Autonomic Testing Laboratory

The Autonomic Testing Laboratory at Stanford Health Care is the only comprehensive autonomic testing laboratory on the West Coast. As one of the most advanced autonomic labs in the nation, we offer all of the five core tests needed to make a diagnosis, including TST. Autonomic testing measures how your autonomic nervous system reacts to stimuli to determine which portions of it are and are not functioning as they should.

Autonomic testing

During autonomic testing, you lie on a long, flat examination table with a foot board and an electrocardiogram (EKG), and respiration monitors are placed on your torso. A blood pressure monitor is put on your finger that squeezes and releases to take a continuous reading for the duration of the test. These testing procedures provide information about your autonomic nervous system - what is working well, and what is not working well.

Five tests are used in our Autonomic Testing Lab to diagnose your condition:
These tests are designed to provide information about specific parts of your autonomic nervous system. Some of the tests are complimentary and some offer distinct information. All five tests are only available at a few labs in the nation and crucial to providing you with an accurate diagnosis.

• Cardiovascular testing with head-up tilt, the Valsalva maneuver, and deep breathing: Measures your heart rate and blood pressure as the table you are lying on is tilted slowly to a semi-upright position of 70 degrees
• Thermoregulatory sweat test (TST): Measures your temperature regulation and sweating ability in a specialized room with controlled temperature, humidity, and air flow capabilities. This test is not commonly available. Our lab is the only lab on the West Coast with a first-of-its-kind, custom-built TST room.
• Quantitative sudomotor axon reflex test (QSART): Measures your sweating ability through your autonomic nerves using a unique device called a sudorometer

To prepare for autonomic testing, our team recommends the following:

The night before or the morning of the test, please shower or bathe. Do not apply lotion to the face, arms, hands, legs, feet, or torso after the bath or shower, as skin must be free from oils and lotions for testing. Avoid using make-up or aftershave on your face.

You may wear your own clothing for the test. A loose fitting top and some pants that will allow for access to your lower legs and arms are recommended.

Eight hours prior to the test, abstain from:

1. Caffeine (coffee, tea, cola, energy drinks, etc.)
2. Tobacco or nicotine replacement products (patches or gum)
3. Alcohol. Do not drink alcohol the evening before the test.

You may eat up until three hours prior to your autonomic testing appointment, eating easy to digest foods, and avoiding foods heavy in fat on your appointment day. You should drink a lot of water on the morning of the test with no limitations up until the time of the test and eat a snack afterward.

We prefer that you do not take any medications the morning of the test. Bring your medications with you to the laboratory so that you can take them after testing is completed. Do not leave them in your vehicle.

A member of our team will contact you before testing to review medications and discuss any modifications that may be needed, as some medications affect test results. We encourage you to also discuss any concerns about medication modification with your primary care doctor.

Patient resources:

• Autonomic Testing Instructions (PDF)
• EMG Testing Instructions (PDF)