Mental effort can trigger symptoms. When I first had POTS after COVID, I could be lying flat and just playing sudoku would still have me tachycardic. I can handle more now, but to this day if I spend a chunk of time concentrating really hard on something I will send myself into brain fog, and I'll be more symptomatic the next day.
Me trying to explain this to my teacher who thinks that putting me in a different room for my tests will magically make my POTS disappear:
I second this. I usually get symptoms when driving and despite being physically pretty chilled out just having my arms elevated and concentrating on the road makes my heart race. Don't underestimate how much simply concentrating can affect you. Sorry to hear about your troubles OP :-(
edit: added some more stuff.
I have hEDS and get this with the piano. I always assumed it was the hypermobility causing my body to fold up a bit and have poor posture and not the POTS causing my piano issues.
One thing to watch for is your breathing with playing. I know I can sometimes forget to breathe/don’t breathe as much if I’m playing things that are unfamiliar/I’m still learning or if I am out of practice and am therefore extra concentrated and not necessarily focused on my phrasing. It’s easy to breathe naturally when you’re familiar with the flow of something and how the piece itself “breathes,” not so much when you’re just trying to figure out what note comes next.
It may also be tension related, if you’re tense you’ll end up fatigued faster.
Yes! Remembering to breathe naturally. That and learning to be much, much more relaxed when I practice, even when symptoms start to rise. Listening to my body and keeping it calm. Taking my time, especially with less familiar or polished pieces. Pacing. Letting the piece "breathe" with the phrasing as you mentioned. Doing so much more consciously has actually improved the quality of my playing!
It's been a major challenge expanding my internal awareness while playing after years of not having to and everything being pretty automatic. I'm getting better at it and able to play a lot longer now, too. It's a weird, refreshing experience.
I play some piano. I do get foggy and dizzy, nauseous and I think it’s just because I’m vertical for a while. How long I get to play depends on the day.
The first i ever fainted, I was playing the piano. It was very hot and we were by a window and I started to feel sick. I was like 12-13, I have hypo pots and OH, they never caught it. 😒 til legit last year at 33yo
YES omg it's so annoying, I'll be in the middle of lesson with a kid, playing some gentle um-chack chords for a 5yo singer and my heart rate will go YOUVE HIT 110+ CALM DOWN
And I'm like.,. I'm not doing anything??????
Had to stop playing many video games because even the excitement and rush I'd get from them would make me a bit too tachycardic for my liking. freaking sucks :/ Some games get me up near 130bpm and I'm not exactly moving anything besides my fingers and wrists.
You can trigger POTS symptoms just by sitting up if you’re severe enough.
I have to be laying down or reclined most of the day and get symptomatic after a few minutes of sitting upright.
I CANNOT sit in a seat without a back. And I have to have my legs folded up in my lap. I went to a wedding last year that had bench seating. Within 15 mins I was shaking violently and POTSing out.
i dont know what subtype of POTS i have yet (still waiting for the big boy tests, although all my doctors think it's POTS), but every time my arms are above my midsection, i start to feel dizzy/palpatations.
I get POTS symptoms when playing piano almost every time. I know having to look up at the sheet music and back down at my hands quickly and multiple times makes me really dizzy and will trigger other symptoms after a while. I also play other instruments and have similar issues when playing them.
Lowering the lighting level in the room or reading from bigger sheet music usually helps. Sometimes, I tense up and breathe abnormally when I play without realizing it, which will also cause symptoms.
Yes! The looking between the sheet music and my hands is a problem for me too. I wish there was a way to have the music down by my hands. I’ll see if I can print out some bigger sheet music, thanks for the advice!
Could it be something about your posture and tension is different when sitting on the piano bench? Maybe cause there’s no back on the seat or the way you keep your feet for the pedals?
Does abdominal compression help?
So, you're sitting down, arms up - have you tried arm and or hand compression?? That actually helps me when I'm making jewelry to keep my hands from feeling like clay.
Luckily, I can play guitar half laying down. I'm sorry you're dealing with that. It's distressing for it to come between you and your art.
Compression is a good idea, thanks! I have an abdominal binder I’ll try, and if that doesn’t help maybe I’ll look into getting some arm compression. I wish you could play the piano half laying down!
Well, you'd have to have a father like Frida Kahlo's who built her a contraption so she could paint while in bed after a bad accident. I imagine there could be ways that you could make the keys strike the strings remotely.
I'd suggest taking up the violin, but there was no way for me to hold my arms up and my head in place long enough to learn before I got cramps everywhere from my waist up.
I will say that knowing the piano makes guitar theory easier (hint hint).
omg, yes I experienced the same thing, I got completely light headed and couldn't think anymore while playing the piano. It got gradually worse. In the beginning it was fine and after 30min really bad
Does your chair have back support? Can you sit with one leg folded under and one on the pedal and then switch around? Also how high/low is your chair? Sitting higher up and resting your hands on the piano instead of lifting them up could also help 👍🏻
I need a breather and notice some upswing of symptoms after doing 3 minutes of Duolingo.
Using the brain / concentrated effort also affects blood flow & HR.
Lifelong keyboardist. Diagnosed with "Orthostatic Intolerance" early last year by an auto neuro after over a year searching, suffering, and waiting. I'm in the sometimes heart rate spikes, other times BP drops, essentially both all over the place OI group. So, meds unfortunately don't work for me.
For a long time just sitting even a few minutes was generally intolerable. Including at a desk.
After several months break during the worst in my early days, I started giving playing at home a try again. At first it was totally horrible. Dizzy, brain fog (couldn't keep focused on anything I tried to play, even simple stuff), headache, feeling like I was about to collapse, disassociated. I only lasted a few minutes. Very discouraging. A couple months afterwards, I tried again. And again. Many times since then. I've kept a log to help keep track and stay motivated. It's slowly, gradually gotten better.
The physiology as I understand it is essentially the same regardless of whether we're sitting or standing. We're still allergic to gravity and have insufficient venous return blood flow with postural changes due to autonomic dysfunction. With the reduced flow, all the symptoms start setting in.
Sitting stationary and not moving really stresses the system! It makes it super hard to manually compensate.
Keeping up with all the usual techniques, especially compression and fluids, has been essential for me. I've also done a LOT of cardio/aerobic work over the past year, plus other exercises to improve my vascular tone. Perhaps improved my autonomic function, too. Hard to say on that one. Carefully, to try to keep from crashing and getting PEM and flairs.
Little by little I saw improvements. It's slowly gotten better. I'm pretty much back to my previous playing level, and am able to practice for well over an hour now, yet still sometimes pay the price of symptoms flairs for several days if I'm not careful. It's an ongoing, often agonizing labor of love. 🙄
Be encouraged. 🌝 Everyone's solution and severity are different. Baby microsteps, taking care of all the essentials, and devoted persistence have been mine. Good luck. There's hope!.🎶
ETA: there's been some very interesting research that's come out in recent years about the neurological effects of playing a musical instrument, and it's therapeutic potential in treating such conditions as traumatic brain injuries and dementia.
I would love to see someone do a study to investigate it's potential in dysautonomias, including POTS and other forms of OI and related conditions.
Thank you so much for the detailed reply! I’m sorry to hear that your symptoms derailed your lifelong hobby, and I’m glad you’ve found ways to mitigate them. Exercise is admittedly something I need to be better about, but knowing it might help me play piano more comfortably is an incentive for sure.
Thanks! Gosh. Hard to say which have done the most good. I've done a ton of cardio/aerobic from recumbent bike, to walking, grocery shopping, you name it. Started out needing a walker, staggering like a wounded duck, and went from there. Very slowly, gradual. Baby steps. Kept track daily of everything. I would like to have tried Heart Rate Variability HRV monitoring. Perhaps someday. But, kept at it.
First, and foremost, I must say after being a wreck in my early days, my turning point was deciding to instead become a warrior.
I've also delved into orthostatic exercises, such as Wilson's, CHOP (selected ones), elliptical, Pilates performer, playing with the cat, being creative.
POTS UK and Dysautonomia International have some excellent presentations on exercise, which I highly recommend.
I tried PT for awhile. That was nearly useless. In my case my PT had never heard of OI, but said she was willing. She still ended up pushing way too hard, drove me to PEM crashes, at one point questioned whether I was "afraid" of getting symptoms and should have therapy! All I could do to keep from yelling at her. We ultimately ended amicably and I at least began a regimen.
Still far from my former active self. But happy that I haven't lost it all forever and seeing progress.
Thanks for the answer. I thought you had meant there are specific “vascular exercises” beyond exercise/physical activity itself. Good on you for getting yourself better!
music triggers my heart. it’s like my heart wants to match the temp of the song. play around with tempos! also posture (having your back straight and your legs down the gravity is pulling your blood to your feet and not letting it come back up) and holding your arms up to play can strain more than you think. kind of the concept how standing is harder than walking
Painting does the same thing; it literally hurts to do so. I’m no real artists, just a miniature painter, but it is a hobby that brings me joy.
But man, when it physically hurts to paint? When the flare-ups happen because of it? Yeah….its not fun.
Piano is much harder then what I do; if mere painting can cause it for me, I can only imagine what piano might do.
I don’t have hyperpots but I also find playing to be very taxing, I’ve hardly touched the piano at all since I got really sick. I think having no back support at the bench is part of it, plus the mental strain (and physical strain if you’re playing something difficult or animated). Even when it’s not triggering extra symptoms for me, I just feel like I have to be at a much much higher threshold of well-being to play piano than to do most other seated things, because I have to be able to focus and maintain coordination in addition to just staying upright.
I sweat like crazy when i play my saxophone. Like, the floor around me is wet from sweat dripping off my face. Its silly. But i also go through a gallon of water in three hours 🤣
Excitement and anxiety can trigger my symptoms (i was never the one for nausea, dizziness, and the like for these before POTS), so I assume it could be that.
For POTS, sitting is like standing, just the effects take longer to happen. As a software engineer, I know that if I'm feeling a bit off, it's time to lie down for a few.
One of the fastest ways of fixing it is [leg up the wall pose (Viparita Karani)](https://www.yogajournal.com/how-to/legs-up-the-wall-pose/?scope=anon), which will help relocate that blood stuck in your lower legs back to your upper body. As a hint, using a yoga strap around your upper thighs (fairly loose) will allow you to relax in the pose more easily and allow the blood to relocate faster. 5-10 minutes of that and I'm good for another 2-4 hours.
Mental effort can trigger symptoms. When I first had POTS after COVID, I could be lying flat and just playing sudoku would still have me tachycardic. I can handle more now, but to this day if I spend a chunk of time concentrating really hard on something I will send myself into brain fog, and I'll be more symptomatic the next day.
Me trying to explain this to my teacher who thinks that putting me in a different room for my tests will magically make my POTS disappear: 
I second this. I usually get symptoms when driving and despite being physically pretty chilled out just having my arms elevated and concentrating on the road makes my heart race. Don't underestimate how much simply concentrating can affect you. Sorry to hear about your troubles OP :-( edit: added some more stuff.
Maybe because it requires you to have your feet at the bottom?
It could be the way you have to use and hold your arms. My friend with POTS has loads of trouble with things that require arm usage.
Really? So do I and I've been assuming I have something else (EDs for example; not tested yet) on top.
Ehlers Danlos? Hypermobile here & I've a hunch I also fall into the zebra category.
Welcome striped friend
Yes, I meant Ehlers Danlos. (Or some sort of hypermobility, maybe. If only it wasn't so difficult to get tested!)
I have hEDS and get this with the piano. I always assumed it was the hypermobility causing my body to fold up a bit and have poor posture and not the POTS causing my piano issues.
Same, washing hair even seated anything that has my arms elevated above my heart or even often times at heart level makes me super tachy.
Possibly also the use of your arms. My HR goes up with any arm activity, I think from blood pooling.
Cashiering too, even seated.
One thing to watch for is your breathing with playing. I know I can sometimes forget to breathe/don’t breathe as much if I’m playing things that are unfamiliar/I’m still learning or if I am out of practice and am therefore extra concentrated and not necessarily focused on my phrasing. It’s easy to breathe naturally when you’re familiar with the flow of something and how the piece itself “breathes,” not so much when you’re just trying to figure out what note comes next. It may also be tension related, if you’re tense you’ll end up fatigued faster.
I practiced the alexander technique for this very reason and it helped me a lot as a profesional musician with POTS
Yes! Remembering to breathe naturally. That and learning to be much, much more relaxed when I practice, even when symptoms start to rise. Listening to my body and keeping it calm. Taking my time, especially with less familiar or polished pieces. Pacing. Letting the piece "breathe" with the phrasing as you mentioned. Doing so much more consciously has actually improved the quality of my playing! It's been a major challenge expanding my internal awareness while playing after years of not having to and everything being pretty automatic. I'm getting better at it and able to play a lot longer now, too. It's a weird, refreshing experience.
It's a lot like riding in a car, with minimal leg engagement. https://www.reddit.com/r/POTS/s/nRKJv7v0fO
I play some piano. I do get foggy and dizzy, nauseous and I think it’s just because I’m vertical for a while. How long I get to play depends on the day.
The first i ever fainted, I was playing the piano. It was very hot and we were by a window and I started to feel sick. I was like 12-13, I have hypo pots and OH, they never caught it. 😒 til legit last year at 33yo
I have had POTS since 17 and they only just diagnosed it last year at 31 almost 32. Sounds about right. :(
YES omg it's so annoying, I'll be in the middle of lesson with a kid, playing some gentle um-chack chords for a 5yo singer and my heart rate will go YOUVE HIT 110+ CALM DOWN And I'm like.,. I'm not doing anything??????
Probably you get excited when playing, I have same with video games…
Had to stop playing many video games because even the excitement and rush I'd get from them would make me a bit too tachycardic for my liking. freaking sucks :/ Some games get me up near 130bpm and I'm not exactly moving anything besides my fingers and wrists.
You can trigger POTS symptoms just by sitting up if you’re severe enough. I have to be laying down or reclined most of the day and get symptomatic after a few minutes of sitting upright.
I can't drive or even ride in my car since this all started 😒
I CANNOT sit in a seat without a back. And I have to have my legs folded up in my lap. I went to a wedding last year that had bench seating. Within 15 mins I was shaking violently and POTSing out.
i dont know what subtype of POTS i have yet (still waiting for the big boy tests, although all my doctors think it's POTS), but every time my arms are above my midsection, i start to feel dizzy/palpatations.
That makes sense. I know for me, holding my arms above my head is the quickest way to get to pre-syncope. I hope you can get the proper testing soon!
I get POTS symptoms when playing piano almost every time. I know having to look up at the sheet music and back down at my hands quickly and multiple times makes me really dizzy and will trigger other symptoms after a while. I also play other instruments and have similar issues when playing them. Lowering the lighting level in the room or reading from bigger sheet music usually helps. Sometimes, I tense up and breathe abnormally when I play without realizing it, which will also cause symptoms.
Yes! The looking between the sheet music and my hands is a problem for me too. I wish there was a way to have the music down by my hands. I’ll see if I can print out some bigger sheet music, thanks for the advice!
Could it be something about your posture and tension is different when sitting on the piano bench? Maybe cause there’s no back on the seat or the way you keep your feet for the pedals?
Does abdominal compression help? So, you're sitting down, arms up - have you tried arm and or hand compression?? That actually helps me when I'm making jewelry to keep my hands from feeling like clay. Luckily, I can play guitar half laying down. I'm sorry you're dealing with that. It's distressing for it to come between you and your art.
Compression is a good idea, thanks! I have an abdominal binder I’ll try, and if that doesn’t help maybe I’ll look into getting some arm compression. I wish you could play the piano half laying down!
Well, you'd have to have a father like Frida Kahlo's who built her a contraption so she could paint while in bed after a bad accident. I imagine there could be ways that you could make the keys strike the strings remotely. I'd suggest taking up the violin, but there was no way for me to hold my arms up and my head in place long enough to learn before I got cramps everywhere from my waist up. I will say that knowing the piano makes guitar theory easier (hint hint).
Sitting is an orthostatic position, sadly.
omg, yes I experienced the same thing, I got completely light headed and couldn't think anymore while playing the piano. It got gradually worse. In the beginning it was fine and after 30min really bad
Does your chair have back support? Can you sit with one leg folded under and one on the pedal and then switch around? Also how high/low is your chair? Sitting higher up and resting your hands on the piano instead of lifting them up could also help 👍🏻
All good ideas, thank you!
I need a breather and notice some upswing of symptoms after doing 3 minutes of Duolingo. Using the brain / concentrated effort also affects blood flow & HR.
the blood pooling alone could be terrible! you could forgo using pedals and try sitting crosslegged on a piano bench and see if that helps?
Lifelong keyboardist. Diagnosed with "Orthostatic Intolerance" early last year by an auto neuro after over a year searching, suffering, and waiting. I'm in the sometimes heart rate spikes, other times BP drops, essentially both all over the place OI group. So, meds unfortunately don't work for me. For a long time just sitting even a few minutes was generally intolerable. Including at a desk. After several months break during the worst in my early days, I started giving playing at home a try again. At first it was totally horrible. Dizzy, brain fog (couldn't keep focused on anything I tried to play, even simple stuff), headache, feeling like I was about to collapse, disassociated. I only lasted a few minutes. Very discouraging. A couple months afterwards, I tried again. And again. Many times since then. I've kept a log to help keep track and stay motivated. It's slowly, gradually gotten better. The physiology as I understand it is essentially the same regardless of whether we're sitting or standing. We're still allergic to gravity and have insufficient venous return blood flow with postural changes due to autonomic dysfunction. With the reduced flow, all the symptoms start setting in. Sitting stationary and not moving really stresses the system! It makes it super hard to manually compensate. Keeping up with all the usual techniques, especially compression and fluids, has been essential for me. I've also done a LOT of cardio/aerobic work over the past year, plus other exercises to improve my vascular tone. Perhaps improved my autonomic function, too. Hard to say on that one. Carefully, to try to keep from crashing and getting PEM and flairs. Little by little I saw improvements. It's slowly gotten better. I'm pretty much back to my previous playing level, and am able to practice for well over an hour now, yet still sometimes pay the price of symptoms flairs for several days if I'm not careful. It's an ongoing, often agonizing labor of love. 🙄 Be encouraged. 🌝 Everyone's solution and severity are different. Baby microsteps, taking care of all the essentials, and devoted persistence have been mine. Good luck. There's hope!.🎶 ETA: there's been some very interesting research that's come out in recent years about the neurological effects of playing a musical instrument, and it's therapeutic potential in treating such conditions as traumatic brain injuries and dementia. I would love to see someone do a study to investigate it's potential in dysautonomias, including POTS and other forms of OI and related conditions.
Thank you so much for the detailed reply! I’m sorry to hear that your symptoms derailed your lifelong hobby, and I’m glad you’ve found ways to mitigate them. Exercise is admittedly something I need to be better about, but knowing it might help me play piano more comfortably is an incentive for sure.
Hi, good to hear you are better! What exercises did you do to improve vascular tone?
Thanks! Gosh. Hard to say which have done the most good. I've done a ton of cardio/aerobic from recumbent bike, to walking, grocery shopping, you name it. Started out needing a walker, staggering like a wounded duck, and went from there. Very slowly, gradual. Baby steps. Kept track daily of everything. I would like to have tried Heart Rate Variability HRV monitoring. Perhaps someday. But, kept at it. First, and foremost, I must say after being a wreck in my early days, my turning point was deciding to instead become a warrior. I've also delved into orthostatic exercises, such as Wilson's, CHOP (selected ones), elliptical, Pilates performer, playing with the cat, being creative. POTS UK and Dysautonomia International have some excellent presentations on exercise, which I highly recommend. I tried PT for awhile. That was nearly useless. In my case my PT had never heard of OI, but said she was willing. She still ended up pushing way too hard, drove me to PEM crashes, at one point questioned whether I was "afraid" of getting symptoms and should have therapy! All I could do to keep from yelling at her. We ultimately ended amicably and I at least began a regimen. Still far from my former active self. But happy that I haven't lost it all forever and seeing progress.
Thanks for the answer. I thought you had meant there are specific “vascular exercises” beyond exercise/physical activity itself. Good on you for getting yourself better!
music triggers my heart. it’s like my heart wants to match the temp of the song. play around with tempos! also posture (having your back straight and your legs down the gravity is pulling your blood to your feet and not letting it come back up) and holding your arms up to play can strain more than you think. kind of the concept how standing is harder than walking
Painting does the same thing; it literally hurts to do so. I’m no real artists, just a miniature painter, but it is a hobby that brings me joy. But man, when it physically hurts to paint? When the flare-ups happen because of it? Yeah….its not fun. Piano is much harder then what I do; if mere painting can cause it for me, I can only imagine what piano might do.
I got out of breath and dizzy from sitting on the floor, legs out, playing guitar and singing. Not a hard song, either.
I don’t have hyperpots but I also find playing to be very taxing, I’ve hardly touched the piano at all since I got really sick. I think having no back support at the bench is part of it, plus the mental strain (and physical strain if you’re playing something difficult or animated). Even when it’s not triggering extra symptoms for me, I just feel like I have to be at a much much higher threshold of well-being to play piano than to do most other seated things, because I have to be able to focus and maintain coordination in addition to just staying upright.
I sweat like crazy when i play my saxophone. Like, the floor around me is wet from sweat dripping off my face. Its silly. But i also go through a gallon of water in three hours 🤣
I get dizzy while seated all the time. I usually need neck support.
Excitement and anxiety can trigger my symptoms (i was never the one for nausea, dizziness, and the like for these before POTS), so I assume it could be that.
Excitement?
Anything that has my arms above waist level makes me dizzy super fast!
For POTS, sitting is like standing, just the effects take longer to happen. As a software engineer, I know that if I'm feeling a bit off, it's time to lie down for a few. One of the fastest ways of fixing it is [leg up the wall pose (Viparita Karani)](https://www.yogajournal.com/how-to/legs-up-the-wall-pose/?scope=anon), which will help relocate that blood stuck in your lower legs back to your upper body. As a hint, using a yoga strap around your upper thighs (fairly loose) will allow you to relax in the pose more easily and allow the blood to relocate faster. 5-10 minutes of that and I'm good for another 2-4 hours.