Actually useful sleep advice for chronic illness

Natasha: Hello and welcome back to The Rest Room, the podcast about living well with chronic illness. I’m your host, Natasha Lipman. 

In today’s episode we’re talking about sleep. 

Sleep is something I talk about a lot because it’s something I’ve struggled with my entire life. Actually, no, that’s not true. As I’ve mentioned before, according to my mum, when I was a baby I didn’t stop sleeping and it would take me all day to get through one bottle! 

That ended up not lasting.

Over the years I’ve read and been told so many of the same “sleep hygiene” tips. But for people living with chronic illness, a lot of these recommendations just aren’t feasible or helpful. They’re a bit… basic and don’t really align with how many of us have to live our lives. 

Looking back, I used to joke that my body clock was set to Eastern Standard Time, going to bed exceedingly late after being on my laptop in bed for hours upon hours. 

It was quite a big revelation for me when I realised in therapy several years ago that the reason I gave up on trying to get sleep or have any form of a healthy sleep routine was because I never woke up feeling rested anyway, so the incentive just wasn’t there. It didn’t feel like I was getting the benefits of sleep, so why did it matter? 

That’s why I wanted to dedicate this episode to sleep. I’m joined once again by my occupational therapist, Jo Southall, who taught me this stuff in a workshop a few years ago and bar external factors like noisy neighbours, I’ve been able to make huge strides towards having a healthier sleep routine. 

Jo’ll be sharing some realistic sleep tips for people who live with long-term health conditions and helping us to understand more about why many people with chronic illness struggle with sleep. 

So let’s start with challenging my old assumption: why is sleep particularly important for people with chronic illness? 

Jo: Your body uses sleep to recover from things, so all of the rebuilding your body important stuff that we rely on for staying healthy is done when we’re asleep. So if you have the sort of chronic illness that means you’re sustaining just small amounts of extra damage as you go through your life, you’re going to need to be able to sleep effectively, and potentially sleep more, so that your body has time to actually fix some of that. Otherwise, what you end up doing is accumulating loads of extra damage that isn’t entirely necessary and is sort of preventable.

Natasha: Ok so everyone knows that sleep is super important, but why can it be such a struggle for so many people? 

Jo: Painsomnia is the one I come across most. There is research that basically documents that persistent pain is worse. It’s more severe at about 2:00 in the morning. 

The way our body goes through these hormonal and these changes in everything really, the natural cycles that we go through, mean that your symptoms can vary across the 24 hour span.The other issue with sleep is that a lot of people use distraction as a coping strategy for whatever it is they’re living with. 

The aim of sleep is to get rid of all those distractions so that your brain can put you to sleep. But if you remove all distractions and your brain doesn’t immediately put you to sleep, what you’re left with is a period where you are just hyper aware of how unpleasant your symptoms are, which is not a great thing in terms of falling asleep. A lot of people will have pain, or they’lll have discomfort, or they just can’t settle. They aren’t comfortable. 

Equally, a lot of people will find that anxiety is worse, or they’ll just replay things that happen during the day that weren’t particularly good or successful, or things that happened 10 years ago that really, logically speaking, do not matter, but emotionally speaking still have a massive impact on us. We’ll find ourselves thinking about those when they just have no impact on our lives currently. Yeah, it can be quite a stressful experience and quite an unpleasant one for a lot of people.

Natasha: You might hear us using the term “sleep hygiene” throughout this episode, but what does it actually mean…and why (just like the word exercise) is it important for those of us with chronic illness to think about it differently?

Jo: I have always been a bad sleeper. Always, always. Right from when Mum first brought me home from the hospital, I’ve been rubbish at sleep my entire life. For me, personally, and probably for a lot of my client group and a lot of my peers and chronically ill folks, sleep hygiene is kind of a set of suggestions or rules that are aimed at promoting a good night’s sleep.

If you have a chronic illness that does have a massive impact on your sleep, your circadian rhythms, your natural lows and highs throughout the day, you may find that you need to modify your sleep hygiene slightly. Things that are a hard and fast rule I tend to avoid doing for anyone with a chronic illness, because if you have the sort of body that doesn’t respond well to hard and fast rules you can end up with a flare up or you can end up feeling really disheartened that the thing you’re trying to do that’s supposed to be amazing isn’t amazing and your body doesn’t like it at all. I try to stick to things as being a guideline or a suggestion, and if you try it and it works beautifully, fantastic. If you try it and it has no impact or it just stresses you out because your body doesn’t respond the way it’s supposed to, maybe that’s not for you. Maybe you need to try something else. Maybe bits of sleep hygiene work really well and bits don’t.

Natasha: One of the things that I’ve always found incredibly frustrating is the reality that I can be SO fatigued during the day, but then night rolls around, and I feel so wired that I just can’t fall asleep. I know I’m not alone in this and it’s something that impacts a lot of us… but why?

Jo: Firstly for those that maybe don’t have chronic fatigue or are new to the chronic fatigue life, there’s a big difference between tired and fatigued. So tired is “I could do with a nap”. Fatigued is “my body does not have enough energy to function in the way that I want it to.” Sometimes a nap will help with fatigue, but there are a big chunk of people with fatigue who could sleep for 24 hours and still wake up feeling completely exhausted. 

It’s very challenging dealing with that frustration, and it is quite a common thing for chronic fatigue to have an insomnia element. So you spend your days wishing you were asleep and your nights wishing you could sleep and you don’t get that natural pattern of activity during the day and rest at night. Part of the reason for this is that actually when you are extra fatigued, if you have pushed yourself past your limits, your body produces all these lovely stress hormones like adrenaline and cortisol to keep you functioning, to keep you going.

The downside with hormones is that they might be a rapid release thing, but they take a while to get out of your system. So if anyone’s ever had a near miss with an accident, or they’ve had a real shock, you get that adrenaline rush to start with where you get the, “Oh, I need to save my life. I need to run away. I need to fight something. I need to have an immediate response here.” But you also get the tail off of feeling a bit jittery or anxious or just really wired for a couple of hours afterwards. So if you’re running on cortisol and adrenaline to get you through the last part of your working day, it’s going to take a while for that to dissipate enough for your body to fall asleep.

Part of the challenge there is that actually you may not be pacing enough to be getting through your day well. You might be getting through your day, but you’re still relying on stress in part to just get your home at the end. 

The other part of that is that actually, if you are really fatigued, you tend to be an indoor sofa kind of person. I know on my bad days fatigue wise, I don’t tend to go out into the garden as much. I don’t tend to do as much. 

Our body uses daylight as a trigger for when we should be awake and when we should go to sleep. So if you’re not getting exposure to daylight, you are just getting filtered through glass daylight, your body might not be getting the same messages that it’s supposed to be really awake, followed by really asleep. So you should stay in this weird sort of twilight perpetually exhausted stage instead.

Natasha: As we heard from Jo, quite often life with chronic illness doesn’t sit alongside so much of the “sleep hygiene” advice that we’re given. 

For example, one of the most common sleep hygiene lines you might have heard is that your bedroom should only be for sleep and sex…but what if you’re not well enough to be outside of your bed the majority of the time? What if your bed is where you’re most comfortable and supported? What if you work from your bed because you have no other option? 

I’d say I’ve spent the vast proportion of my mid-twenties to early thirties in bed, but along with a lot of other things I’ve been doing, I have also been building up spending time outside of it – like on the sofa, on the bench outside (with my trusty cushions!) or at my desk. 

But my ability to do that is very dependent on how I’m feeling on any given day. It was a big thing for me during the pandemic when we were able to start regularly having our evenings on the sofa instead of bed, and now I’m able to have a chunk of time before I go to sleep that doesn’t involve watching tv in my room – creating a separation, even if I’m in my room for the greater part of the day. 

And if you have to spend the majority of your day in bed, the thought of leaving it, even for a short period, can be daunting – especially if you’re really struggling with pain and fatigue. But Jo says there are subtle changes you can make even from your bed, which will help your brain to know when it’s day time and sleep time…

Jo: This is where I tend to aim for progress rather than perfection. So sleep hygiene, if you’re getting better sleep hygiene, you will hopefully get better sleep. You don’t have to have amazing sleep hygiene to get amazing sleep. Sometimes a little bit of progress is appreciated. So if the advice is to keep your bed for just sleeping and sex, great. But if you need to be in bed, how can we put you in bed but in a way that does not mirror how you would be asleep in bed? I’m in a very kind of privileged position here because I have one bed for sleeping and then my guest bedroom at home is my office. So I’m in bed, but I’m in a different bed. So if you’re in a house with multiple bedrooms and you need to work, but you need to be laid down, sometimes working in a different bed is the solution.

Sometimes changing your own environment enough that it feels like you’re somewhere different can be useful. So, as an example, if I am sleeping in this bed, I will have pillows. If I’m working in this bed, I have sofa cushions. It feels more like I’m in a chair situation. Like I’m at work. Like I’m doing awake things. Equally, things like being under the covers, your body needs to associate laying down under the covers with going to sleep. So if you are sitting up and you are not under the covers, that feels different. That feels like awake time. Likewise, things like facing a different direction or even just putting a different blanket on so it’s an entirely different colour, any kind of difference you can make between sleep bed and awake bed is going to be helpful.

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Natasha: Jo briefly mentioned light cues in that last clip and it’s something I want to pick up on because I’ve been really mindful of this recently. I used to basically live in my bed in what we called “vampire mode” – I was in the dark with my curtains closed all the time, and I don’t think that was helping my sleep. 

Over the last few years, I’ve been working on upping my light exposure – starting with opening my curtains a bit more in the day, and then progressing to sitting by an open window, or going outside with some headphones and listening to music on the bench. 

When I was in Germany, I got more fresh air and sun than I have in probably a decade, and I felt like I was just craving it more and more. 

I am aware that this is easier said than done for some, especially if you have light sensitivities…so what does Jo recommend in this situation?

Jo: In terms of light exposure, light sensitivity is a big problem for a lot of people. It may be that actually exposing yourself to daylight first thing in the morning, even for a few minutes is enough. So when you have your first cup of tea, or coffee, or whatever it is you’re drinking first thing in the morning, as you have your breakfast, just sit outside for that or open a window and have the sun full on in your face, and you can have your eyes closed and you can have your SPF on, and you should have SPF on, that kind of thing, but just get some exposure to natural light, even if it is just for a few minutes and even if it’s just while you’re doing the waking up process. If you can’t get exposure to natural light, because of lack of access, etc, you can get blue light lightbulbs for your house. And you can get alarm clocks that will turn on with kind of simulated daylight as the alarm goes off in the morning. So it wakes you up gradually to what is effectively, fake sunlight. And they can be really effective too, particularly if you’re not lucky enough to have windows pointing in the right directions in your house.

Natasha: And it’s not just natural light. I’m sure you’ve heard all the talk about our screen obsession causing issues with sleep – not just from being on them all the time, but also from the blue light they emit…

Jo: I actually had a really in depth discussion about this with my optometrist a couple of years ago. So I wear orange tinted lenses all of the time for visual stress, migraine headache, dyslexia-type reasons. I was concerned it was contributing to my weird sleep cycle, because often people wear blue light blocking glasses in the evening to cut out some of the kind of digital light that we’re all exposed to pretty much constantly. And those blue light blocking glasses are often quite a similar shade of orange to the ones I wear 24/7. So I was really concerned that I was giving myself, effectively, contributing to insomnia by just blue light blocking 24/7.

But yeah, so it turns out there’s a very particular set of light waves that generally fall in the blue spectrum, which basically keep us awake. They perk us up, they give you awake feelings. Some of the information out there says that’s the same light spectrum given off by tablets, smartphones, digital alarm clocks, TV, basically all kind of LCD devices, e-readers that sort of thing. So by using those up close and personal right in front of our faces before we attempt to go to sleep, we’re giving our body all of the awake signals and then immediately trying to turn that off and go to sleep shortly after. And it’s not always a success.

Some people seem to have more of an impact from this than others. So some people will respond really, really well to blue light blocking glasses in the evening, as an example. And this is particularly important for shift workers. If you are coming off a night shift and your commute home is in brilliantly blinding, first thing in the morning daylight, getting all of that wake up time information before you go home and attempt to sleep. So a lot of people coming off night shift, as an example, will wear blue light blocking glasses for the commute, keep them on when they get home, get into their bedroom with their blackout curtains and then take them off. That might work if you’re in the sort of situation.

My partner and I kind of jokingly call this owl mode, but I will occasionally go through phases where my sleep cycle gets so wonky that it ends up needing to be reset by a full kind of 12 hour cycle. It doesn’t happen as often now. And it doesn’t stress me out as much as it used to. It used to be a major source of anxiety for me, but I’ve kind of just accepted that my sleep is a little bit wonky regardless of how good my sleep hygiene is. I just have to live with this, but when I’m trying to do like a big reset, I’ll be very aware of blue light so that I can not use devices for hours. And I’ve got blue light blocking filters on all of my screens or my digital stuff, my laptop, to try and make sure that I’m not contributing extra to the natural sleep wonkiness that is me.

Natasha: I’ve found one of the most helpful ways of training myself to know it’s night time is by nailing my pre-bed routine. 

Jo says this is actually one of the most important parts of sleep hygiene and it’s something we can all do, no matter how big or how small…

Jo: … because it doesn’t require you to buy anything extra. It doesn’t require you to change your environment. It just requires a little bit of consistency. So your sleep routine is literally just the things you do every night before going to sleep. And this can be a 10 step skincare routine, brushing, flossing, mouthwash, changing into your luxury pyjamas. Or it can just be: wash your face, brush your teeth, get in bed from the same side every time. It does not have to be something completely extravagant, but it can be if you want. But I think your sleep routine is a really nice way to wind down from the day. It’s a really nice way to get you in the mindset of, you’re going to bed. You’re feeling relaxed. Everything’s very chill. We’ll just calmly and consistently get in bed.

It’s also one of the things I really like for people who have to travel, or maybe who end up spending time in hospital on a semi-regular basis. Being outside your own environment is guaranteed to wreck your sleep, if you have problems with sleep. So staying in hotels, the hospital stays are almost always a nightmare because it’s loud, it’s light. There are people walking around all the time. You’ve got neighbours that you’re not used to having in the next door cubicles. People will come and check on you at 6:00 in the morning because that’s for your own good. But actually, you’d rather just be asleep. All these kinds of things.

If you can have a sleep routine that’s very, very consistent, that you can replicate wherever you go, it starts to really help. So the items I have on my bedside table, I will also have on the bedside table of wherever else I stay. So if I’m staying with a friend, bedside table has the same items. If I’m in hospital, bedside table has the same items. If I’m in a hotel bedside table, same items, same order. And I will go through my sleep routine in the same way, wherever I go, because it’s really important to me to be consistent like that.

The other thing I’ve also managed to do is to work my daily physiotherapy into my sleep routine. One of the big challenges for people who’ve got quite a lot of health homework, so the things you have to do in order to stay healthy, is that it takes up an awful lot of your day. Being chronically ill is literally a full-time job. And if you’ve also got an actual job, or a family, or hobbies, you’re literally doubling up on things you need to do 24/7. So my sleep routine includes physiotherapy. While I’m brushing my teeth, I will do calf raises at the sink. While I’m doing my skincare routine, I’ll do squats in between each stage. That kind of thing can be really useful for efficiency, basically.

Natasha: For me, my sleep routine starts quite early. After we eat, I put my phone away for the night, often hidden in a draw or on a shelf outside of my room. 

Then, we get cosy on the sofas and watch tv or read with only lamps on. We brush our teeth, and because Sebastian and I sleep in separate bedrooms, I get into bed, he sits on it, we say the same little goodnight thing every night, he tucks me in, turns off my light and we go to sleep. I used to listen to a sleep story, but I now sleep with earplugs in, so I don’t do that anymore. 

Obviously, that’s the ideal. Some nights I end up checking my phone. Or if I’m very anxious and I can’t settle down I’ll just go on my laptop to watch something as a distraction. Or sometimes, like I did the other night, I get up in the middle of the night and record a bit for the podcast before I forget! But having phones and laptops away is probably the most important base of my sleep routine. 

If I’m being honest, this routine took years to develop. Sebastian is an early-bird, and I’ve always very much been a night owl, so when he went to bed, I’d just stay awake in my bed with my laptop on until I was ready to fall asleep. 

Over the years, I’ve been able to train myself to go to bed when he does – and that has helped a lot, primarily because I’m not behind my laptop. I feel like turning my phone off early is not just about being away from screens, it’s also being away from constant pinging notifications and other people. When I lived alone, I wanted that, so I understand why that’s so much easier said than done. It’s connection. But I tended to find that late night messages left me wired.

Funnily enough, in Germany we were both so tired really early, and that has kind of stuck since coming home. I think it might actually be all the fresh air and sun we were getting. 

I asked Jo if she wouldn’t mind sharing her evening routine with me and she said yes… 

Jo: So night time routine generally starts. If my partner is not on nights, we’ll go to bed at roughly the same time. If my partner is on nights, I’ll do the same thing, but on my own. So it’s more efficient because adding another person to the mix always creates chaos.

I will brush my teeth and floss first. And while I’m brushing my teeth, I will do calf raises or like sit down, stand up style squats on the side of the bath, depending on how much physio I need to fit in. Then I will take off makeup if I’m wearing it, cleanse, and then braid my hair ready for bed. I always braid my hair sat down because it’s like a postural tachycardia trigger if I try to do it stood up. Then I’ll get changed for bed. I tend to sleep starkers, but with pyjamas next to the bed on the off chance that I need paramedics at 2:00 in the morning. It doesn’t happen often, but I like to be prepared.

I will then have at the moment I’m doing press-ups. So it’ll be five press-ups just because I’m trying to build some fitness, go me. And then it will be serums and like moisturiser and CBD balm. And I’ll usually swap out my pain patches if I’m wearing those as well, and then I’ll get into bed. And the last thing I do is basically cover myself in CBD balm and then I will put on a relaxation recording and that’s it.

Natasha: Jo’s sleep routine sounds lovely, and it’s interesting to hear how we all do things differently. I find that when I do my skincare routine too close to bed time, it actually wakes me up a bit so I do mine earlier in the evening, generally before I eat. 

If our sleep routines sound extremely long and complicated for you (especially if you struggle to get out of bed at all), it’s worth thinking about what a routine, any routine, looks like for you. It could literally be putting your slippers next to your bed in the same place before you get in, running a water wipe over your face instead of having a skincare routine, or just putting on some hand cream or doing a short meditation before you turn off your light. The aim is to have some things that are relaxing, but also signal to your brain that it is time for sleep. 

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Ok Sooo..you’ve done whatever your little routine is, and your head hits the pillow… and then you start to feel every itch, every pain or bit of discomfort in your body. Your mind starts racing thinking about the pain, all the things you need to do tomorrow, or that thing you wish you said 5 years ago, and you cannot, for the life of you, fall asleep. 

I asked Jo for her tips on falling asleep once we’re actually in bed…  

Jo: The first and number one most important thing; do not have anything facing you with the time on it, particularly not anything that’s illuminated. The least helpful thing you can know is how long it’s taking you to fall asleep because your brain automatically goes, “But I’ve got to be up in seven hours, and now it’s six and a half hours, and now it’s six hours, and now it’s five hours. And now, I need to be up for work in four and a half hours. I’m getting more and more stressed about it.” Get rid of anything that tells you the time.

If you are not asleep and you have been laying there for ages and you are just getting back ache and you’re getting angry, and you’re looking at your partner having a really glorious night’s sleep and you want to smother them with a pillow a little bit, but you’re not going to because you love them, at that point, give up and get out of bed. Take some time. Do something, something relaxing. Something that isn’t… Don’t go for a run, or something at three in the morning. Read for a little bit, and then you go through your sleep routine again. And you try again fresh.

Laying in bed angrily not being asleep is not the right mindset to fall asleep. So, actually resetting that, even if it means you get less sleep, you are going into that feeling good, feeling relaxed, hopefully not feeling too frustrated with your partner who can just turn their brains off at the drop of a hat. It’s that relaxation mindset that allows you to fall asleep really well. So, actually, give up, get out of bed. Try again. Hopefully, that will work.

A lot of people have success with relaxation recordings. So, something that gives you something to focus on besides your own body can be quite useful. Guided relaxations, guided meditation-type exercises can be really useful. A lot of the kind of hypnotherapy, psychotherapy advice out there you can get, like a lot of sleep recordings and things which are brilliant. I think, particularly for people with pain as a symptom, not focusing on your own body can be quite useful. So, following a story or listening to somebody else talk, or something like that, can be quite useful.

Natasha: So we’ve talked about sleep hygiene, sleep routines and some small changes we can make to help improve our quality of sleep. 

But this wouldn’t be a sleep podcast without talking about naps. I am fundamentally incapable of napping during the day. I will occasionally crash out if I haven’t slept for days but on the whole I’m not a napper. 

Sebastian on the other hand is the world’s best napper… he literally closes his eyes and then he’s asleep! I’m so jealous. I can not for the life of me understand how he does it and it seems I’m not alone… 

Jo: I am very much in the same situation where my partner is the best sleeper I have ever met. If sleep was a superpower, he is the face of that superpower. He, at one point in our relationship, was working very early morning shifts and it was like a local kind of paper shop-type situation. So he’d go to work at like four in the morning just as I was going to bed at this time. And he’d have a nap at like nine. So he’d have like a 15-minute break and he’d make a cup of tea, sleep for 12 minutes, drink his tea and then go back to work. And I’m going, “But 15 minutes isn’t enough time to fall asleep, let alone have a 12 minute nap.” Completely blows my mind how good he is at sleeping. And I think that makes it worse for a lot of us if we’re bad at sleep, having somebody to compare to who’s excellent at sleep is not a good feeling, but yeah.

So nap time… I don’t typically nap, but I occasionally have like enforced naps or I can feel my brain going, “We are going to sleep now, you’ve got two minutes to finish this drop powering down.” And I’ve spoken to a few people who’ve had the same where they’ve got these two kinds of naps as the kind of nap where your body is falling asleep, whether you want it to or not. And then there’s this kind of nap where you deliberately think I could do is a bit more sleep. And then I’m going to get something done afterwards. The falling asleep because you’ve got no choice powering down mode tends to just happen whenever it happens and you will sleep for as long as you need to sleep for.

The deliberate kind of nap is another story. So deliberate napping should, generally speaking, be done in the first part of the day. But later in the day you nap, the more likely it is to have an impact on your ability to fall asleep in the evening, like your nighttime sleeping routine. So napping should generally… I tend to say 3:00 PM as a cut-off but if you can get it earlier than that, brilliant. The reason I tend to say 3:00 PM whereas a lot of the literature is like don’t nap after lunchtime, a lot of the people I work with don’t get up at 7:00 AM. They get up at eight or nine or 10. So you have to push it round a little bit otherwise you’re up for an hour, have a nap, and then you’ve got to be awake for the rest of the day, which doesn’t tend to work so well.

So generally speaking, try to keep your naps as early as possible but also try to nap for 90 minutes. The 90-minute thing is basically roughly the time it takes for your brain to go through like a full sleep cycle from lightest sleep right the way through your deep kind of REM dreaming sleep, and then back up to the lightest bit. So I don’t know if you’ve ever had that situation where you wake up naturally just before your alarm goes off and it feels absolutely amazing. You’re just ready to start your day. I think I’ve probably only done it about 10 times in my life, but it feels amazing, that natural wake up ready-to-start-the-day feeling versus the times when you are absolutely in the middle of a really intense, really confusing dream and your alarm yanks you out and you don’t know what day it is or where you are for a few seconds just after you wake up.

This is what we’re aiming for with the nap thing. So if you go for a 90-minute nap, you’re more likely to wake up kind of feeling really alert, feeling really awake, feeling good, versus if you have say a 60-minute nap and your alarm then yanks you out of the middle of a dream and you wake up feeling confused and lethargic and not really knowing what’s going on. So 90 minutes tends to be a good time to aim for. If you know it’s going to take you 15 minutes to fall asleep, factor that in so you are getting 90 minutes of actual sleep rather than having a 90-minute nap but it takes you 20 minutes to doze off.

Natasha: And finally, what if your body just doesn’t fit with ‘regular’ sleep cycles? It’s something lots of people with chronic illness find – and Jo says understanding your own natural sleep cycle is really important.

Jo: So unless I really force myself, medicate myself into oblivion or literally remove all reminders of the time and do sleep hygiene to such a degree that it becomes a chore, my natural sleep cycle runs from two in the morning until half 10 in the morning. So I fall asleep at 2:00 AM, I wake up at half 10. If I am not super mindful of when I’m going to bed, that is the point my body absolutely always resets to. If I stop forcing myself to sleep at wrong times, that’s what happens. That’s just when my body goes to sleep. The more I think back, the more I’m convinced it’s been that way for a very long time, because even through like my high school years, I had to force myself to sleep before one or two in the morning. It was a real difficult kind of struggle. And that struggle led to a lot of anxiety.

So actually part of my work with my own hypnotherapist, my own psychotherapy work, was around actually, do I need to force myself to sleep at weird times or can I just accept that my body is bad at sleep before one in the morning? Not stress about it, not be angry about it, not be anxious about it. So for me, a reasonable adjustment in my workplace in my work is that I don’t start work until 11:00 AM.

So sometime, and I, again, I’m in a privileged position where I’m self-employed. So I can just decide that. But if you are the sort of person who genuinely your sleep is so disordered that you just cannot function at nine in the morning, it might be worth having a discussion with your employer, with your family, with your friends, whether it’s worth it. Is it worth the fight or are you going to be happier and healthier if you are not constantly fighting your body’s natural circadian rhythms? So, yeah, I just kind of, I want to put that out there because I think it’s a perfectly reasonable adjustment, but it’s not the sort of thing we see as a reasonable adjustment. And I want to spread the word that lots of us are just not morning people and that’s okay.

Natasha: A huge thank you to Jo Southall for once again sharing her expert insight with us. If you missed my other episodes with Jo on pacing, I’d highly recommend going back and listening to them. 

Thank you again to our sponsor, Phlo – the online pharmacy that makes ordering your medication easy. Visit wearephlo.com – that’s wearephlo (P-H-L-O).com or download Phlo on your favourite App Store to manage, track and have your medication delivered at the touch of a button.

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Aaand that’s all from me. Thanks so much for joining me in The Rest Room. Ta ta for now!