Managing Stress

22nd October 2023 | Dr Boon Lim


A diagnosis of vasovagal syncope and autonomic dysfunction can be life-altering. These conditions can cause fainting spells, rapid heartbeats, shortness of breath, chest pain and feeling weak and tired. These symptoms may seem overwhelming, but having knowledge can be a powerful tool for patients. Understanding the complexities of vasovagal syncope and autonomic dysfunction empowers individuals to take control of their health, adhere to recommended treatments, and ultimately improve their quality of life.

Stress is the body’s natural response to a threat. In most cases, the physical (e.g. running for a bus, or away from a threat) or mental (e.g preparing for an interview or exam) or emotional stress (e.g. bereavement or frustration) can be clearly understood. Symptoms such as palpitations, a “funny feeling” in the gut, or slight breathless and tremulousness, can be clearly explained or even expected whilst experiencing these acute stresses.

However in vasovagal syncope and other autonomic dysfunction syndromes, the acute stress may not be clearly registered by your “brain”, as this specific form of orthostatic stress is not something most people will understand. Orthostasis simply means “to stand up” and in people who suffer with these conditions, the mere act of standing up can cause a significant acute stress in the body, through a complex series of reflexed that aim to maintain your blood pressure, which typically falls when standing. The upshot of this orthostatic stress is that during standing, your body may well be experiencing the same amount of acute stress (for example experienced during an argument) which releases a neurochemical profile consistent with the fight or flight response (i.e plenty of acute adrenaline and cortisol).

However, over time, patients who have uncontrolled chronic symptoms of orthostatic stress may develop a longer term chronic stress pattern, which may be associated with an ongoing state of emotional and psychological tension which can arise when dealing over a longer period with a recurrent debilitating medical condition, such as recurrent fainting, or associated symptoms which worsen when standing up.

The Vicious Cycle: Stress and Fainting

Stress and recurrent fainting often go hand in hand. Stressful situations can trigger fainting episodes, and the fear of fainting can, in turn, lead to more stress. This creates a vicious cycle that can be emotionally draining and physically taxing. So, what can you do to break this cycle and regain some control over your life? The following vidoes highlight some of our own observations within the Imperial Syncope Clinic with respect to stress and symptoms:

Stress Management Tips

1. Education Is Empowerment: Understanding your condition is the first step to managing stress. If you haven’t already, look up your condition on this link – which has links to vasovagal syncopeorthostatic intolerancedysautonomiaKnowledge can help alleviate anxiety and empower you to take control of your health.

2. Lifestyle Adjustments: Some lifestyle changes can significantly reduce the frequency of fainting episodes. Staying hydrated, and having adequate salt (if your BP is not high), maintaining a balanced diet, and getting enough sleep can make a big difference. Avoiding excessive caffeine, alcohol, and tobacco can help.

3. Stress-Reduction Techniques:

a. Acute stress “Reset” breathing: Try a “reset” breath during a period of acute stress by inhaling deeply through your nose to fully expand your lungs, and at the end of that, take another “sniff in” to get your lungs as expanded as they can be, before letting go with a deep long slow exhale through your mouth (you can allow the flow of this breath to make a low-frequency sound if you want during the exhale). Having just a single “reset” breath like this or doing several “reset” breaths over a minute may take the edge away from the symptoms and shift your autonomic state acutely.

b. Deep breathing exercises can calm your nervous system and reduce stress in the longer term. In the link to breathing exercises, we discuss and demonstrate how a slow rhythmic deep nasal belly breathing technique (for example 5 seconds in, 5 seconds out) practiced for 10 minutes twice a day may be useful in shifting your autonomic nervous system state in the longer term. For example on breathing yourself better, see here

c. Mindfulness and Meditation: These practices can help you stay in the present moment and reduce anxiety. Regular meditation sessions coupled with mindful breathing exercises can be especially effective. However, simply being mindful about everything you do is an excellent way to bring yourself away from the anxiety of the past and fear of the future. When walking outdoors, pay attention to the sights and sounds around you, rather
than staying in your “head”, and similarly when performing any tasks, such as preparing a meal or drinking tea, fully immerse yourself in the moment of that activity.

d. Yoga, Tai Chi, or any other mode of gentle regular exercise: Gentle yoga and stretching can improve your physical and mental well-being. It promotes relaxation, flexibility, and balance, which can help manage stress and improve your overall health.

e. Consider working with a therapist who specializes in dealing with chronic stress. There are various forms of therapy which may help you to change negative thought patterns and develop coping strategies. Look up, or to find out more about how to seek support.

4. Family and friends support structure: Don’t hesitate to lean on friends and family for support. Sharing your experiences and feelings with loved ones can be therapeutic. Theycan also be there to assist during fainting episodes.

5. Stay Hydrated and Well-Nourished: Proper nutrition and hydration are essential for maintaining your health and reducing the risk of fainting episodes. Consult with a healthcare professional or nutritionist for guidance on a diet suitable for your condition.

6. Keep a Journal: Keeping a diary of your fainting episodes, triggers, and symptoms can provide valuable insights. You may start to notice patterns that can help you anticipate and prevent fainting spells.


Living with recurrent fainting can be challenging, but with the right strategies and support, you can manage both the condition and the stress that comes with it. Remember that stress management is a journey, and what works for one person may not work for another.

You can regain some control over your life and minimize the impact of recurrent fainting, allowing you to lead a fulfilling and balanced life.

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