Dysautonomia at Work

Symptoms of dysautonomia can make navigating the workplace challenging.

Symptoms like brain fog, fatigue, temperature dysregulation, and orthostatic intolerance can all potentially impact work performance. In one large study, 52% of people with postural orthostatic tachycardia syndrome (POTS) could not work due to their symptoms. ¹

However, workplace accommodations may provide an avenue for those with a form of dysautonomia to obtain and maintain meaningful employment. Below you will find information related to the law and available accommodations.

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The Law

The Americans with Disabilities (ADA) is a federal civil rights law passed in 1990. The purpose of the ADA is to stop discrimination and allow individuals with disabilities and chronic illnesses to participate in all areas of society, including work. Employers are required by the ADA to provide reasonable accommodations for employees with disabilities. In 2008, amendments were added to the ADA, known as the Americans with Disabilities Act Amendments (ADAAA), to expand the meaning and definition of disability. ² Thanks to the ADAAA, the term “disability” now includes those who use medications, assistive technology, accommodations, or modifications to help their disability, as long as they still have substantial limits to major life activity. ³ Someone with dysautonomia would be considered having a disability if they meet those qualifications.

Accommodations

Employers are required to provide reasonable accommodations to employees with disabilities. These accommodations primarily enable employees with disabilities to perform the necessary functions of the job, but accommodations can be requested to aid in the application and interview process if needed. Reasonable accommodations are typically low-cost and easy to implement. Conversely, an unreasonable accommodation would be difficult to implement or very costly for the employer. For example, installing a push button to make a door more accessible is a reasonable accommodation, but asking your employer to pay for your custom wheelchair is not a reasonable accommodation.

There are many possible accommodations for those with dysautonomia. Below are some examples:

  • Flexible work schedule
  • Break schedule
  • Telework/working remotely
  • Seated workstations
  • Anti-glare covers for computer screens
  • Accessible parking space
  • Written instructions/direction for completing tasks
  • Use of an app or other electronic reminders
  • Noise-canceling headphones to reduce distractions
  • Flexible schedule
  • Time extension for projects
  • Dictation software
  • Permission to record meetings
  • Sound absorption and soundproof panels 
  • White noise machine
  • Ability to sit as needed
  • Ability to have food/drink at the workstation
  • Break schedule
  • Supine workstation
  • Adjustable workstation
  • Anti-fatigue matting
  • Periodic rest breaks
  • Stand-lean stools
  • Use of stool or ottoman to prop up legs/feet
  • Use of a fan or space heater at a workstation
  • Heated gloves/cold resistant gloves
  • Air deflectors
  • Footwarmers

Below are resources for reasonable accommodations based on disorder from the Job Accommodation Network (JAN).

Although there is not a guide for each form of dysautonomia, many of the accommodations listed in these guides may be applicable.

Reviewed by Medical Content Experts, 2021

REFERENCES

Bourne, K., Chew, D. Stiles, L., Shaw, B., Shibao, C. Okamoto, L., Garland, E., Gamboa, A., Peltier, P., Diedrich A., Biaggioni, I., SHeldon, R., Robertson, D., Raj, S. (2021). Postural orthostatic tachycardia syndrome is associated with significant employment and economic loss. Journal of Internal Medicine, 290(1), 203-212. {1}

U.S. Department of Labor. (2009). ADA Amendments Act of 2008 frequently asked questions. {2}

U.S. Equal Employment Opportunity Commission. (n.d.). Question and answers on the final rule implementing the ADA Amendments Act of 2008. {3}

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