The Testing Protocol
Five complementary autonomic function tests in one session. Same equipment and protocol used at public hospital autonomic units — with the report back in your hands within a week.
You do not need a referral from your doctor. Request an appointment online in about two minutes, and we will call you to arrange a time. Testing takes 40–60 minutes.
Request an appointment →Please note the tests themselves are not covered by a Medicare rebate. Questions? Call 02 9388 0615.
Each of the five tests targets a different autonomic domain — cardiovagal (parasympathetic), adrenergic (sympathetic), and sudomotor. Interpreted together, they map your autonomic function across the whole nervous system.
Active stand test with recovery blood pressure
The cardiovascular autonomic core
Continuous non-invasive blood pressure and heart rate are recorded while you rest lying down, as you actively stand, throughout the standing period, and again as you lie back down (the recovery blood pressure). This characterises the orthostatic response — the inappropriate heart-rate rise of POTS, the sustained blood-pressure drop of orthostatic hypotension, and the slow blood-pressure recovery seen in adrenergic failure.
The recording captures beat-by-beat values, which gives substantially more diagnostic information than a single supine-then-standing reading at the GP.
Domain: adrenergic + cardiovagal + baroreflexPaced-breathing heart rate variability
Quantitative measure of vagal function
You breathe at a controlled rate (typically 6 breaths per minute) for a couple of minutes while the heart rate is recorded continuously. The size of the heart-rate swing during this controlled breathing (the E:I ratio) is a sensitive measure of parasympathetic / vagal function. Reduced variability is a hallmark of cardiovagal involvement — common in diabetic autonomic neuropathy and in synucleinopathies.
Domain: cardiovagalValsalva manoeuvre
Sympathetic + parasympathetic in one test
You blow into a mouthpiece against a fixed pressure for 15 seconds while the beat-to-beat blood-pressure and heart-rate response is recorded. The four characteristic phases of the response provide a quantitative read on adrenergic (sympathetic) blood-pressure recovery, cardiovagal Valsalva ratio, and baroreflex sensitivity. The pattern of which phase is abnormal pinpoints which limb of the autonomic system is affected.
Domain: adrenergic + cardiovagal + baroreflexIsometric handgrip test
Sympathetic adrenergic function
You squeeze a handgrip dynamometer and hold a steady, sustained contraction for several minutes while the beat-to-beat blood pressure is recorded. Sustained handgrip drives a reflex rise in blood pressure through the sympathetic nervous system; the size of that rise is a quantitative measure of efferent adrenergic function. A blunted blood-pressure response points to sympathetic adrenergic failure.
Domain: adrenergic (sympathetic)SudoScan
Small-fibre sudomotor function
You place your palms and soles on stainless-steel electrodes for about three minutes. The device measures electrochemical skin conductance, providing a quantitative read on sudomotor (sweating-fibre) function. SudoScan is rapid, non-invasive, and sensitive to early small-fibre involvement — particularly useful in suspected small fibre neuropathy and in early diabetic autonomic neuropathy where conventional nerve conduction studies are still normal.
Domain: sudomotor (small-fibre)Want the full Patient and Doctor walk-through? The sibling site autonomictesting.com.au takes the same protocol and shows it in two views — side-by-side — one written for patients and one written for referring doctors. Useful if you want either a deeper plain-English explanation or the clinical-interpretation framing.
How to Prepare
Simple steps to make the recording as accurate as possible.
✓Avoid caffeine & nicotine
For at least 4 hours before. Both alter heart rate and vascular tone.
✓Light meal only
No heavy meals in the 4 hours before. Hydrate normally.
✓Avoid alcohol
For at least 24 hours before.
✓Wear comfortable clothing
Loose-fitting clothing makes electrode placement easier. Skirt or shorts works well.
✓Medication list
Bring a current list. Some medications affect the recording — your specialist will advise.
✓Allow 40–60 minutes
The full session takes about 40 to 60 minutes, from arrival to departure.
Do not stop your usual medications unless your specialist has specifically told you to. If you take blood pressure medications, beta blockers, or other cardiovascular medications and you're unsure, contact us before your appointment.
Contraindications & Modifications
A few situations need adjustment to the standard protocol.
Implanted devices
SudoScan is not performed in people with pacemakers, ICDs, or neurostimulators. The rest of the protocol proceeds normally.
Pregnancy
SudoScan is not performed in pregnancy. The rest of the protocol is modified as clinically appropriate.
Unstable cardiovascular status
The active stand and handgrip portions are modified or more closely supervised as appropriate. Discussion with referring doctor when needed.
Recent severe illness
If you've been very unwell in the days before the appointment, contact us to discuss whether to proceed or reschedule.
What Your Report Will Show
A single integrated document covering each test and your overall autonomic pattern.
Each test result is reported with measured values alongside normative ranges. The narrative interpretation integrates the findings with your clinical history and identifies which autonomic domains are affected (and which are spared). The report is suitable for use in subspecialty workup, treatment planning, and where relevant medicolegal documentation.
Frequently Asked Questions
How long does the testing session take?
Usually 40 to 60 minutes from arrival to departure. The five tests are performed in one visit with no separate appointments needed.
How should I prepare?
Avoid caffeine, nicotine and alcohol for at least four hours before the appointment. Avoid heavy meals in the four hours before testing. Wear comfortable, loose-fitting clothing. Bring a list of your current medications. If you take medications that affect blood pressure or heart rate, your specialist will advise whether to continue or pause them before testing — do not stop any medication without that advice.
Are there any contraindications?
SudoScan is not performed in pregnancy or in people with implanted electronic devices (pacemakers, ICDs, neurostimulators). The active stand and handgrip portions are modified or supervised more closely in people with unstable cardiovascular status. Let us know about any of these before your appointment.
Will the tests be uncomfortable?
The tests are well tolerated. The active stand test is the most likely to reproduce symptoms — that is sometimes the point of the test, to capture the symptoms you have at home in a monitored setting. Most people feel only mild lightheadedness. Recordings are stopped as soon as symptoms are reproduced.
When will I get my report?
Within one week. Your specialist analyses each recording, integrates the findings with your clinical history, and issues a detailed report directly to your referring doctor.
Book Your Autonomic Test
One session. Five complementary tests. Detailed report within a week.
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