POTS in Lyme Disease: Why You Feel Worse Standing

POTS (postural orthostatic tachycardia syndrome) in Lyme disease is a form of autonomic dysfunction that causes dizziness, rapid heart rate, brain fog, and fatigue—especially when standing. Many patients describe adrenaline surges, feeling worse upright, and symptoms that fluctuate day to day.

While dizziness is common, this page focuses on POTS in Lyme disease—a specific pattern of autonomic dysfunction that helps explain why symptoms worsen when standing and improve when lying down.

POTS is part of a broader pattern of autonomic dysfunction in Lyme disease, where the nervous system has difficulty regulating heart rate, blood pressure, and circulation.

For a broader overview of symptoms, see our Lyme Disease Symptoms Guide.

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What Is POTS in Lyme Disease?

POTS is a condition in which the body has difficulty maintaining stable circulation when upright. When standing, blood flow is not properly regulated, leading to a rapid increase in heart rate and symptoms such as lightheadedness, fatigue, and brain fog.

In Lyme disease, POTS may develop due to inflammation, nervous system disruption, or impaired autonomic regulation.

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Common Symptoms of POTS in Lyme Disease

• Dizziness or lightheadedness when standing
• Rapid heart rate (especially when upright)
• Fatigue and exercise intolerance
• Brain fog or difficulty concentrating
• Palpitations or internal trembling
• Symptoms that improve when lying down

These symptoms often overlap with dizziness in Lyme disease, but the key pattern is that symptoms worsen with standing.

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Adrenaline Surges and Hyperadrenergic POTS

Some patients with POTS in Lyme disease describe sudden episodes of adrenaline surges—often referred to as “adrenaline dumps.” Learn more about adrenaline surges in POTS.

These episodes can include a racing heart, shakiness, anxiety-like symptoms, and difficulty sleeping.

These symptoms are not simply anxiety. They may reflect a form of hyperadrenergic POTS, where the autonomic nervous system is overactive.

Patients often report:

• Waking up with a racing heart
• Sudden surges of adrenaline without a clear trigger
• Feeling worse at night or after minimal exertion
• Episodes mistaken for panic attacks

This pattern is frequently misunderstood and may contribute to delayed Lyme disease diagnosis.

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Dizziness in POTS and Lyme Disease

Dizziness is one of the most common symptoms in patients with POTS. However, unlike classic vertigo, the sensation is often described as lightheadedness, weakness, or a feeling of being physically unstable.

Symptoms typically worsen with standing, walking, heat, or exertion and improve with rest or lying down.

For a deeper dive into symptom patterns, see dizziness in Lyme disease.

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Why POTS Is Often Missed

POTS is frequently overlooked because standard cardiac and neurologic tests may appear normal. Symptoms are often attributed to anxiety, stress, or deconditioning.

However, when symptoms follow a pattern—worse when standing, better when lying down—they may reflect an underlying autonomic disorder rather than a primary psychiatric condition.

This contributes to delays in diagnosis and appropriate care.

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POTS vs Anxiety

POTS symptoms are often mistaken for anxiety because of overlapping features such as palpitations, shakiness, and a sense of internal distress.

However, key differences include:

• Symptoms triggered by standing rather than emotional stress
• Improvement with rest or lying down
• Presence of neurologic or circulatory symptoms

In some cases, what appears to be anxiety may reflect physiologic dysregulation rather than a primary psychiatric disorder.

POTS in Lyme disease may overlap with broader patterns seen in neurologic Lyme disease, especially when symptoms include brain fog or sensory changes.

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Clinical Takeaways

Pattern recognition matters: Symptoms that worsen when standing and improve when lying down suggest POTS.

Common but overlooked: POTS is a frequent but underrecognized complication of Lyme disease.

Not just anxiety: Adrenaline surges and palpitations may reflect autonomic dysfunction.

Next steps: When symptoms include dizziness, fatigue, brain fog, and palpitations—especially when triggered by standing—a broader evaluation may be needed.

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Frequently Asked Questions

Why do I feel worse when I stand up?
This may be due to POTS, where the body has difficulty regulating circulation when upright, leading to dizziness, fatigue, and a rapid heart rate.

Can Lyme disease cause POTS?
Yes. Lyme disease can affect the autonomic nervous system, leading to symptoms consistent with POTS in some patients.

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Related Topics in POTS and Lyme Disease

• POTS and brain fog
• POTS in children with Lyme disease
• POTS and Lyme disease

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Dr. Daniel Cameron, MD, MPH
Lyme disease clinician with over 30 years of experience and past president of ILADS.

Symptoms • Testing • Coinfections • Recovery • Pediatric • Prevention