The short answer
- Daily habits are usually the first line of POTS care, often before or alongside medicines: more fluids, extra salt if your doctor agrees, compression, a gradual exercise plan and avoiding triggers [1, 2].
- Common triggers include heat, large meals, long periods of standing and over-exertion [1].
- Go slowly with exercise. Start lying down or seated, build up gradually, and expect that it may take weeks to feel the benefit [1, 2].
- Get the amounts from your doctor. Extra salt and fluid aren’t right for everyone, especially people with high blood pressure, heart or kidney problems [1, 3].
Most people with POTS learn to manage it the hard way: by noticing which mornings end with them sitting on the bathroom floor, which errands are too much, and which tricks buy them an extra hour on their feet. If you’re newly diagnosed, you don’t have to start from scratch.
This post gathers the everyday strategies that POTS guidelines and experts describe, arranged roughly as a day. It’s not a prescription. Bring it to your doctor and build your own plan together. For background on diagnosis and medicines, see our POTS page.
First, a word about why these habits help
Many people with POTS have low blood volume [1, 4], and blood can pool in the lower body when they stand [3]. The thinking behind most daily strategies is to keep more blood circulating: fluid and salt to expand blood volume, compression to reduce pooling, and gradual exercise to reverse deconditioning [2, 3]. POTS has several possible mechanisms, so what helps one person most may differ for another [4].
Morning: the hardest part of the day for many
- Drink before you get up. A 2022 nutrition review suggests starting fluids early in the morning, even before getting out of bed [3].
- Get up in stages. Sit on the edge of the bed for a moment before you stand. MedlinePlus notes that getting up slowly can help prevent fainting [5].
- Know your warning signs. Before fainting, people may feel weak, sweaty or sick, or notice tunnel vision [5].
- Raise the head of your bed. It’s among the common strategies listed by Dysautonomia International. Ask your clinician what height makes sense for you [4].
Through the day: fluids, salt and meals
Fluids. Many POTS experts suggest drinking more fluid, often 2–3 liters a day [1, 2]. Some guidelines, like the Canadian position statement, say at least 3 liters [3]. Ask your doctor what’s right for you. Spreading drinks through the day is easier than catching up at night.
Salt, with your doctor’s guidance. Guidelines often suggest extra salt, but it isn’t right for everyone. It can raise blood pressure and cause swelling, so your clinician should set your target [1, 3]. Dysautonomia International points out that salt only helps when you also increase fluids [6]. The 2022 review adds that too much salt at one time can trigger nausea [3]. The NIH consensus notes that more research is needed on the true benefit and best amount of salt [1].
Meals. Meals can make POTS symptoms worse [1]. The 2022 review suggests small, frequent meals with fewer refined carbohydrates [3]. Many people notice that a big lunch is followed by a rough afternoon.
Alcohol and caffeine. The same review advises avoiding alcohol and caffeine, which may increase symptoms, and avoiding dehydration [3]. Talk with your clinician if you rely on coffee to get through the day.
Gut symptoms. Nausea and other gut problems are common in POTS [1, 4]. One study found celiac disease in 4% of people with POTS, about four times the general rate, so the review suggests screening for celiac disease before cutting out gluten if a gluten problem is suspected [3]. It also recommends avoiding unnecessarily restrictive diets, and screening for eating disorders, which are more common in this group [3].
Managing heat
Heat is a common trigger [1]. The 2022 review notes that excess heat can worsen symptoms and that cooling improves orthostatic intolerance. Simple tools such as spritzing with cool water, a cooling vest or a portable fan can help [3]. Plan errands for cooler parts of the day, and be careful with hot showers and baths.
Compression
Compression garments are used to reduce pooling of blood in the lower body [3]. In a 30-person trial, waist-high compression covering the abdomen and legs reduced heart rate and symptoms during tilt testing [1, 7]. The 2022 review notes that garments covering only the calf and thigh may be less effective, and that it can take some experimenting to find a type and strength that doesn’t cause bruising or digestive discomfort [3]. Ask your clinician what kind to try.
Movement you can actually do
Deconditioning can make POTS worse, and worse symptoms make exercise harder, which can become a downward spiral [2, 3]. The Heart Rhythm Society says a regular, structured, progressive exercise program can help, starting with exercise that doesn’t require being upright, such as rowing machines, recumbent bikes and swimming [2]. As people get stronger, they may be able to move on to upright activity [3].
Two cautions matter:
- Expect a slow start. The NIH consensus warns that you may feel worse for up to 6 weeks before you feel better [1].
- Not everyone should follow a standard graded plan. The 2022 review notes UK guidance that cautions against graded exercise for people with ME/CFS, and suggests a physical therapist with relevant expertise for people with severe symptoms, ME/CFS or hypermobility [3]. If exercise leaves you crashing for days, tell your clinician.
Pacing your energy
Build activity gradually rather than pushing through on good days and crashing afterward [1, 2]. Practical ideas:
- Sit for tasks you’d normally stand for, like cooking, brushing teeth or folding laundry.
- Break big jobs into smaller pieces with rest in between.
- Avoid long periods of standing still, which is a common trigger [1].
- Keep a rough log of activity and symptoms so you can see your limits.
School, work and daily life
POTS can limit daily function as much as some heart and lung conditions [4]. It’s worth asking about accommodations such as seating, access to water and snacks, and flexible schedules. Dysautonomia International estimates that about 25% of people with POTS are unable to work [4], so if you’re struggling, you’re not alone.
Check your medicine list
Some medicines can make POTS worse. The Heart Rhythm Society specifically advises against drugs that block the norepinephrine transporter [2]. Review all your prescriptions and supplements with your clinician rather than stopping anything on your own. If you also have mast cell symptoms, beta-blockers need extra caution [8].
What’s known and what’s debated
Generally accepted: fluids, salt with medical guidance, compression and gradual exercise are standard first steps [1, 2, 4]. POTS is not caused by anxiety [4].
Still being researched: the best fluid and salt targets, how well individual medicines work, and the underlying causes [1, 9].
There’s reason for hope. In a Mayo Clinic follow-up of patients whose POTS began in adolescence, 18.2% reported their symptoms had resolved and 52.8% reported improvement about 5 years after diagnosis [4].
Questions to ask your doctor
- How much fluid and salt is right for me, given my blood pressure, heart and kidneys?
- What kind of compression should I try?
- What exercise plan is safe for me to start, and how should I build up?
- Are any of my current medicines making my symptoms worse?
- Should I be screened for celiac disease or nutrient problems before changing my diet?
- Would a physical therapist or an autonomic specialist help?
When to get urgent help
Call 911 or your local emergency number if someone faints and doesn’t become alert within a couple of minutes, is injured or bleeding, is pregnant, or has chest pain, a pounding or irregular heartbeat, loss of speech, vision problems, inability to move a limb, or a seizure [5]. Also call for sudden crushing chest pressure or chest pain with shortness of breath [10]. If you’ve never fainted before, faint often, or have new symptoms with fainting, see your provider [5].
The bottom line
POTS management is mostly built from small, unglamorous habits: water before you stand, salt your doctor has approved, compression, cooler rooms, smaller meals, a gentle exercise plan and a lot of pacing. None of them is a fix on its own, but together they can make days more predictable. If you also live with mast cell symptoms or hypermobility, read our overlap post and keep our Trifecta reference handy.
Sources
Numbers in brackets in the text link to these sources. Links were checked in October 2026. Some sources are written by people who support a particular approach; we've tried to say so in the text.
- Vernino S, Bourne KM, Stiles LE, et al. Postural orthostatic tachycardia syndrome (POTS): State of the science and clinical care from a 2019 National Institutes of Health Expert Consensus Meeting - Part 1. Auton Neurosci. 2021;235:102828. PMID: 34144933. https://pmc.ncbi.nlm.nih.gov/articles/PMC8455420/
- Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome, inappropriate sinus tachycardia, and vasovagal syncope. Heart Rhythm. 2015;12:e41-e63. PMID: 25980576. https://pmc.ncbi.nlm.nih.gov/articles/PMC5267948/
- Harris CI. COVID-19 Increases the Prevalence of Postural Orthostatic Tachycardia Syndrome: What Nutrition and Dietetics Practitioners Need to Know. J Acad Nutr Diet. 2022;122:1600-1605. PMID: 35697326. https://pmc.ncbi.nlm.nih.gov/articles/PMC9186518/
- Dysautonomia International. Postural Orthostatic Tachycardia Syndrome. Web page, accessed October 10, 2026. https://www.dysautonomiainternational.org/page.php?ID=30
- MedlinePlus. Fainting. Web page, accessed October 10, 2026. https://medlineplus.gov/ency/article/003092.htm
- Dysautonomia International. Please Pass the Salt (The Dysautonomia Dispatch blog). June 17, 2014. https://dysautonomiainternational.org/blog/wordpress/pleasepassthesalt/
- Bourne KM, Sheldon RS, Hall J, et al. Compression Garment Reduces Orthostatic Tachycardia and Symptoms in Patients With Postural Orthostatic Tachycardia Syndrome. J Am Coll Cardiol. 2021;77(3):285-296. PMID: 33478652. https://doi.org/10.1016/j.jacc.2020.11.040
- Shibao C, Arzubiaga C, Roberts LJ, et al. Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders. Hypertension. 2005;45(3):385-390. PMID: 15710782. https://doi.org/10.1161/01.HYP.0000158259.68614.40
- Gunning WT, Kvale H, Kramer PM, Karabin BL, Grubb BP. Postural Orthostatic Tachycardia Syndrome Is Associated With Elevated G-Protein Coupled Receptor Autoantibodies. J Am Heart Assoc. 2019;8(18):e013602. PMID: 31495251. https://pmc.ncbi.nlm.nih.gov/articles/PMC6818019/
- MedlinePlus. Chest pain. Web page, accessed October 10, 2026. https://medlineplus.gov/ency/article/003079.htm