POTS and Planes

Do you plan on flying soon? Here is what flying actually does to your body.

Immobility from prolonged sitting causes blood flow in your legs to become stagnant. Your calves act as a “second heart” by pumping blood from the legs back to the heart, fighting against gravity. When calf muscles contract, the gastroc and soleus squeeze the deep veins and push blood upward through one-way valves. Immobility slows this return, allowing blood to pool in the lower body instead of circulating efficiently.

Dry cabin air contributes to dehydration, which makes blood more viscous and reduces total blood volume. If you experience POTS symptoms, this is particularly rough and generally what I try to avoid all day, every day. Dehydration lowers already low blood pressure and can amplify dysautonomia symptoms. My personal brand includes vomiting and being golf-carted off aircrafts like the POTS princess I am.

Lower cabin pressure can also cause veins to dilate, making those tiny valves less effective at keeping blood moving upward. If venous return is already a weak link, this adds another layer of chaos.

Why does this matter?

Because flying stacks multiple stressors that all point in the same direction.

Reduced movement, lower blood volume, and less efficient circulation mean less blood reaching the brain. For people with POTS, this can show up as dizziness, nausea, motion sickness, air hunger, brain fog, tachycardia, or the sudden realization that you might throw up on a stranger.

Motion sickness is not just about the inner ear. It is also about poor cerebral perfusion and autonomic instability. When blood pressure drops and circulation lags, your nervous system has to work overtime to compensate. That mismatch between what your eyes see, what your vestibular system senses, and what your cardiovascular system can support is where things unravel.

Understanding the “why” matters because it removes the shame. You are not dramatic. You are not fragile. Your body is responding predictably to a perfect storm of conditions.

What can you do?

You cannot control cabin pressure or flight duration, but you can support circulation and blood volume.

Move your calves early and often.
Ankle pumps, heel raises, toe taps, and gentle knee extensions keep the calf muscle pump active. You do not need a workout. You need rhythm and frequency. Channel your childhood tap routine.

Hydrate aggressively and intentionally.
Water alone may not be enough. Fluids paired with electrolytes, in an amount per your physician’s recommendation, can help maintain blood volume more effectively than plain water, especially before and during the flight.

Use compression if it helps you.
Graduated compression socks or tights can reduce blood pooling in the legs and support venous return. They are not glamorous, but neither is getting escorted off the plane.

Fuel yourself.
Flying on empty worsens symptoms. Low blood sugar and low blood pressure are a miserable combination. Eat something balanced before travel and bring snacks that actually contain salt and carbohydrates.

Choose movement over stillness whenever possible.
Stand up when allowed. Walk the aisle. Even brief movement can help reset circulation and calm symptoms.

Plan for recovery.
Landing is not the finish line. Expect fatigue and autonomic flare afterward and give yourself permission to rest instead of pretending you are fine.

If flying makes you feel like your body is betraying you, it is not. It is communicating very clearly. Supporting circulation, hydration, and movement is not about being “extra.” It is about meeting your physiology where it actually is.

Signed,
A very hydrated, lightly compressed, aggressively calf-pumping POTS princess ✈️