When people think about dysautonomia, they often imagine it to be an exceedingly rare disease, impacting only a few people. However, this is far from the case.  In fact, the most common form of dysautonomia affects about 22% of the population ^[1] – which means that at least one in five people has dysautonomia. 

This type of dysautonomia is known as neurocardiogenic syncope, and it is enormously common. In fact, 3%^[2] of all emergency room visits in the United States can be attributed to this concern. 

What is Syncope?

The term syncope is essentially the medical term for the act of fainting. If you’ve ever fainted in your life, you’ve experienced a moment of syncope. 

There are numerous types of syncope, which affect you in different ways. These include^[3]:

• Cardiac Syncope: This happens when there is a problem with your heart, and it is not working as it should. In such situations, your brain does not receive an adequate amount of blood, causing fainting incidents.

• Orthostatic Syncope: This is a situation in which fainting results from a drop in blood pressure when you stand up or change position unexpectedly.

• Cerebrovascular Syncope: This occurs when there is a problem with the blood vessels in and around your brain. Like with cardiac syncope, the main problem in this type of syncope is that your brain is not receiving enough blood. 

However, the most common form of syncope is reflex syncope. Reflex syncope happens when there is a problem regulating certain reflexes. Depending on which reflexes your body has trouble regulating, you may experience different subtypes of reflex syncope. These subtypes include:

• Situational: This happens when your fainting incidents are dependent on your performing certain actions or being in certain situations. For example, laughter can cause syncope in some people.

• Carotid sinus syncope: This happens when there is pressure placed on the carotid artery. For people with this type of syncope, even the slightest pressure, such as from wearing a shirt with a tight collar, can result in fainting.

• Vasovagal: This type of syncope happens when your body overreacts to a trigger. The trigger or triggers in question differ from person to person and can include everything from standing for too long to feeling pain. Over 50% of all syncope cases result from vasovagal syncope. 

Vasovagal syncope is also known as neurocardiogenic syncope or vasovagal neurocardiogenic syncope. If you have been diagnosed with this type of syncope, you have also been diagnosed with dysautonomia. 

Triggers for Neurocardiogenic Syncope

As mentioned above, there are numerous triggers that can set off neurocardiogenic syncope, and these often differ from person to person. That said, some of the most common triggers include^[4][5]: 

• Standing for too long
• Being outside on a hot day or otherwise being exposed to too much heat
• Being dehydrated 
• Not eating enough or skipping meals
• Feeling intense pain

Some people’s triggers are unfortunately more common than these and can include:

• Coughing or swallowing
• Having a bowel movement or urinating

It is easy then to see why neurocardiogenic syncope can be a debilitating condition. Consider knowing you’re at risk of fainting episodes every time you swallow something or visit the washroom – for people with severe forms of this illness, living a “normal” life can be extremely challenging.

It is essential to note that syncope, and specifically neurocardiogenic syncope, is not the same as feeling dizzy or even feeling a little faint. Neurocardiogenic syncope (NCS) is specifically accompanied by a loss of consciousness, so if you do not actually faint, you may not be experiencing this condition. 

However, the only way to actually tell whether or not you have neurocardiogenic syncope is to get a formal diagnosis. There are several tests that a doctor may recommend when testing for NCS, including^[6]: 

• Tilt Table Test: This involves a patient lying flat on a table, following which the table is titled, and the patient’s blood pressure and heart rate are monitored for up to an hour. 

• Electrocardiogram (EKG): A test that measures electrical activity in the heart to determine if there is a fault in the heart. This is the most common test for diagnosing NCS^[7].

• Event Monitor: Essentially a portable EKG that is worn until symptoms occur.

• Echocardiogram: A ultrasound of the heart

• Electrophysiology Study: A test that records the electrical activity in your heart.

• Halter Monitor: Another version of a portable EKG. Unlike the event monitor, it is worn for 24-48 hours. 

Following an official diagnosis of NCS, a doctor can advise you on lifestyle changes. NCS, like all dysautonomias, cannot be cured completely – however, it can be managed to reduce symptoms and syncope episodes.

People with NCS, especially those with severe NCS, are advised to avoid risk factors that increase syncope episodes. These include:

• Diabetes: As mentioned above, low blood sugar can trigger fainting, and diabetes increases the risk for low blood sugar episodes.

• Anxiety and panic disorders. One of the common triggers for NCS is emotional stress.

• Alcohol and illegal drug use. While prescription drugs can also increase the risk of a fainting episode, it is not always possible to avoid consuming these drugs, depending on the reason for their prescription. Drugs and alcohol can cause dehydration and lower your blood pressure and blood sugar, all of which increase the risk of syncope.

Treatment 

As mentioned above, NCS cannot be cured completely. However, there are treatments available that can help people manage symptoms of NCS. These include:

• Tilt Training^[8]: This involves training people to adjust to sudden changes in posture with the help of diagnostic tilt tables

• Medication: Depending on the cause and triggers of your NCS, medications may help address the issue. This is especially true if your triggers include low blood pressure, which can be treated with medication, and anxiety disorders, for which SSRIs and antidepressants are often prescribed.

• Biofeedback Therapy^[9]: This is a therapy that helps patients consciously control some involuntary actions, such as their heartbeat. Biofeedback therapy can also help with other illnesses like stress and anxiety, IBS, constipation, headaches, high blood pressure, and more.

Lifestyle Modifications 

One of the most common treatments for NCS involves lifestyle modifications. These modifications will be discussed by your doctor and can include things like avoiding risk factors like alcohol and wearing compression socks to increase your blood pressure.

An especially common recommendation is to increase your intake of salt^[10]. Part of the reason for this increased intake is because it helps boost your blood pressure. As your salt intake increases, you will also need to increase your fluid intake. 

In general, doctors recommend increasing a patient’s sodium intake to about 5g^[11] from the recommended daily value of 2300 mg, or 2.3 g. However, this recommendation differs from person to person, depending on your unique needs, so it’s always best to get a professional opinion before changing your diet.

One way to increase your salt intake is to add more salt to your meals or increase the amount of salty foods you eat. However, this requires a significant dietary change, and most people aren’t able to alter their food likes and dislikes to go along with it. 

If you’re one of them and aren’t keen on changing the way you eat, you can also consider adding salt pills to your daily routine. Klaralyte offers salt capsules that contain 250mg of sodium and 50mg of potassium in each capsule. You can take these with water, and it makes boosting your salt intake easy and convenient like never before!

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