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Can A Sedentary Lifestyle Develop Into An Autonomic Dysfunction Of The System?
Question: I've had a sedentary lifestyle for the past 10 years and although I mountain bike now (2 times a week) I still pass 2 days at a time only sitting all day then going to sleep. Also, I climb mountains slowly so it's been a more anaerobic activity rather than aerobic. I've ruled out most problems and am in perfect health other than experiencing presyncope while standing for 1-2 hours straight playing the trumpet after spending all week in a chair. I've played trumpet for 20 years and this was never a problem and it all started about 11 months ago and I haven't been able to find an answer. An O.D. suggested my problem is dysautonomia which seems to point to most of my symptoms (heat makes it worse, biking removes all symptoms because of the muscle contractions, feeling faint when standing too quickly, shaking legs when sitting as my brain's trick of contracting muscles to get oxygen back up to my head).
The only other thought would be anxiety and stress. I've checked my heart, my blood sugar, full blood tests that showed everything else as normal. Different doctors basically told me that it's anxiety and for me over-thinking it but there have been weeks that go by without a single symptom even if I think about it. Then all of a sudden without thinking about it it comes back hard. It feels as if there is really something wrong and my body is trying to tell me something but keep dismissing it as anxiety. My blood pressure doesn't go up nor does my heart rate so it doesn't look like a panic attack either.
My question is: Can a long-term sedentary lifestyle develop into autonomic dysfunction of the system? Almost as if sitting down for so long through the whole nervous system out of whack that regulates things like blood pressure, breathing, heart rate etc...
If it could be (pure) dysautonomia (I say pure because I also went to a neurologist and do not have MS or Parkingsons which also can cause dysautonomia) what can I do to cure it? From what I understand it's curable with a change in lifestyle but what would be the best way to go about it? This is a very new problem in my life but the years of the sedentary lifestyle may have finally caught up to me.
The only other thought would be anxiety and stress. I've checked my heart, my blood sugar, full blood tests that showed everything else as normal. Different doctors basically told me that it's anxiety and for me over-thinking it but there have been weeks that go by without a single symptom even if I think about it. Then all of a sudden without thinking about it it comes back hard. It feels as if there is really something wrong and my body is trying to tell me something but keep dismissing it as anxiety. My blood pressure doesn't go up nor does my heart rate so it doesn't look like a panic attack either.
My question is: Can a long-term sedentary lifestyle develop into autonomic dysfunction of the system? Almost as if sitting down for so long through the whole nervous system out of whack that regulates things like blood pressure, breathing, heart rate etc...
If it could be (pure) dysautonomia (I say pure because I also went to a neurologist and do not have MS or Parkingsons which also can cause dysautonomia) what can I do to cure it? From what I understand it's curable with a change in lifestyle but what would be the best way to go about it? This is a very new problem in my life but the years of the sedentary lifestyle may have finally caught up to me.
Brief Answer:
Read below.
Detailed Answer:
I read your question carefully and i understand your concern.
Regarding your first question, dysautonomia is not caused by a sedentary lifestyle. Of course a sedentary lifestyle is not beneficial in other directions, but it doesn't induce dysautonomia, so you shouldn't feel guilty about it.
As for managing pure dysautonomia, there is no cure, the measures and medications which are employed are only to address symptoms, but they do not influence the supposed damaged autonomic nervous system nerves. Non medication measures include high salt intake and taking plenty of water. Also measure to facilitate fast emptying of the digestive system such as having many fibers and eating small frequent meals.
However it is not clear whether you have simply labelled yourself with dysautonomia or whether you have had any tests for it, starting from simple ones like measuring blood pressure while supine and standing, tilt table test, sudomotor tests etc. Some variations of vagal tone or sympathetic response among individuals do not necessarily mean one has dysautonomia. Your presyncope episodes are related to the increased intrathoracic pressure opposing return of blood and hence heart output, it does indicate an inadequate adaptation from autonomic nervous system, but not enough to make such a diagnosis.
I hope to have been of help.
Read below.
Detailed Answer:
I read your question carefully and i understand your concern.
Regarding your first question, dysautonomia is not caused by a sedentary lifestyle. Of course a sedentary lifestyle is not beneficial in other directions, but it doesn't induce dysautonomia, so you shouldn't feel guilty about it.
As for managing pure dysautonomia, there is no cure, the measures and medications which are employed are only to address symptoms, but they do not influence the supposed damaged autonomic nervous system nerves. Non medication measures include high salt intake and taking plenty of water. Also measure to facilitate fast emptying of the digestive system such as having many fibers and eating small frequent meals.
However it is not clear whether you have simply labelled yourself with dysautonomia or whether you have had any tests for it, starting from simple ones like measuring blood pressure while supine and standing, tilt table test, sudomotor tests etc. Some variations of vagal tone or sympathetic response among individuals do not necessarily mean one has dysautonomia. Your presyncope episodes are related to the increased intrathoracic pressure opposing return of blood and hence heart output, it does indicate an inadequate adaptation from autonomic nervous system, but not enough to make such a diagnosis.
I hope to have been of help.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for your response. I'd also like to add that these symptoms usually occur only at certain times and sometimes I go weeks without any symptoms whatsoever. Today for example I'm currently performing as a trumpet player andnI feel an extreme weakness when playing as if I don't even have the strength to play the notes. Although no feelings of passing out luckily. I feel very sick andnI can't figure out what it is. I also have a long history of very poor sleep with lots of sleep debt accumulated. Notbsure if that can be an underlying cause.
My next question is what can I do now to resolve this and figure out what is wrong? I've been to so many doctors that dismiss it as anxiety but it doesn't seem right. What kind of doctor would you recommend I go see that will be able to figure this out? A neurologist or an endocrinologist in case it's more to do with my adrenal glands? It's a very complex series of symptoms that occur at certain times and others at very random times. I spent 2.5 weeks completely symptom free then one day I went bike riding I felt something very wrong. It's a debilitating feeling that is very new and only about 11 months since first occurrence. Thank you in advance for any suggestions you have for me!
My next question is what can I do now to resolve this and figure out what is wrong? I've been to so many doctors that dismiss it as anxiety but it doesn't seem right. What kind of doctor would you recommend I go see that will be able to figure this out? A neurologist or an endocrinologist in case it's more to do with my adrenal glands? It's a very complex series of symptoms that occur at certain times and others at very random times. I spent 2.5 weeks completely symptom free then one day I went bike riding I felt something very wrong. It's a debilitating feeling that is very new and only about 11 months since first occurrence. Thank you in advance for any suggestions you have for me!
Brief Answer:
Read below.
Detailed Answer:
Thank you for your feedback. The fact that it comes and goes does speak against an endocrinological condition which manifestations would be persistent to a degree and not disappear entirely. That applies to most neurological conditions as well, there are some electrolyte disturbances which could cause such transitory muscle weakness but you state you blood tests to be normal.
Sleep could be a factor. Sleep deprivation can cause daytime somnolence and fatigue.
The most appropriate specialist would be a neurologist as it is a specialty which deals with muscle issues, orthostatic hypotension, sleep conditions and anxiety as well, so can make a broad consideration of these hypothesis which are discussed. I suggest prior to a consult you start to keep a sleep diary in order to identify sleep patterns and their relation to your symptoms, there are several ready models online, just google sleep diary, here's one example link http://sleepfoundation.org/sleep-diary/SleepDiaryv6.pdf
The neurologist might ask for nerve conduction studies/electromyography to look for possible muscle conditions explaining your weakness. Some other tests which should be made (if not already done) are thyroid function, vitamin B12 and D, complete electrolyte panel.
There is the possibility of everything coming normal, the symptoms do not fully fit in any diagnosis, in that case perhaps anxiety might really be a factor and just a healthy lifestyle and observation of the evolution of symptoms will have to be the approach.
Read below.
Detailed Answer:
Thank you for your feedback. The fact that it comes and goes does speak against an endocrinological condition which manifestations would be persistent to a degree and not disappear entirely. That applies to most neurological conditions as well, there are some electrolyte disturbances which could cause such transitory muscle weakness but you state you blood tests to be normal.
Sleep could be a factor. Sleep deprivation can cause daytime somnolence and fatigue.
The most appropriate specialist would be a neurologist as it is a specialty which deals with muscle issues, orthostatic hypotension, sleep conditions and anxiety as well, so can make a broad consideration of these hypothesis which are discussed. I suggest prior to a consult you start to keep a sleep diary in order to identify sleep patterns and their relation to your symptoms, there are several ready models online, just google sleep diary, here's one example link http://sleepfoundation.org/sleep-diary/SleepDiaryv6.pdf
The neurologist might ask for nerve conduction studies/electromyography to look for possible muscle conditions explaining your weakness. Some other tests which should be made (if not already done) are thyroid function, vitamin B12 and D, complete electrolyte panel.
There is the possibility of everything coming normal, the symptoms do not fully fit in any diagnosis, in that case perhaps anxiety might really be a factor and just a healthy lifestyle and observation of the evolution of symptoms will have to be the approach.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thank you doctor for your help on this matter. Today I am also performing and I am not fatigued nor feeling faint at all. It's a warm day and I feel fine.
I would like to add that I am also a stock market trader and I was going through a tremendous amount of stress and so took a break on July 6 to remedy that. I have actually kept a sleep journal through my mobipe phone since February of this year and found that for the first 5 months I accumulated a sleep debt of about 50 hours. I yawned often and just couldn't get to sleep because I tend to overthink things.
I have not been diagnosed with dysautonomia so it's possible that your insight is more correct in that it's likely not neurological nor endocrinological in nature as my symptoms fade for several days sometimes weeks at a time. When I stopped the stock market on July 6 my symptoms faded completely for 19 days. I had energy and felt like my old self again. Then I only slept for 5 hours one night and the day after my symptoms began again.
It's a very strange set of occurrences but it is possible to be anxiety as I have not completely ruled that out either.
I've taken a full blood test of vitamin B-12, thyroid(although I'm not sure if there are other thyroid tests that can be done?), and also vitamin D. In July 2014 my vitamin D was 16ng/ml and this past may it went up to 32 after I spent 6 months mountain biking more. I have very poor aerobic resistance but very strong anaerobic resistance through my legs from so much slow mountain biking.
I have the blood tests and reports if you would like to see them. I'm sure I can scan and upload them here.
What I haven't checked for would be the electrolyte panel. I've also understood that sometimes the problems are heart related and that aside a visit to a neurologist a consult with a cardiologist woupd be beneficial.
My mother has a bit of anxiety and diabetes and my father died of a heart attack. I don't have diabetes as my diet is strong but I haven't checked my heart in about 6 years.
Thank you very much doctor you have been much more helpful than many of the doctors I've already been to. I think the symptoms that come and go for days and weeks at a time are a clue my body is giving me about what the problem might be.
I would like to add that I am also a stock market trader and I was going through a tremendous amount of stress and so took a break on July 6 to remedy that. I have actually kept a sleep journal through my mobipe phone since February of this year and found that for the first 5 months I accumulated a sleep debt of about 50 hours. I yawned often and just couldn't get to sleep because I tend to overthink things.
I have not been diagnosed with dysautonomia so it's possible that your insight is more correct in that it's likely not neurological nor endocrinological in nature as my symptoms fade for several days sometimes weeks at a time. When I stopped the stock market on July 6 my symptoms faded completely for 19 days. I had energy and felt like my old self again. Then I only slept for 5 hours one night and the day after my symptoms began again.
It's a very strange set of occurrences but it is possible to be anxiety as I have not completely ruled that out either.
I've taken a full blood test of vitamin B-12, thyroid(although I'm not sure if there are other thyroid tests that can be done?), and also vitamin D. In July 2014 my vitamin D was 16ng/ml and this past may it went up to 32 after I spent 6 months mountain biking more. I have very poor aerobic resistance but very strong anaerobic resistance through my legs from so much slow mountain biking.
I have the blood tests and reports if you would like to see them. I'm sure I can scan and upload them here.
What I haven't checked for would be the electrolyte panel. I've also understood that sometimes the problems are heart related and that aside a visit to a neurologist a consult with a cardiologist woupd be beneficial.
My mother has a bit of anxiety and diabetes and my father died of a heart attack. I don't have diabetes as my diet is strong but I haven't checked my heart in about 6 years.
Thank you very much doctor you have been much more helpful than many of the doctors I've already been to. I think the symptoms that come and go for days and weeks at a time are a clue my body is giving me about what the problem might be.
Brief Answer:
You're welcome.
Detailed Answer:
I am starting to believe anxiety might really be the cause given the relation in time with work you describe. Anxiety is a main contributor of sleeping difficulties as well.
Feel free to upload the reports anytime. I am sure you must have had an electrolyte panel, very routine, so now that you mention to have done vit b12, d and thyroid function I am sure electrolytes were included as well.
Wishing you good health.
You're welcome.
Detailed Answer:
I am starting to believe anxiety might really be the cause given the relation in time with work you describe. Anxiety is a main contributor of sleeping difficulties as well.
Feel free to upload the reports anytime. I am sure you must have had an electrolyte panel, very routine, so now that you mention to have done vit b12, d and thyroid function I am sure electrolytes were included as well.
Wishing you good health.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Yes, I believe that they were.
The only question I have now regarding the anxiety is one that was never answered to before nor could I find any reference online.
My whole life I never had any symptoms andbI was perfectly healthy is everyway. My first anxiety attack came on Sep. 10, 2014. I remember feeling slightly odd and to "shake it off" I got up and did about 80 jumping jacks exercises. That's when it REALLY got worse and I felt like I was dying and about to faint even though I was lying down. It was a terrible feeling. Do anxiety attacks become worse when instead of relaxing you "force" exercise through it?
Is anxiety a condition that builds over years until it finally explodes and all the symptoms start as a result of anxiety and continue? I ask because for the first 33 years of my life I was perfectly normal. I'm sure I had a few dizzy spells but nothing like it was these past 11 months. Then all of a sudden the doctors as the hospital gave me Xanax and told me I had anxiety! I just couldn't believe it because I never had those feelings before. It's almost as if my body could not handle the anxiety anymore and is now showing all the symptoms.
Nobody could ever tell me this which is why I couldn't be sure if it was anxiety or not. Thank you doctor!
Doctor,
I would also like to add another condition which VERY closely relates to all my symptoms that you may be familiar with. Neurocardiogenic syncope. It sounds like dysautonomia, however. This is the site that describes almost all of my symptoms:
http://www.YYYY.info/neurosyn.asp
I DO remember about 2 years ago entering a hot sauna and I felt VERY sick as soon as I got out. I felt like I was about to faint. That might also be a clue my body is trying to tell me.
Would stronger aerobic and cardiac strength help?
I feel like I am finally starting to narrow down and find the cause of my mysterious problem thanks to you. I appreciate your help!
The only question I have now regarding the anxiety is one that was never answered to before nor could I find any reference online.
My whole life I never had any symptoms andbI was perfectly healthy is everyway. My first anxiety attack came on Sep. 10, 2014. I remember feeling slightly odd and to "shake it off" I got up and did about 80 jumping jacks exercises. That's when it REALLY got worse and I felt like I was dying and about to faint even though I was lying down. It was a terrible feeling. Do anxiety attacks become worse when instead of relaxing you "force" exercise through it?
Is anxiety a condition that builds over years until it finally explodes and all the symptoms start as a result of anxiety and continue? I ask because for the first 33 years of my life I was perfectly normal. I'm sure I had a few dizzy spells but nothing like it was these past 11 months. Then all of a sudden the doctors as the hospital gave me Xanax and told me I had anxiety! I just couldn't believe it because I never had those feelings before. It's almost as if my body could not handle the anxiety anymore and is now showing all the symptoms.
Nobody could ever tell me this which is why I couldn't be sure if it was anxiety or not. Thank you doctor!
Doctor,
I would also like to add another condition which VERY closely relates to all my symptoms that you may be familiar with. Neurocardiogenic syncope. It sounds like dysautonomia, however. This is the site that describes almost all of my symptoms:
http://www.YYYY.info/neurosyn.asp
I DO remember about 2 years ago entering a hot sauna and I felt VERY sick as soon as I got out. I felt like I was about to faint. That might also be a clue my body is trying to tell me.
Would stronger aerobic and cardiac strength help?
I feel like I am finally starting to narrow down and find the cause of my mysterious problem thanks to you. I appreciate your help!
Brief Answer:
Read below
Detailed Answer:
Hello again! Thank you for your appreciative words.
Regarding the question on the relation of anxiety and physical activity. In general physical activity is actually helpful in trying to reduce anxiety. That is because they induce the release of endorphins which have a calming effect. Also the simple psychological effect of having a goal, of being involved in something useful reduces basic anxiety level. It does not have this immediate effect though, it does not cure anxiety at one precise moment, rather trying to force it to use the same term as you do increases the stress level and it not working and fear of those new symptoms affected it even more, sort of an avalanche effect.
As for why did anxiety become prominent at the age it did. The exact mechanism of anxiety is not completely understood. It is a question of delicate balance of many transmitters in the brain and the different receptors they act on. When the balance shifts slightly to one side symptoms occur. That is thought to be partly genetic, the same way we have different body features, we have have varying neurotransmitter levels, which makes us prone to anxiety. On the other hand environmental factors play a role as well pushing us over a certain threshold where the symptoms manifest. So factors like stressful work might induce the symptoms in someone who has a genetic predisposition. That might have been a factor in your case. The mechanisms though as I said in the beginning are not always exactly understood.
As for the neurocardiogenic syncope, yes that can well be the case. I already mentioned in my very first answer that variations in vagal tone can be a cause
and that is what neurocardiogenic syncope is an abnormal predominance of the vagal tone. That can cause symptoms when coming out of a hot bath as your peripheral vessels are dilated with less blood for the brain so would need the sympathetic system which increases heart output to predominate instead of the vagal (parasympathetic) one. That is the case when you play the trumpet when the increased intrathoracic pressure lowers heart output, so again would need more sympathetic and less parasympathetic. And coming to anxiety that is a common trigger of vagal syncope as well. So one thing doesn't exclude the other. You have a genetic tendency for increased vagal tone (not necessarily progressing into a pandysautonomia, no reason for panic) which can be put into evidence by anxiety or other triggers like the trumpet or hot bath/sauna.
As for the exercises, as they help prevent anxiety attacks they are helpful, light to moderate exercise, no extreme exertion, exercises like light jogging, swimming. Yoga is also very helpful.
Wishing you good health
Read below
Detailed Answer:
Hello again! Thank you for your appreciative words.
Regarding the question on the relation of anxiety and physical activity. In general physical activity is actually helpful in trying to reduce anxiety. That is because they induce the release of endorphins which have a calming effect. Also the simple psychological effect of having a goal, of being involved in something useful reduces basic anxiety level. It does not have this immediate effect though, it does not cure anxiety at one precise moment, rather trying to force it to use the same term as you do increases the stress level and it not working and fear of those new symptoms affected it even more, sort of an avalanche effect.
As for why did anxiety become prominent at the age it did. The exact mechanism of anxiety is not completely understood. It is a question of delicate balance of many transmitters in the brain and the different receptors they act on. When the balance shifts slightly to one side symptoms occur. That is thought to be partly genetic, the same way we have different body features, we have have varying neurotransmitter levels, which makes us prone to anxiety. On the other hand environmental factors play a role as well pushing us over a certain threshold where the symptoms manifest. So factors like stressful work might induce the symptoms in someone who has a genetic predisposition. That might have been a factor in your case. The mechanisms though as I said in the beginning are not always exactly understood.
As for the neurocardiogenic syncope, yes that can well be the case. I already mentioned in my very first answer that variations in vagal tone can be a cause
and that is what neurocardiogenic syncope is an abnormal predominance of the vagal tone. That can cause symptoms when coming out of a hot bath as your peripheral vessels are dilated with less blood for the brain so would need the sympathetic system which increases heart output to predominate instead of the vagal (parasympathetic) one. That is the case when you play the trumpet when the increased intrathoracic pressure lowers heart output, so again would need more sympathetic and less parasympathetic. And coming to anxiety that is a common trigger of vagal syncope as well. So one thing doesn't exclude the other. You have a genetic tendency for increased vagal tone (not necessarily progressing into a pandysautonomia, no reason for panic) which can be put into evidence by anxiety or other triggers like the trumpet or hot bath/sauna.
As for the exercises, as they help prevent anxiety attacks they are helpful, light to moderate exercise, no extreme exertion, exercises like light jogging, swimming. Yoga is also very helpful.
Wishing you good health
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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