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  • Writer's pictureMaria Arini Lopez, PT, DPT, CSCS, CIMT, CMTPT

Thermoregulation Issues in Dysautonomia

October 24, 2022 - Written By: Maria Arini Lopez, PT, DPT

Symptoms of dysautonomia are caused due to dysfunction within the autonomic nervous system (ANS). One of these symptoms is difficulty regulating your body’s internal temperature. This is an automatic process that is coordinated by the ANS, involving the sweat glands and blood vessels near the skin.

Normally, when we get overheated, our blood vessels dilate or get bigger near the skin. This allows heat to transfer from the body’s core via convection (movement tendency of heat to rise) to the surface of the skin. At the same time, sweat glands activate, allowing the body to cool through water evaporating as sweat off of the surface of the skin.

People with dysautonomia may sweat too much or too little, causing the body to retain or lose too much heat. In dysautonomia, the ANS may also have difficulty regulating the dilation and constriction of the blood vessels to allow for release or retention of heat.

The inability to regulate core body temperature is known by the medical term, poikilothermia.

Ways to Manage Cold intolerance

People with dysautonomia may experience intolerance to the cold if they have:

  • poor blood circulation due to low blood volume

  • problems coordinating blood vessel dilation and constriction

  • lose too much heat through excessive sweating

To combat cold intolerance:

  • Layer clothing

  • Use gloves, hats, and hand warmers

  • Use heated blankets or mattress pads

  • Apply warm compresses

  • Soak the hands and feet in warm water

  • Avoid rapid or large temperature changes (for example: coming into an air-conditioned building from the heat outside and taking lukewarm showers to avoid going from hot to cold extremes too quickly)

  • Stay well hydrated to maintain blood volume

  • Increase salt and fluid intake to replace salt and water lost through excessive sweating

Ways to Manage Heat intolerance

People with dysautonomia who do not sweat sufficiently or whose blood vessels do not dilate enough to release internal body heat may become intolerant to the heat.

To combat heat intolerance:

  • Wear cooling vests

  • Carry a miniature portable fan or spray bottle of water to cool the skin down

  • Use cold compresses or ice packs

  • Sleep on a cooling mattress

  • Take lukewarm showers

  • Make sure your home has a functional air-conditioner

  • Be careful with intense outdoor exercise in the heat. Instead, choose to exercise in an air-conditioned gym and moderate exercise intensity, taking frequent rest breaks to prevent overheating.

While there are no cures for thermoregulation problems caused by dysautonomia, there are many lifestyle modifications and ways that can help manage the symptoms of cold or heat intolerance.

References and Resources

  1. Thermoregulation. Dysautonomia Support Network. Accessed October 20, 2022,

  2. Velez K. Impaired thermoregulation. PM&R Knowledge Now. Accessed October 20, 2022.

  3. Wong BJ, Hollowed CG. Current concepts of active vasodilation in human skin. Temperature (Austin). 2016;4(1):41-59. doi:10.1080/23328940.2016.1200203

  4. McCallum K. How Sweat Works: Why We Sweat When We're Hot, as Well as When We're Not. Houston Methodist Leading Medicine. Accessed October 20, 2022.

  5. Dysautonomia symptoms & treatment. Aurora Health Care. Accessed October 20, 2022.

  6. Important Lifestyle Changes: Temperature Regulation. POTS UK. Accessed October 20, 2022.

Maria Arini Lopez, PT, DPT

Maria Arini Lopez, PT, DPT, CSCS, CIMT, CMTPT is a freelance medical writer and Doctor of Physical Therapy from Maryland. She has expertise in the therapeutic areas of orthopedics, neurology, chronic pain, gastrointestinal dysfunctions, and rare diseases, especially Ehlers Danlos Syndrome.

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