Autonomic Nervous System Disorders: Symptoms and Solutions

Is there autonomic nervous system dysfunction?

Hello, doctor.
I have been living a reversed day-night schedule since I was around 18 years old, which has lasted for about 7 to 8 years now.
Gradually, I have started to feel some issues with my body.
In the past two years, I have wanted to change my sleep schedule, but due to my previous habits, I have been unable to sleep at night! Recently, I have been experiencing insomnia and palpitations (where I feel my heart suddenly beating strongly) at night, and sometimes I feel the need to cough, especially when lying in bed.
This has been going on for several days and has affected my sleep.
A few months ago, I had two electrocardiograms, both of which showed normal results.
When lying in bed, I also feel a sensation in the back of my head, as if there is a heartbeat.
Sometimes, while waiting for a consultation, my heart races inexplicably, and I recall it being over 100 beats per minute! I never used to experience this...
I don’t know what is happening! Additionally, a few months ago, I experienced unexplained anxiety or nervousness, which led to palpitations and difficulty breathing (feeling like I couldn't get enough air), making me feel unsteady when standing.
The doctor examined me and noted that my thyroid was slightly enlarged and recommended blood tests to check for hyperthyroidism.
The results came back normal, and shortly after, another doctor examined me, and both tests were normal! PS: These symptoms occur intermittently...
I also experience dizziness, unsteadiness, squinting, head shaking, slight tremors in my fingers, and my heart races when climbing two or three flights of stairs.
I have also noticed that I have started breathing through my mouth.
I apologize for the many questions, but these symptoms have been occurring intermittently for several years.
How should I go about getting checked?

Mr. Chen, 20~29 year old female. Ask Date: 2011/12/08

Dr. Wang Chongren reply Psychiatry

Dear Dr.
Wang Chong-Jen, Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare:
Hello,
In your letter, you mentioned experiencing persistent insomnia due to a disrupted day-night cycle, along with various physical symptoms for which no underlying medical condition has been identified.
Indeed, we may suspect that these symptoms could be attributed to psychological or emotional factors leading to sympathetic nervous system hyperactivity.

When faced with critical or significant situations, physiological responses such as elevated blood pressure, increased heart rate and respiration, and muscle tension are normal reactions of the body to cope with sudden stress.
However, many individuals who lack life goals and maintain irregular schedules often experience unexplained excessive anxiety, which can manifest as various physical symptoms.
If one does not establish clear life goals and improve their daily routine, they may become increasingly troubled by physical symptoms, exacerbating their anxiety (sympathetic nervous system hyperactivity).
This can lead to frequent visits to clinics or a reliance on sedatives.
If one is unable to alleviate these psychosomatic symptoms, especially if they impact social and occupational functioning, it is advisable to seek medical attention and discuss these issues with a psychiatrist or a psychosomatic medicine specialist.
Wishing you good health and peace of mind!
Sincerely,
Department of Psychiatry, Tainan Hospital, Ministry of Health and Welfare

Reply Date: 2011/12/08

More Info

Understanding autonomic nervous system (ANS) disorders is crucial, especially when symptoms like palpitations, anxiety, and sleep disturbances arise. Based on your description, it seems you have been experiencing a range of symptoms that could be linked to ANS dysfunction, particularly given your history of irregular sleep patterns and the stress that has accumulated over the years.

The autonomic nervous system is divided into two main branches: the sympathetic nervous system (SNS), which prepares the body for 'fight or flight' responses, and the parasympathetic nervous system (PNS), which promotes 'rest and digest' functions. When these systems are out of balance, it can lead to various physical and psychological symptoms, including those you are experiencing.

Symptoms and Their Implications
1. Palpitations and Heart Rate Variability: The sensation of your heart racing, especially when lying down or in a state of rest, can be indicative of heightened sympathetic activity or anxiety. This can be exacerbated by poor sleep patterns, which you mentioned have been an issue for several years. The heart's response to stress can sometimes manifest as palpitations, which may feel more pronounced during periods of anxiety or when transitioning from a state of rest to activity.

2. Sleep Disturbances: Your struggle with insomnia and the inability to maintain a regular sleep schedule can significantly impact your overall health. Chronic sleep deprivation can lead to increased sympathetic nervous system activity, which may further exacerbate feelings of anxiety and physical symptoms like heart palpitations.

3. Anxiety and Breathing Difficulties: The feelings of tightness in your chest and difficulty breathing can be associated with anxiety disorders. These symptoms can create a feedback loop where anxiety leads to physical symptoms, which in turn increases anxiety. This is often seen in conditions like panic disorder or generalized anxiety disorder.

4. Neurological Symptoms: The sensations of dizziness, unsteadiness, and tremors in your fingers may suggest a neurological component to your symptoms. While these could be related to anxiety, they may also indicate an underlying issue with the nervous system that warrants further investigation.

Recommended Steps for Evaluation and Management
1. Comprehensive Evaluation: Given the complexity of your symptoms, a thorough evaluation by a healthcare provider is essential. This may include:
- Neurological Assessment: To rule out any neurological disorders that could be contributing to your symptoms.

- Cardiac Evaluation: Although previous ECGs were normal, consider discussing the possibility of a Holter monitor test to assess your heart's rhythm over a 24-hour period, especially during symptomatic episodes.

- Endocrine Evaluation: Since thyroid issues can mimic anxiety symptoms, ensure that your thyroid function tests are comprehensive, including TSH, Free T4, and Free T3 levels.

2. Lifestyle Modifications: Implementing changes to your daily routine can help manage symptoms:
- Sleep Hygiene: Establish a regular sleep schedule, create a calming bedtime routine, and limit exposure to screens before bed.

- Stress Management Techniques: Practices such as mindfulness, yoga, and deep-breathing exercises can help regulate the autonomic nervous system and reduce anxiety.

- Physical Activity: Regular exercise can improve sleep quality and reduce anxiety. Aim for moderate aerobic activity, which can also help regulate heart rate.

3. Psychological Support: Consider seeking support from a mental health professional. Cognitive-behavioral therapy (CBT) has been shown to be effective in treating anxiety and can provide you with tools to manage your symptoms.

4. Follow-Up: Regular follow-up with your healthcare provider is crucial to monitor your symptoms and adjust your treatment plan as necessary.

In conclusion, while your symptoms may be distressing, they are not uncommon in individuals with autonomic nervous system dysregulation, particularly in the context of chronic stress and sleep disturbances. By taking a comprehensive approach to evaluation and management, you can work towards alleviating your symptoms and improving your overall quality of life.

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