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Autonomic Nervous System Testing – Ewing’s Test - Evaluation of POTS or Dysautonomia
Reveal the Hidden Cause Behind Fatigue, Dizziness, and Heart Palpitations
At the Holistic Healing Heart Center, we believe that healing starts with understanding the root cause—not just treating symptoms. Many patients struggle with unexplained fatigue, brain fog, palpitations, or lightheadedness, often without clear answers from standard cardiovascular tests. One key system frequently overlooked is the autonomic nervous system (ANS)—the body’s internal regulator of heart rate, blood pressure, digestion, and stress response.
When the ANS becomes dysregulated—a condition called dysautonomia—it can disrupt your daily life and often coexists with conditions like POTS (Postural Orthostatic Tachycardia Syndrome), chronic fatigue syndrome, autoimmune diseases, long COVID, and diabetes.
To investigate the health and responsiveness of your autonomic nervous system, we offer the Ewing’s Test Battery—a clinically validated series of non-invasive maneuvers designed to assess both sympathetic (fight-or-flight) and parasympathetic (rest-and-digest) activity.
What Is Ewing’s Test?
Developed by neurologist Dr. David Ewing, the Ewing battery of tests is the gold standard for evaluating autonomic function in a clinical setting. It consists of a series of non-invasive maneuvers that assess how your nervous system regulates involuntary functions.
These tests evaluate the two branches of the autonomic nervous system:
- Sympathetic ("fight or flight")
- Parasympathetic ("rest and digest")
At our center, we use Kubios HRV Premium, the most advanced software currently available for heart rate variability and autonomic function analysis, to interpret your results and guide treatment. Kubios HRV software has been developed over the past 20+ years. The development started in 2000 as academic research work at the Department of Technical Physics, University of Eastern Finland, Kuopio, Finland. This advanced software is currently used in clinical practice in specialty offices and academic centers worldwide.
What to Expect: The Ewing Maneuvers
Developed by Dr. David Ewing, this battery of tests is a gold standard in autonomic nervous system evaluation. It is widely used in clinical and research settings to detect early signs of autonomic dysfunction and to monitor progression or recovery. At our center, the Ewing’s Test is performed in a quiet, controlled environment and includes four core maneuvers, each offering a window into how well your autonomic system adapts to stress and physiological change.
1. Deep Breathing Test
You will breathe slowly and evenly (about 6 breaths per minute) while we monitor your heart rate. In a healthy nervous system, your heart rate should naturally rise with inhalation and fall with exhalation—a phenomenon called respiratory sinus arrhythmia. This maneuver assesses parasympathetic tone by monitoring how your heart rate changes in response to slow, paced breathing. A healthy nervous system should show natural variability between inhalation and exhalation, known as respiratory sinus arrhythmia. Blunted variability can indicate parasympathetic dysfunction.
2. Valsalva Maneuver
You’ll be asked to blow into a closed system (like a syringe or mouthpiece) for 15 seconds, simulating a strong exhalation against resistance. This challenges both sympathetic and parasympathetic branches and helps evaluate baroreflex sensitivity—your body’s ability to stabilize blood pressure and heart rate under stress.
3. Orthostatic (Tilt) Test
This test evaluates your body’s sympathetic regulation under gravitational stress and can detect POTS or orthostatic hypotension. This test assesses your sympathetic nervous system’s response to a change in posture. As you move from lying down to standing, we monitor your heart rate and blood pressure. In healthy individuals, the body compensates quickly. In those with dysautonomia, symptoms like dizziness, tachycardia, or a drop in blood pressure may occur.
4. 30:15 Ratio (Heart Rate Response to Standing)
Closely related to the Orthostatic Tilt, this evaluates the 30:15 ratio—a time-based measurement of how your heart rate shifts in the first seconds after standing up, which reflects parasympathetic withdrawal and sympathetic activation. We analyze the heart rate at 15 and 30 seconds after standing to calculate the 30:15 ratio—another marker of how quickly and effectively your autonomic system responds to postural changes.
Powered by Kubios HRV Premium: Scientific-Grade Analysis
To enhance the accuracy and clinical value of these tests, we use Kubios HRV, a research-grade software platform trusted by top institutions around the world. Kubios allows us to analyze heart rate variability (HRV) in depth, using time-domain, frequency-domain, and non-linear metrics. These insights help us quantify the balance between sympathetic and parasympathetic activity, monitor recovery patterns, and identify subtle dysfunctions that other tools might miss.
Through Kubios, we assess:
- Time-domain and frequency-domain HRV parameters (like RMSSD, SDNN, LF/HF ratio)
- Baroreflex sensitivity—an important biomarker of cardiovascular resilience
- Poincaré plots and nonlinear metrics—for visualizing patterns of dysfunction
- Kubios ANS Index—a summary of your autonomic balance, integrating multiple variables into a single score
Kubios follows rigorous scientific standards and has been cited in over 1,800 peer-reviewed studies, ensuring our testing meets the highest levels of clinical accuracy.
Why This Matters
Your autonomic nervous system plays a central role in your energy, circulation, sleep, digestion, and mood. When it’s off-balance, your entire well-being can be affected. Early detection of autonomic dysfunction can significantly improve outcomes for patients struggling with vague or unexplained symptoms. Ewing’s Testing provides vital insight into how your nervous system is functioning and offers a clear direction for holistic treatment strategies—from hydration and lifestyle support to targeted supplements and mind-body therapies.
If you’re experiencing lightheadedness, fatigue, rapid heart rate, or have been told your tests are “normal” despite persistent symptoms, this advanced testing could offer the clarity you need.
Through this testing, we can:
- Identify hidden imbalances
- Tailor treatment strategies (hydration, nutrition, movement, nervous system retraining)
- Track your progress with objective biomarkers
- Support your recovery from chronic illness or dysautonomia-related conditions
If you’ve been told “everything looks normal” but still don’t feel well, this testing may provide the answers you’ve been searching for.
Schedule your Autonomic Nervous System Evaluation today and take the first step toward healing from the inside out and restoring balance and vitality.