The first step is to determine the base-line behavior of the autonomic nervous system. This is achieved by monitoring key physiological parameters such as heart-rate variability and respiratory frequency amplitude while the patient undertakes a few simple activities such as deep breathing, breath-holding, and standing up from a sitting position. Standing posture assess the optimal balance or coherence of the autonomic system. After analyzing the data, comparing them with phenotypes, and relating them to existing symptoms.
Our highly complex body is kept functioning efficiently under widely varying physical and emotional conditions by a central control system continuously running in the background. This is the autonomic nervous system and the Hypothalamus – central vagal axis or HPV axis at the brain-stem. This system is autonomous, and we can’t voluntarily control it. Heart and breathing rates vary, our digestive and cooling functions modify when needed. Various organ systems are auto-regulated to maintain optimal functionality and step-up to our bodies demands and needs according to how we call for them. A professional athlete’s needs are different compared to a normal individual’s needs.
Our needs are modified by our indulgence and our cognitive thoughts. Stress and emotions are part and participles of our functional capacity. The autonomic system is the central control system that is continuously running in the background. There is a circadian rhythm to our body. This is created by the rhythmic triggering of the autonomic system. Sympathetic wakes us up while parasympathetic is responsible for sleep regulation. Sleep in-fact is an actively regulated process that is essential for the body. During the sleep cycle parasympathetic resets and re-charges hormonal and cardiovascular systems to replenish body physiology for the next day and so on.
The control system has two distinct modes – the sympathetic system (SNS) otherwise called “fight or flight” and the parasympathetic (PSNS) is responsible for “rest/relax and digest” responses. They generate different responses to changes in our body physiology and emotions. In general, SNS activity is energy utilization and is catabolic while PSNS is energy conservation and is anabolic to the body physiology. They can also be looked upon as the reflex and reactive system – SNS and the rebound and regulative system – PSNS.
To maintain excellent health these two branches, need to be in balance – this is referred to as autonomic coherence. When the system is out of balance and the two arms are not in rhythm it is referred to as autonomic resistance. Certainly, we have to take rapid avoidance actions when danger is sensed this a natural protective reflex response that is common to all living beings, while, at the same time, analyzing the situation in a rational way and not over-reacting is important to maintain sanity and stability. In other words, we must be able to uncouple from the continual stimulation of today’s world and call on our parasympathetic mode to relax and get a good night’s sleep while using the sympathetic under cautious regulation of the parasympathetic to be effective and efficient in our lives.
Animals react impulsively and do not have remorse or regret for their actions, therefore limit emotional stress from their actions. This is because they do not have central HPV axis communication channels or central sympathetic input. Humans on the other hand have cognitive power that warns us of our actions and we feel the remorse and stress from our actions.
Cognitive faculty is a function of the central vagal center and HPV axis. Stress induced physiologic alterations are through the HPV axis. Among all the organ systems in the body cardio-vascular system and hormonal systems have the maximum autonomic innervation. Therefore, diseases of hormonal dysfunction and cardiovascular system are the price we pay for higher cognitive stress.
The crux problem behind the occurrence and perpetuation of these disease states is autonomic imbalance or autonomic system resistance. The practice of medicine over the last 100 years has evolved towards addressing the consequences of organ system dysfunction such as elevated blood sugar or high cholesterol or blocked artery, hence the relentless persistence of the disease process despite significant strides in pharmacologic therapies and interventional procedures.
By addressing the crux problem i.e, autonomic resistance and dysautonomia one can alter the progression of the disease process favorably and reduce complications. This will also improve response to treatment approaches and minimize poly-pharmacy. Pre-screening and intervention of autonomic imbalance have a great potential to prevent and reverse the disease process in many of the current chronic conditions that have increased the morbidity and cost of medicine over the last 40-50 years.
Humans have evolved from 4 legged animals to up right posture. This puts a constant demand on our peripheral arterial system and particularly venous system that works against gravity to maintain an optimal tone to accomplish circulation, hemodynamic, vascular stability and fluid electrolyte balance. This also plays a major role in our body temperature regulation and tolerance to changing environment.
The optimal peripheral vascular tone is described as the Pitch tone. Pitch tone is maintained by optimal balanced input from both SNS and PSNS. Hence dysautonomia syndromes include postural orthostasis tachycardia syndrome (POTS), Erythromelalgia (EM), reflex sympathetic dystrophy (RSD), orthostatic hypotension, recurrent syncope, Fibromyalgia, chronic fatigue syndrome (CFS), Barlow’s or mitral valve prolapse syndrome. Cannons description of the four postulates of homeostsis in the 1940s appropriately applies to the autoregulatory functions of the HPV axis and autonomic nervous system.
Clinical manifestations of cognitive dysfunction disorders such as attention deficit disorder (ADD) and autistic traits can be explained on the basis of dysautonomia.
Breathing is primarily regulated by central parasympathetic through central vagal and respiratory center interaction at the brainstem. These interactions are coordinated by HPV axis. Sleep disorders, central sleep apnea and restless leg syndrome are due to dysautonomia as the underlying mechanism. Clustering and co-existing of type ll diabetes, coronary artery disease, metabolic syndrome and sleep apnea is a powerful argument in favor of this hypothesis. At RENU-CA research we have successfully demonstrated quantification of dysautonomia and common patterns of autonomic imbalance in many of these conditions.
An unbalanced system can result in drastic “blast” over-reactions that can even result in death. It is believed most forms of sudden deaths on the playing field, or in a baby’s crib, and acute vascular events such as mini-strokes (TIA’s) and acute coronary vascular events could be a direct consequence of dysfunctional autonomic system over-reacting.
This balanced auto-regulatory system evolved during human hunter-gatherer times. Unfortunately, it has not adapted fully to modern life styles and up-right posture puts constant strain on the autonomic system and pre-disposes to imbalance. If the sympathetic mode is over stimulated, then stress, hypertension, and poor sleep can result. If the parasympathetic mode takes over, then lethargy and fatigue win-out. Deviating on either side of a perfect balance triggers a range of health issues.
Paradoxic parasympathetic response. Pitch tone is maintained by a balanced Sympathetic Nervous System (SNS) and parasympathetic (PSNS) input. This is achieved by a steady basal SNS tone and a dynamic modulation of the SNS oscillations by the PSNS. Loss of pitch tone induces a hypothalamic response at the brainstem that in turn triggers a Central Vagal Nucleus (CVN) response at the brainstem. CVN has reflex feedback inhibition of the hypothalamus and SNS stimulation triggering a hyper-sympathetic state. This is called paradoxic parasympathetic syndrome (PPS) (Adiraju). PPS can have multi organ system effects due to regulatory function of the CVN crux of the problem is dysautonomia. Hormone imbalances trigger metabolic derangement and systemic inflammation due to parasympathetic dysfunction and loss of CCALA coherence.
According to cardio-vascular Interventionalist and researcher, Dr. Ramesh Adiraju, a poorly functioning central autonomic system, a so-called “dysautonomia” state, may be the root cause of many modern diseases including type-II diabetes, attention deficit syndrome, hypertension, congestive heart failure, PTSD, migraine, systemic inflammation, sleep apnea, chronic fatigue and hormonal imbalances. Treating the underlying cause rather than just the symptoms can lead to a much healthier lifestyle with lower dependence on pharmaceuticals or medical devices.
By – Cardio-vascular Interventionalist and researcher, Dr. Ramesh Adiraju.
RENU-CA Research Institute is a clinical research institute established by Dr.Ramesh Adiraju in 2005