The vagus nerve has become one of the most talked-about parts of the nervous system. “Tone your vagus nerve.” “Vagus nerve stimulation for POTS.” “Activate your parasympathetic system.”
Most of it misses the point entirely.
What The Vagus Nerve Actually Does
The vagus nerve isn’t a simple on/off switch for calm. It’s a mixed nerve — meaning it carries both motor signals going out and sensory signals coming in. And the sensory part dominates.
“Vagus nerve is a mixed nerve that speaks directly from the nucleus ambiguous and the dorsal motor nucleus of the vagus in the brain stem... Most of the traffic that’s going that nerve is sensory inputs from your gut, your heart, and your lungs. So most of it is just information about what’s going on — like the periscope, the camera — what is going on in that system with how the reflexes are working.”
The vagus nerve is primarily a sensor. It’s reading what’s happening in your organs and reporting back to the brain. Thinking of it as a “calm down” button oversimplifies what it does.
The “Paired Antagonism” Myth
One of the most common misconceptions in the POTS community is that the sympathetic and parasympathetic systems work like a seesaw — one goes up, the other comes down. Stimulate the vagus, calm the sympathetic system.
That’s not how it works.
“People use vagus nerve stimulation because they think ‘oh it’s a parasympathetic nerve, the sympathetic system is running too hot, the parasympathetic system inhibits the sympathetic system.’ This is a concept called paired antagonism, and it is not functionally the way that these systems work... They’re not all parasympathetic nerves working at large to do the same thing. So it’s not like an all-or-none response. Not all sympathetic nerves are an all-or-none response — they’re functionally distinct.”
The autonomic nervous system isn’t a seesaw. Sympathetic and parasympathetic branches have multiple functionally distinct pathways. Stimulating “the vagus” doesn’t uniformly calm “the sympathetic system” because neither system operates as a single unit. This is why understanding how the brain controls the autonomic system is so important.
Why Vagus Nerve Stimulators Don’t Fix The Root Problem
If the vagus nerve is primarily a sensor, and the autonomic system doesn’t work as a simple seesaw, then stimulating the vagus nerve with a device doesn’t address the question that actually matters: Why is the system dysregulated in the first place?
A stimulator can modulate activity. But it doesn’t ask why the brain is generating that pattern. And that’s the question that leads to actual resolution.
What’s Actually Happening In Dysautonomia
The sympathetic “overactivity” in POTS isn’t the system being broken. It’s the system compensating. Understanding this distinction is central to conditions like hyperadrenergic POTS.
“In some of those cases, we’ll see, especially those ones that affect that brain stem component, because we have that sense of motion, you’re going to get a ramp up of activity in the autonomic system, which may overfire or over mobilize energy in that system.”
The autonomic output you’re feeling — the racing heart, the adrenaline surges, the heat intolerance — is the brain’s response to something it perceives as wrong. A vagus nerve device doesn’t change what the brain is responding to.
The Better Question
Instead of “how do I stimulate my vagus nerve,” the better question is: What is my brain solving for?
When you understand the input that’s driving the output, you can address the actual mechanism. The vagus nerve is part of the information highway. But the traffic pattern is being set by the brain. This is the foundation of functional neurology — finding what the brain is responding to, and changing that input.
Key Takeaways
- The vagus nerve is mostly sensory — it reports information from your organs, not just “calm signals”
- Paired antagonism is a myth — sympathetic and parasympathetic don’t work as a simple seesaw
- Autonomic pathways are functionally distinct — not all-or-none responses
- Stimulators modulate activity but don’t address why the system is dysregulated
- Ask what the brain is solving for — not how to override its output
Tried Vagus Nerve Stimulation With No Results?
If you’ve been told to stimulate your vagus nerve but nothing changed, a free consultation call can help identify what your brain is actually responding to — and how to address the real mechanism.
I'm Ready to Get Better