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Pots Home Standing Test

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The essentials, before you begin

What you’re testing for. POTS is a condition that affects the autonomic nervous system, which controls automatic body functions like heart rate and blood pressure, among others. When a person with POTS stands up, their heart beats much faster than normal leading to symptoms like dizziness or fatigue.

Who should consider testing for POTS? Testing for POTS can be meaningful if you have symptoms of orthostatic intolerance, particularly lightheadedness, palpitations, presyncope, generalized weakness, or blurred vision that occur with standing and improve with lying down.

The home standing test is a screening tool. It can raise suspicion but it cannot fully diagnose. POTS is a diagnosis that requires a clinician to rule out other causes (dehydration, medications, thyroid disease, adrenal issues, arrhythmias, anemia, structural heart disease, and more). But the test can give you and your clinician meaningful information and help start the conversation.

When not to do this test at home. If you have known cardiac disease, arrhythmias (abnormal cardiac rhythm, such as A-fib), a history of falls with injury, or you tend to lose consciousness rather than just feel lightheaded, do this test with your clinician rather than alone. If you are currently acutely ill, dehydrated, or newly on a medication that affects heart rate or blood pressure, wait for a more representative day.

What you need

A heart rate monitor of some kind. This can be:

• A blood pressure cuff that measures heart rate in addition to blood pressure. This is beneficial to measure how your BP also changes with position change. You can buy this at any pharmacy or online.

• A chest strap heart rate monitor

• A fingertip pulse oximeter

• A fitness tracker or smartwatch with continuous heart rate display

A wall you can lean against

A quiet room with no interruptions

About 20 minutes of free time

A notebook, phone note, or the printable protocol at the end of this post to record your numbers

If you can, get a family member or a friend to help you.

The test

Step 1. Lie flat and quiet for at least 10 minutes.

Turn your phone face-down. Don’t scroll, don’t read anything stimulating, don’t get up to check something. This is the resting phase, and the numbers depend on you actually being at rest. Bathroom before you start.

Step 2. Take your resting heart rate.

At the end of the 10 minutes, still lying down, record your heart rate. Take it again a minute later and average the two. Write both numbers down.

Step 3. Stand up and lean lightly against a wall.

Shoulders and buttocks touching the wall, heels 6-8 inches out from the baseboard. This is a supported stand not rigid attention.

Step 4. Record your heart rate at 1, 3, 5, and 10 minutes of standing.

Stay against the wall the entire time. Don’t shift weight, don’t cross your ankles, don’t fidget as those small movements activate the calf muscles and can artificially lower your heart rate.

Step 5. Record your symptoms as they happen.

Lightheadedness, palpitations, nausea, brain fog, tingling, visual changes, ringing in the ears, feeling faint, warmth in the face, cold hands, tremor.

Step 6. Sit or lie down

Record how you feel after the test and note how quickly symptoms resolve.

Interpreting your numbers

POTS is defined by a specific pattern. When you stand, your heart rate rises by at least 30 beats per minute above your lying-down rate within 10 minutes of standing (or 40 bpm if you are under 20) without a significant drop in blood pressure, and with symptoms.

A more transient spike in the first minute or two that then settles back down is common and not specific for POTS.

If your heart rate rises but you are also experiencing a significant drop in blood pressure, that points toward orthostatic hypotension rather than POTS, a different condition with different management.

Symptoms matter as much as numbers. Some patients have a clear POTS heart rate pattern with modest symptoms. Others have significant symptoms with borderline numbers. Both are worth taking to a clinician. As I said earlier, this test is meant to be a conversation starter.

What to do with your results

If your test suggests POTS. Bring the numbers to your clinician. Ask them to look at the pattern with you. Depending on your other conditions, the right next referral may be to cardiology, to a neurologist with autonomic expertise, or to an internist familiar with dysautonomia. Your physician may also give you direction on beneficial lifestyle changes. Be aware that not every clinician is comfortable evaluating for POTS, and even less are comfortable treating POTS.

If your test is normal but you have significant symptoms. A negative home test does not rule out POTS. Symptoms can fluctuate day to day; your hydration status, sleep, hormones, and stress load all affect the numbers. If your symptoms are real and consistent, the test being negative on one occasion should not close the door. You can repeat the test on another day, Or you may need a formal tilt table test in an autonomic lab that is more sensitive than the home version.

If you have MS, hEDS, small fiber neuropathy, or a rare neuroimmune condition. Even a mild positive result is worth raising. Dysautonomia is a well-documented comorbidity of these conditions, and may be a missing piece contributing fatigue, brain fog, or exercise intolerance.

If your test is unremarkable and your symptoms are mild. That’s useful information too. It doesn’t rule out other forms of autonomic dysfunction, but it makes classical POTS less likely as the explanation.

In your corner,

Dr. Freeman

But perhaps the hardest season of all comes just after the new year, when health plans reset, coverage changes, and a wave of reauthorizations begins. Too often, that wave brings something else with it: denials for medications and therapies that had already been approved and were working.

This happens when employers switch insurers, when plan structures change, or when individuals are forced to select new coverage in the marketplace. These decisions are almost always driven by cost. But the downstream consequences are not abstract, they are deeply human.

2026 has been an especially difficult transition. With new federal policies, rising healthcare costs, and increasing consolidation in provider markets, we are seeing sharp increases in premiums and significant instability, particularly for small employers and individuals. I am not an economist, and I won’t attempt to unpack all the “why.” What I can speak to are the consequences for people like you and me, and especially for those living with chronic illness like MS, where staying on a treatment that works is essential not just for daily function, but for preventing future disability.

So let me tell you what I am seeing.

Over the past few months, more patients have walked into my office telling me their premiums doubled, from ~$600 to over $1200 per month, forcing them into plans that “don’t cover much.”
I have had patients ask me if there is any other way to access their treatment because they are being priced out of insurance entirely.
I have seen medication costs skyrocket to the point where patients are choosing between their health and putting food on the table.

I have seen our nurses work tirelessly to prevent gaps in treatment after plan changes.
I have seen medications that kept patients stable for years suddenly denied because they are not on a new formulary.
I have spent evenings writing urgent appeal letters, while my children waited for me to finish work that no one reimburses.

I have seen “STAT” appeals downgraded to non-urgent, leaving patients waiting months for decisions that cannot wait.
I have seen avoidable hospitalizations while we sit in those queues.
I have seen the look on patients’ and care partners’ faces when yet another appeal is denied.

Preventing someone from accessing a therapy that has kept them stable is not only morally wrong, it is economically irrational. It requires a kind of magical thinking to believe that a patient who achieved remission on a high-efficacy therapy will remain stable without it, or on a lower-efficacy alternative. And yet, this is exactly what the system repeatedly asks us to accept.

When patients are forced off effective therapies, we see what follows: relapses, hospitalizations, loss of function, costs that are far greater, both financially and humanly, than the treatment that was working in the first place.

The disregard for continuity of care reveals how far we still are from a truly person-centered system. Clinicians continue to advocate through peer-to-peer calls, appeal letters, and external reviews, often in hours that go unseen and unreimbursed. Meanwhile, entire plans of care can be dismantled by insurers with little explanation, and evidence of long-term stability is often not enough to secure continued access.

Patients are left with impossible choices: navigate complex assistance programs that require time and resources they may not have, or switch to a therapy they are not confident will work as well. For people living with a chronic illness, changing medications can feel like a monumental decision even when it is necessary. Being forced into that change erodes trust in ways that are hard to rebuild.

For clinicians, this work is now part of care, but it comes at a cost. In a system driven by productivity metrics and volume, this added burden contributes to burnout and, increasingly, to clinicians leaving medicine altogether.

Current “continuity of care” protections, often called transition-of-care laws, offer only partial relief. At the federal level, they focus primarily on maintaining access to providers, not medications. At the state level, protections are inconsistent and typically temporary, offering a bridge of 30 to 90 days at best.

In practice, these laws provide a window, not a guarantee. They buy time to appeal, to request exceptions, to scramble for alternatives. But they do not ensure that patients can remain on the therapies that are keeping them well. For conditions like complex and chronic neurological illnesses, where treatment interruption carries real risk, this gap between temporary protection and long-term stability is not just inconvenient, it is dangerous.

A more person-centered approach would embrace a simple principle: stable patients should remain on stable therapies.

This would mean requiring insurers to honor effective treatments after plan changes, mandating continuity of medication coverage for chronic conditions, and limiting step therapy when a patient has already demonstrated benefit. It would mean faster, clinically informed appeals and greater transparency around denials.

At its core, it would shift the system from prioritizing short-term cost containment to protecting long-term outcomes, function, and trust.

These protections are even more critical for people living with rare diseases. For them, finding a treatment that works can take years, years of uncertainty, dismissal, and searching. When a therapy finally makes a difference, it is not just a medication, it is a lifeline.

To have that lifeline suddenly taken away is a level of suffering that is difficult to put into words.

We can do better.

We cannot accept a system where patients are destabilized because their employer changed plans or because costs continue to rise. We cannot accept that formularies shaped by rebate negotiations take precedence over clinical judgment, lived experience, and common sense.

And we should not accept that staying well is treated as optional.