Autonomic Interventions

The autonomic nervous system (ANS) is a tricky beast that may, at first, seem untamable. The majority of medical doctors that work with dysautonomia understand that regulation is needed, and that this should come primarily from the patient. However, they still favor more in-depth conversations on pharmaceuticals rather than how the patient can work to restore their autonomic function. Commonly, I see the attempt of addressing this provided through recommendations of adding salt and water to the diet and, perhaps, starting the Levine protocol. This may be helpful for some, but it is barely skimming the surface of autonomic interventions and is definitely not individualized to work toward the best results. Protocols are meant to be suggestions of a plan to recovery. Not everyone follows the same protocol progression after a knee surgery, so why would we think the autonomic system, as fickle as it is, would want to do the same?

While I am not here to recommend a protocol to anyone regarding their own personal recovery, I’d like to expand a bit on some ways to tackle the autonomic beast. There are a few approaches I use with my patients, and the combination is different for each one. There are “top down”, “bottom up”, and “meet in the middle” strategies to work on the autonomic system. Once we implement something that feels right, we reassess a few weeks or months later and adjust. Some people resonate more with one strategy or don’t have the time for others. The good thing is, there is a lot to chose from!

“Top down” approaches are the ones that sometimes get me an eye roll, which is why I am so glad there are other ways to address the ANS. This is where we work at the level of the brain and thought to influence the response of our ANS on our heart rate, blood pressure, etc. Some examples of “top down” approaches are meditation, mindfulness, music therapy, interventions to help with auditory processing, and frequency therapy. We can change the state of the ANS from working on the brain and thought patterns. Emotions activate the ANS and the HPA Axis (hypothalamic-pituitary adrenal axis) which influences our body system and organs. Working on changing the emotions we feel will change the way our ANS is functioning.

“Bottom up” approaches are away from the thought pattern and brain and, instead, influence the ANS in a more physical way to make a change. Some of these strategies are healthy hydration blend intake (classic water and table salt don’t cut it for most), compression stockings or other compression garments, elevating the head of the bed slightly to acclimate the system a bit overnight, taking more frequent horizontal breaks during the day, slowly progressing into aerobic activity, and cranioelectrical stimulation. I find these are much easier for most to start with (excluding aerobic activity) and are easier to stick to.

The “meet in the middle” approach is finding a way to work on both the input and output of the ANS. Trying to change what the ANS is doing physically while trying to change the mindset in the same moment. This is new to my practice, but seems to be beneficial if approached in a slow and gentle manner depending on the person ready to try it. The technique I’ve explored within my clinic is heart rate variability (HRV) training. This measures the average distance/time between heart beats, looking for a consistent rhythm that would let us know how well the ANS is working and regulating. This goes along with a visual app to watch the HRV while performing some mental exercises.


There is no gold standard protocol to working on the ANS. There are more options out there and more understanding of how the system works in the past decade or so, but it will always be an individual exploration of what works best for each person. I do believe most will eventually need to approach the system from all directions: “top down”, “bottom up”, and “meet in the middle”.

There are a good number of these approaches that can hit a road block as our brains prefer its “normal” state rather than making changes, even if it is for the better. There may be an uncomfortable period with some of the “top down” and “meet in the middle” approaches that I recommend working gently through with a professional trained in some of these methods.

Even when a steady beneficial treatment plan has been developed for someone, if the mindset (stress, grief, etc) changes, or the physical system changes (illness, injury, surgery, etc), sometimes an entirely new approach needs to be found. One of the most important discussions I have with my patients is that the body is always providing messages we need to learn to interpret. It may seem frustrating at first, but learning to communicate with our body and minds is what will keep us healthy long-term. We can learn to regulate our own systems, maybe with a bit of help from specialist or two in this area, but learning the language of the body is ridiculously empowering.