions and then swings to HTN. Headaches and neck pain that wakes me from sound sleep. It is hard to believe that my run in with black bears and rattle snakes have not harmed me, but these little creatures have me off trail due to extreme fatigue.
I have had to individualize treatments. I hope you find an answer
Thanks Dr. Cameron for taking time to reply. Would you happen to know of a Lyme literate MD within 200 miles of Knoxville, TN? Again, thank you for all this information.
Sorry