So… Why Does It Feel Like I’m Going to Pass Out When I Stand Up?

What Does POTS Feel Like?

You stand up—and just like that, the world starts to slip away. Not spinning like vertigo, but like you're fading out of the moment. Lightheaded. Unsteady. Like you're about to pass out, even though you're just standing still. And it doesn’t stop there.

Everyday activities like sitting, standing, or even showering can trigger a cascade of symptoms. I remember one morning when I stood up from bed, determined to tackle a normal day, only to feel that familiar wave of blackness creeping in. My heart raced, my legs felt shaky, and I had to sit down immediately. It wasn’t simple exhaustion or dehydration—it was something deeper, harder to explain.

Basic tasks like carrying a laundry basket up the stairs can feel like climbing Mount Everest. On “bad” days, even something as basic as showering feels like a marathon. 

So why does it feel like you’re going to pass out when you stand up?

With POTS, the autonomic nervous system isn’t adjusting properly. When most people stand, their blood vessels gently tighten to help keep blood flowing to the brain. But in POTS, that adjustment doesn't happen the way it should. Blood can pool in the lower body, and the heart ends up working harder and faster to try to push it back up.

That mismatch can leave you feeling lightheaded or dizzy, like your vision is fading, and suddenly shaky or weak—all in a matter of seconds.

It doesn’t have to be a dramatic fainting spell (though that can happen too). More often, it feels like a dark night sky, and you have to act quickly before everything dims. Sitting or lying down usually brings relief, but it can still be unsettling every time it happens.

What is POTS?

Postural Orthostatic Tachycardia Syndrome (POTS) is a type of dysautonomia—a condition where the autonomic nervous system (ANS) doesn’t work quite right. The ANS controls things we don’t consciously think about, like heart rate, blood pressure, and digestion.

POTS often develops after an illness or trauma and affects people differently because it involves a system responsible for so much of what our bodies do automatically. It’s like your internal autopilot suddenly goes haywire.

POTS is getting more attention lately, especially with long COVID cases, but it isn’t new. It’s a diagnosis that connects the dots for so many symptoms that can feel unrelated.

Common Symptoms and Triggers

POTS can look and feel different from person to person, but many people experience a mix of lightheadedness, fatigue, brain fog, and a racing heart—especially after standing up. Other symptoms might include nausea, headaches, shakiness, or feeling unusually hot or cold.

What makes symptoms worse can also vary, but standing still for long periods (like doing dishes), hot showers, or even mild dehydration often makes things harder. Some people also notice symptoms flare in the morning or after meals.

It’s not about being out of shape or overreacting—it’s about a body trying to self-regulate with mixed signals.

What Isn’t POTS?

There are other conditions that can cause symptoms similar to POTS, like low iron or low B12. If you’re experiencing lightheadedness or fatigue, it’s worth checking for underlying issues or deficiencies before assuming it’s POTS.  

How POTS Affects the Heart (and Why It’s Not a Heart Problem)

Even though POTS can cause symptoms like a rapid heart rate, it’s not a problem with the heart itself. The heart is typically healthy—it’s just receiving the wrong signals.³ I’ve had moments when my heart felt like it was racing a mile a minute, and I hadn’t even moved. It’s unsettling when you don’t understand what’s happening, but knowing my heart is actually fine helped ease some of that worry.

Nervous System Regulation: Why It Matters

​​POTS symptoms can feel unpredictable—like a revolving door of ups and downs, symptoms and triggers that come and go without warning. But even with that unpredictability, you can begin to support your autonomic nervous system (ANS) through simple lifestyle choices.

This isn’t a replacement for medical care—it’s about developing practical coping strategies you can use across a spectrum: from quick rescue techniques to daily habits that help maintain balance, and eventually, ways to gently expand what your body can handle.

Breathwork can be a go-to strategy, but first, you need to notice what’s happening in your body—the physical sensations, the emotions you’re feeling, and the thoughts running through your mind.⁴ One simple technique is the audible sigh: take a slow, deep breath in through your nose and exhale out through your mouth with a soft sigh or “haaa” sound. Repeat this audible sigh breath 3 to 5 times. Afterward, check in again—has anything shifted? This simple practice may help you feel calmer and ease some of your worries.  

The Bottom Line

Living with POTS means navigating a lot of unknowns—from mysterious symptoms to triggers that seem to come out of nowhere. But understanding what’s happening in your body is the first step toward making daily life a little easier—or at least worrying less about what’s “wrong.”

It also means learning how to support your body with tools that meet you where you are—not where you think you should be. That’s exactly why I created the Pilates for POTS courses: accessible, adaptable movement designed for real life with conditions like POTS.

And while nervous system regulation and exercise won’t make POTS vanish, it can help you recover more quickly after standing—or at the very least, not make things worse. With practice, these techniques can become your body’s way of finding its footing again.

You don’t have to push through pain or ignore what your body’s telling you. You can feel better. You can get active—gently, safely, and at your own pace. Feeling better and getting active is within your reach.

 ¹ National Heart, Lung, and Blood Institute. Postural Orthostatic Tachycardia Syndrome (POTS). https://www.nhlbi.nih.gov/health/pots

² Dysautonomia International. (n.d.). What is POTS?https://www.dysautonomiainternational.org/page.php?ID=30

³ Grubb, B.P., & Karas, B.J. (1999). The potential role of the autonomic nervous system in the pathogenesis of syncope.Journal of Interventional Cardiac Electrophysiology, 3(2), 157–165. https://doi.org/10.1023/A:1009895213941

⁴ NSIF, 2025 — The Embodied Business Institute, Anne C. Bishop M Ed., BBC, NPCT and Chantill Lopez BBC, NPCT