Can POTS Cause Insomnia? Why It Happens and How to Sleep Better

Quick answer: Yes, POTS commonly causes insomnia. The condition keeps the body's "fight or flight" nervous system active at night, which raises heart rate and adrenaline when they should be falling. This makes it hard to fall asleep, stay asleep, and wake up rested. Poor sleep then worsens daytime POTS symptoms, so the two feed each other. Raising the head of the bed, managing evening fluids, and keeping a consistent sleep schedule can help.

If you have POTS, you probably know the feeling of being exhausted but unable to sleep. You lie down ready to rest, and instead your heart races, your mind stays switched on, and morning arrives like you never slept at all.

You are not imagining it, and you are not alone. Sleep problems are one of the most common parts of living with postural orthostatic tachycardia syndrome (POTS), even though they get far less attention than the dizziness and racing heart most people associate with the condition.

Below, we explain why this happens, the specific sleep problems POTS tends to cause, and what you can do to sleep better.

What Is POTS?

POTS stands for postural orthostatic tachycardia syndrome. It is a type of dysautonomia, which means a problem with your autonomic nervous system. That is the part of your body that runs things you never think about, like your heart rate, blood pressure, digestion, and body temperature.

The main sign of POTS is a heart rate that climbs too fast when you stand up. In someone with POTS, the heart rate rises by at least 30 beats per minute (or 40 in teenagers) within 10 minutes of standing, without a major drop in blood pressure. POTS affects an estimated 1 to 3 million people in the United States, most of them women between the ages of 15 and 50.

Symptoms vary from person to person, but most people with POTS deal with some mix of:

• Lightheadedness or dizziness, especially when standing, sometimes leading to fainting

• A racing or pounding heartbeat (palpitations)

• Fatigue that does not go away with rest

• Brain fog, or trouble focusing and remembering

• Headaches, shakiness, or nausea

• Trouble sleeping

There are several main types of POTS, which are grouped by what causes them. These types can overlap, meaning one person can show signs of more than one type at the same time.

• Neuropathic POTS occurs when the small nerves that help blood vessels tighten when standing are damaged. If these nerves aren't working, blood can pool in the lower body instead of flowing back to the heart and brain.

• Hyperadrenergic POTS happens when the body has high levels of the stress hormone norepinephrine. This can lead to feelings of anxiety, sweating, shakiness, and a significant increase in heart rate.

• Hypovolemic POTS is related to having a lower-than-normal blood volume. With less blood to circulate, the heart has to work harder to support the body when standing.

• Secondary POTS develops alongside another condition that affects the nerves, like diabetes, Lyme disease, or autoimmune disorders such as lupus or Sjögren's syndrome.

POTS has also drawn far more attention since 2020 because it is one of the most common autonomic conditions tied to long COVID. In one study of people with severe, long-lasting COVID symptoms, about 31 percent were found to have POTS, which has driven a wave of new cases and renewed research into the condition. 

Also Read: Sleep and Inflammation: How They Affect Each Other 

Does POTS Affect Your Sleep?

Yes, POTS affects sleep for most people who have it. POTS is named for the racing heartbeat that happens when you stand, but that is not what most people say bothers them the most. For many, the worst part is feeling tired all the time and never waking up refreshed.

A 2011 study in the Journal of Clinical Sleep Medicine found that people with POTS have worse sleep and a lower quality of life than healthy individuals. Sleep problems play a significant role, accounting for about half of the decline in their physical quality of life. For many people with POTS, difficulty sleeping is a major issue that affects their daily lives.

Also Read: Nervous System Dysregulation and Sleep

Why Does POTS Cause Insomnia?

Insomnia in POTS is not just caused by stress or bad habits. It results from how your nervous system works, especially at night. Several factors usually contribute to this issue:

• Your "fight or flight" system stays on. Good sleep depends on your body's "rest and digest" mode taking over in the evening, so your heart rate slows, and your muscles relax. In POTS, the "fight or flight" side often stays active instead. That is why you can feel wired and tired at the same time, drained but unable to settle.

• Your heart rate and adrenaline stay high. Surges of adrenaline and a heart rate that does not slow down the way it should can make it hard to fall asleep and can wake you up with a pounding chest.

• Blood shifts when you lie down. During the day, blood tends to pool in your legs. When you finally lie flat, that fluid moves back through your body, which can leave you needing to use the bathroom and breaking up your sleep.

• Other conditions add to it. Anxiety, pain, and the conditions that often come with POTS each make good sleep harder to get.

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Common Sleep Problems With POTS

POTS does not cause just one sleep issue, and researchers have not found a single sleep disorder that is unique to it. Instead, most people with POTS deal with a recognizable cluster of sleep disorders. In a survey of POTS patients, 63 percent reported trouble falling asleep, 62 percent reported trouble staying asleep, and 83 percent said they do not wake up feeling rested.

Here are the sleep problems that show up most often.

Insomnia (trouble falling or staying asleep)

This is the most common complaint. An overactive nervous system makes it hard to drift off, and symptoms like a racing heart can wake you repeatedly through the night. In a large survey by Standing Up to POTS, about 60 percent of patients reported failing to fall asleep within 30 minutes at least three nights a week, and 69 percent reported waking in the middle of the night or early morning.

Non-restorative sleep (waking up unrefreshed)

Many people with POTS sleep a normal number of hours but still wake up feeling like they never rested. Doctors call this non-restorative or unrefreshing sleep, and it is one of the classic symptoms of POTS. In fact, the review in Autonomic Neuroscience notes that fatigue and unrefreshing sleep, not the racing heartbeat, are the symptoms most patients describe as their most disabling.

Generalized hyperarousal ("tired but wired")

People with POTS often describe feeling completely exhausted yet unable to switch off, even when they desperately want to sleep. Experts call this hyperarousal, and it is one of the main reasons the insomnia in POTS is so stubborn. 

Circadian rhythm and delayed sleep phase

Many people with POTS run on a shifted body clock, feeling most awake late at night and unable to fall asleep until the early hours. This is sometimes called a delayed sleep phase. Daytime resting and napping, which are common when fatigue and dizziness make it hard to stay upright, can reinforce this pattern and push the sleep schedule even later.

Co-occurring sleep disorders to screen for

POTS does not appear to cause these directly, but they show up often enough that doctors look for them, because treating one can meaningfully improve sleep:

• Obstructive sleep apnea (OSA): breathing repeatedly stops and starts during sleep. People with POTS are also more likely to have hypermobile Ehlers-Danlos syndrome, which can affect the airway and raise OSA risk. Loud snoring, gasping at night, or constant exhaustion are reasons to ask about a sleep study.

• Restless legs syndrome (RLS): an uncomfortable urge to move the legs in the evening that makes it hard to fall asleep. It is common in the general population and turns up in some people with POTS, and some POTS medications can make it worse.

Note: Because some POTS symptoms feel similar to sleep complaints, and because night sweats and daytime sleepiness can be part of the picture, it helps to keep a short sleep diary before a doctor's visit. Tracking when you get into bed, how long it takes to fall asleep, and how often you wake gives your care team a clearer starting point.

Does Lack of Sleep Make POTS Worse?

Yes, this is frustrating: poor sleep and POTS make each other worse. 

When you don't sleep well, your body produces more stress hormones, your fatigue worsens, and it's harder to stand up. Many people find their POTS symptoms are worse in the morning because blood volume is lowest overnight, making it harder for the body to adjust to being upright. A bad night often leads to a bad day, and a bad day can lead to another bad night. 

That's why it's important to treat sleep as a priority instead of thinking you can catch up later. 

Also Read: Why Sleep Deprivation Can Lead to Serious Health Issues

How Much Sleep Do You Need With POTS?

People with POTS need 7 to 9 hours of sleep a night, the same as most other adults. The hard part is that POTS makes good, restful sleep tougher to reach, so it usually takes more planning around your routine and your bedroom setup than it would for someone without the condition.

Also Read: What Is the Best Time to Go to Bed?

Medical Treatment for Sleep Problems in POTS

There is no medication approved just for POTS, but doctors often prescribe treatments that target the causes, which can help your sleep too. These may include:

• Heart-rate-lowering medications such as beta-blockers or ivabradine.

• Blood-volume or blood-pressure support such as midodrine or fludrocortisone.

• Treatment for any related sleep disorder, such as a CPAP machine for sleep apnea.

These are personal decisions you make with your doctor, based on your type of POTS, your other conditions, and how you respond. If sleep is a big problem for you, tell your care team, because it may change how they plan your treatment.

How to Sleep Better With POTS

There is no single fix, but several changes can help. Talk to your own care team before making big changes, since the right approach depends on your situation and any medications you take.

1. Raise the head of your bed. Lifting the head of the whole bed by about 4 to 6 inches can reduce the overnight blood shifts that disturb sleep and may make mornings easier. This is not the same as piling up pillows, which only prop up your neck. You want the upper part of the bed on a gentle slope.

2. Time your salt and fluids carefully. Many POTS plans include extra salt and fluids to support blood volume, but timing matters at night. Ask your doctor how to stay hydrated during the day while cutting back on drinks late in the evening so you are not up using the bathroom.

3. Wear compression during the day. Compression garments can reduce blood pooling while you are up and about, which may ease the symptoms that follow you into the evening.

4. Keep your bedroom cool and dark. Since POTS can throw off your temperature control, a cool, dark, quiet room helps. Going to bed and waking up at the same times each day makes falling asleep easier over time.

5. Wind down before bed. Anything that helps your body shift out of "fight or flight" mode can make a difference, like gentle stretching, slow breathing, or dimming the lights an hour before sleep.

About the author

Dr. Ruchir P. Patel, MD, FACP, is the Medical Director of the Insomnia and Sleep Institute of Arizona and the founder of Sip2Sleep. He is triple board-certified in sleep medicine, obesity medicine, and internal medicine. Dr. Patel is a multi-year Phoenix Magazine Top Doctor and holds the Inspire Excellence designation.

References

1. National Institute of Neurological Disorders and Stroke. (2026, March 13). Postural tachycardia syndrome (POTS). National Institutes of Health. https://www.ninds.nih.gov/health-information/disorders/postural-tachycardia-syndrome-pots

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