Addressing Four Key Questions on Autonomic Nervous System Disorders

Q: Addressing Four Key Questions on Autonomic Nervous System Disorders

Hello, Xiao Bi：<br>1. <br>Autonomic nervous system disorders can sometimes make you feel very uncomfortable (such as dizziness, head pressure, rapid breathing, and palpitations). <br>However, there are times when you feel okay, but the symptoms may recur the next day due to chang

Please ask your four questions?

Thank you, doctor, for your previous response on https://adoctor.tw/article/106596.
I would like to ask a few questions.

1.
Sometimes, individuals with autonomic nervous system dysfunction feel very uncomfortable (for example, dizziness, head pressure, rapid breathing, palpitations).
However, there are times when they feel their condition is okay, but the next day, due to changes in temperature or noise, symptoms may recur.
Should we wait until there are no recurrences at all before engaging in sexual activity with our partner, or is it acceptable to engage in sexual activity when feeling generally well?
2.
For patients with autonomic nervous system dysfunction and anxiety disorders, should they avoid high-dose B vitamins (for example, those exceeding 200%) as well as fried and overly salty foods?
3.
Sometimes I count my heartbeats to check if they are normal.
I notice that sometimes my heart doesn't beat very fast, but at other times, it may beat ten times and then pause.
I previously had an electrocardiogram (not a 24-hour one) which was normal, and both ultrasound and X-rays were normal, with no thyroid issues.
Is it possible that these pauses are caused by autonomic nervous system dysfunction?
4.
Currently, I am taking two medications: Alprazolam, 0.17 mg twice daily (I am trying to reduce the dosage), and Escitalopram, 5 mg every evening (I have been taking it for over three weeks).
However, I find that I particularly experience chest tightness, head pressure, and palpitations in the morning upon waking.
I initially thought this was due to the long interval after taking Alprazolam at night, but on several occasions, I took Alprazolam at around 5 AM and then went back to sleep until 7 AM, yet I still woke up with symptoms of autonomic nervous system dysfunction.
This seems particularly pronounced in the morning.
What could be the reason for this? Could it be related to the psychological stress of taking care of my child’s breakfast and sending them to school in the morning? Or could it be due to the effects of the medication? Thank you again for your response, doctor.

Xiao Bi, 40~49 year old female. Ask Date: 2016/05/30

Dr. Wu Enliang reply Psychiatry

Hello, Xiao Bi:
1.
Autonomic nervous system disorders can sometimes make you feel very uncomfortable (such as dizziness, head pressure, rapid breathing, and palpitations).
However, there are times when you feel okay, but the symptoms may recur the next day due to changes in temperature or noise.
Should you wait until there are no recurrences at all before engaging in sexual activity with your partner, or is it acceptable to proceed when you feel generally well?
A: I apologize for the delayed response due to my recent trip abroad.
Engaging in sexual activity is fine and is not related to autonomic nervous system disorders.
2.
Should individuals with autonomic nervous system disorders and anxiety disorders avoid high-dose B vitamins (for example, those exceeding 200%) as well as fried and overly salty foods?
A: There is no scientific evidence to support that individuals with autonomic nervous system disorders and anxiety disorders should avoid high-dose B vitamins (such as those exceeding 200%) or fried and overly salty foods.
Dietary guidelines are generally applicable, and it is not necessary to consume B vitamins at such high levels.
Fried and overly salty foods are detrimental to cardiovascular and kidney health, but they are not specifically related to autonomic nervous system disorders.
3.
Sometimes I count my heartbeats to check if they are normal.
I have noticed that sometimes my heart does not beat very fast, but at other times it will beat ten times and then pause.
I previously had an electrocardiogram (not a 24-hour monitor) that was normal, and both the ultrasound and X-ray were normal, with no thyroid issues.
Is it possible that the occasional pause in my heartbeat could be caused by autonomic nervous system disorders?
A: "The heart beating ten times and then pausing" may indicate arrhythmia.
Did the cardiologist say everything is fine? You should follow up with your cardiologist.
4.
Currently, I am only taking two medications: Alprazolam, 0.17 mg twice daily (I am trying to reduce the dosage), and Escitalopram, 5 mg every night (I have been taking it for over three weeks).
However, I find that I particularly feel chest tightness, head pressure, and palpitations in the morning upon waking.
I initially thought it was because I took Alprazolam at night and it had been too long by morning, but there were times when I took Alprazolam at around 5 AM and then went back to sleep until 7 AM, yet I still experienced symptoms like chest tightness, head pressure, and palpitations upon waking.
It seems to be particularly noticeable in the morning.
What could be the reason for this? Could it be due to the psychological pressure of taking care of my child’s breakfast and sending them to school in the morning? Or could it be caused by the medication?
A: It is unlikely that the medication is causing this, as it should alleviate the aforementioned symptoms.
It is possible that psychological stress is contributing to these feelings.
I recommend discussing these concerns thoroughly with your physician.

Reply Date: 2016/05/30

More Info

Addressing your questions regarding autonomic nervous system (ANS) disorders is essential, as these conditions can significantly impact daily life and overall well-being. Let's break down your inquiries one by one.

1. Engaging in Sexual Activity During Fluctuating Health States: It's common for individuals with autonomic nervous system disorders to experience fluctuations in their physical condition. Symptoms such as dizziness, rapid breathing, and palpitations can indeed vary based on environmental factors like temperature and noise. Engaging in sexual activity when you feel relatively well is generally acceptable; however, it is crucial to listen to your body. If you feel any discomfort or if symptoms arise during or after sexual activity, it may be wise to pause and consult with your healthcare provider. Communication with your partner about your symptoms and comfort levels can also enhance intimacy while ensuring both partners feel secure.

2. Dietary Considerations for Autonomic Nervous System Disorders and Anxiety: Diet plays a significant role in managing symptoms associated with ANS disorders and anxiety. High doses of B vitamins, particularly B6 and B12, can sometimes lead to increased anxiety or jitteriness in sensitive individuals. It is advisable to consume a balanced diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains, while minimizing processed foods high in sugar, salt, and unhealthy fats. Fried foods and excessively salty foods can exacerbate symptoms of anxiety and autonomic dysfunction, so moderation is key.

3. Heart Rhythm Variability and Autonomic Nervous System Dysfunction: The heart's rhythm can be influenced by the autonomic nervous system, which regulates involuntary bodily functions. It is not uncommon for individuals with ANS disorders to experience irregular heartbeats or palpitations. The sensation of your heart "pausing" could be related to a phenomenon known as "premature ventricular contractions" (PVCs), which are often benign but can be concerning. Since your previous cardiac evaluations were normal, it is likely that these sensations are related to autonomic dysregulation. However, if these symptoms persist or worsen, further evaluation by a cardiologist may be warranted to rule out any underlying issues.

4. Morning Symptoms and Their Potential Causes: The symptoms you experience upon waking, such as chest tightness, head pressure, and palpitations, could be attributed to several factors. It is possible that the psychological stress of morning routines, such as preparing breakfast and getting children ready for school, contributes to your symptoms. Additionally, the medications you are taking, particularly Alprazolam, can have residual effects that may lead to morning anxiety or withdrawal symptoms if not taken consistently. It is essential to discuss these symptoms with your prescribing physician, as they may need to adjust your medication regimen or explore alternative treatments to alleviate morning discomfort.

In summary, managing autonomic nervous system disorders requires a holistic approach that includes lifestyle modifications, dietary considerations, and open communication with healthcare providers. Regular follow-ups with your doctor can help tailor your treatment plan to better suit your needs and improve your quality of life. Always prioritize self-care and seek support when needed, as mental health is just as crucial as physical health in managing these conditions.

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