A fair number of clients who suffer from chronic health problems come though my metaphorical door. Personally, I’ve dealt with a chronic health condition called POTS since my early teens. 

When you’re dealing with longer term, physical chronic health problems that cause fatigue, brain fog, or pain, standard productivity advice might not work. Common advice can even backfire, leaving you worse off. Similarly, shorter term problems such as a concussion or pregnancy will temporarily change what you can do. 

Of course, I am not a doctor. This is a collection of productivity tips based on many conversations I’ve had, not proven medical advice. If you have a chronic health issue, you should be getting medical advice from appropriate professionals. 

Invest in your capacity

Improving your habits and better managing your symptoms will almost certainly increase your productivity more than trying to power through. So work smarter, not harder. Here are some tips for improving your capacity to do work. 

Spend time trying to find treatments as early as possible. The biggest productivity gains may come from finding better ways to manage your condition. You may need to talk to many specialists, try different medications, adopt new routines, or learn new ways of moving. The earlier you do these, the longer you will be enjoying the rewards. College is a great time to do this. Of course, grant yourself some compassion if navigating a complicated medical landscape seems like an overwhelming burden on top of dealing with your normal work.

Get enough sleep. Sleeping less than you need so that you have more time awake will reduce your productivity. If you have any kind of chronic fatigue issue, you just need more sleep than average. It’s common to need nine hours a night or more in such cases. If you’ve been running a sleep debt, you may need a lot of rest to catch up over many days. 

Adapt your environment to support you. If people are getting annoyed that you’re taking longer than normal to reply to their emails, set up an autoreply that you’re slow to reply right now because of a health problem. If you’re struggling to remember to take your pills, get a weekly pill organizer or an electric bottle cap that tells you when you last took your meds. Build in redundant systems to make sure the vital habits happen. 

Make your key habits robust and flexible. When you find the actions, medication, or tricks that make or break your day, plan a way to do those even when you let your other work slide. When you're “falling behind,” it can feel like you don’t have time to exercise or sleep enough or do your stretches. Build routines flexible enough to adapt. Maybe you may need to schedule your deep work for today based on when you have energy. Or maybe you need to make a scaled down habit list with just one or two items that you follow when you’re not feeling up to your full normal routine. 

Learn your warning signs and pay attention to them. Learn the warning signs that your body is nearing its limit. When those warning signs pop up, plan responses that will leave you ready to be productive again tomorrow. E.g. if you have carpal tunnel, stop before your hands hurt. 

Plan on not being 100%. When you’re setting goals, give yourself buffer time. Are you brain foggy one in three days? Then don’t make a plan that requires you to be at peak capacity every day. If you can do more than you planned, great! If not, you already have a plan in place for dealing with it. 

Slow down and respond to new conditions. If your condition recently developed, slow down a bit more than you think you need. You’re still calibrated to what you could do before, but your “normal” has changed. You need to accept that a good day right now isn’t as good as what you used to consider a good day. While you’re figuring out what you can do, you don’t want to push yourself too hard. You might make things worse. This is especially common in repeated stress injuries like carpal tunnel. Second, aggressively try to solve this new problem. The above argument for solving a problem earlier rather than later applies. More importantly, however, some health issues are much easier to fix early on. E.g.If you keep working with a concussion, you might cause further brain damage. 

Personal examples: 

It’s not always easy to imagine what these tips would look like in practice. So I’ve included some personal examples of what they look like for me. 

• One of my key habits is regular exercise. So I start off the day with fifteen minutes of yoga. A habit established mainly, I confess, through committing to pay a housemate for each missed day. I sat out half the standing poses today because I was feeling lightheaded (one of my warning signs). Since overexercising can leave me tired for weeks, I’m not trying to push myself here. 

• I have three bottles of salted water beside my bed so I stay hydrated. After what feels like the pharmacological equivalent of shopping for new clothes, one of that many drugs that my doctors recommend works really well. The salt water, meds, and other things I’ve done to manage POTS have been huge in increasing my productive time - there is no way I could have just pushed through to my current levels of productivity. 

• I went to bed early enough last night that I could get a solid 8.5 hours of sleep. My housemates graciously agreed to pause our board game and finish it today so I could get enough sleep. 

Figure out your limits

Most advice you hear will argue either to accept your limits or push yourself more. That’s because most people giving such advice are trying to push back on the pendulum swinging too far in one direction.

This post isn’t about recommending either. 

I get the arguments for wanting to accomplish more, and sometimes being able to do so if you push yourself more. I also understand why pushing yourself too much can be net harmful to your productivity (and, of course, your happiness). 

What is hard is deciding when you should do each. 

Because “push yourself” and “accept your limits” isn’t a binary choice. Rather, you’re trying to find where your limits should be and when you want to push yourself more. 

This is hard because the normal benchmarks don’t apply. If work is a boulder each person has to push up a hill, your boulder is bigger than that of a “normal” person. So it doesn’t make sense to measure yourself against the arbitrary eight-hour workday. 

Instead, you need to figure out for yourself what you can accomplish. When will you expect that you “should” be productive and push through? When will you accept that you gave it your best but hit a limit? 

A couple of therapists and I put our heads together to brainstorm the following criteria for deciding where to set your limit. The goal we aimed for is sustainability – can you maintain this threshold without burning out or further damaging your health? 

Here’s some questions we came up with:

• Are you exhausted all of the time? Does increasing time off work or rest reduce the exhaustion? If you’re exhausted unless you sleep more, sleep more. Running an increasingly large sleep deficit is not sustainable. 

• Is your pain increasing? If your actions cause your physical pain levels to steadily increase, maybe slow down and experiment with more gradually increasing your activity levels. If your pain or other symptoms get worse, ease back off. 

• Are you experiencing sudden changes? E.g. sudden loss of energy, sudden low mood or mania, sudden loss or increase of appetite, sudden increase in brain fog, sudden loss of weight? If you experience sudden changes, check with a doctor. These can be a symptom of something severe.

• Does taking a break (e.g. a weekend off) substantially improve your symptoms? If taking a break improves your symptoms, think about what breaks you need for sustainability. “I’ll just push through” often doesn’t work for prolonged periods of time, and you can set yourself back far more if you over do it. Draw your limits based around protecting the necessary amount of break time.   

• Is your physical health impacting your behavior? E.g. snapping at people or making many typos. If so, how costly could these mistakes be? If you might mess up something important because you’re fatigued, consider whether it’s actually more effective for you to work less and rest more. 

These questions are about you over time, not just this moment. You might feel okay today getting less sleep, but then consistently be tired after a week of doing so. Your limit isn’t the max you can possibly push yourself; it’s healthy boundaries that protect your ability to sustainably do important work. 

Trying to do more 

As you build your habits, you probably want to try doing things and noticing when you should ease off. However, constantly checking in with yourself might cause more stress and heighten awareness of symptoms. So it's useful to watch out for that and find a pattern of checking in with yourself that works well for you. 

Here are some tips for when you want to try doing more.

Prioritize ruthlessly. You have more limited capacity than other people. However, this usually reduces the amount you can do more than the importance of what you can do. You can make up a good deal of that gap by doing just the most important tasks. 

Try to avoid failing with abandon. It can feel tempting to write off the entire day when you wake up feeling awful. Or to think that you shouldn’t try because you’ll never be able to do something. There may be times when those responses are warranted, but they shouldn’t be the default. Even if your day started out bad, maybe you’ll feel up to doing some work in the afternoon. So check in with what you feel up to right now. 

Try the 5-minute test. A therapist mentor once told me that for people dealing with anxiety, they suggest the person ask themselves “Can I do this for five minutes?” If the answer is yes, do it for five minutes. Then ask the question again. When the answer is no, it’s okay to stop. You can apply a similar check in with yourself. Ask yourself questions like these: “Do I feel up to doing my top priority for five minutes? If not, do I feel up to doing easier work? If not, what break is most likely to leave me feeling better later?” You can also use it for self-care, “Can I do five minutes of exercise?” or “Can I spend 5 minutes figuring out which meds I need to order?”

Work up slowly. Set goals based on what you’ve done previously. No one would expect to go from couch potato to running a marathon instantly. Similarly, if you normally work three hours a day, don’t suddenly jump to eight. Even if you manage to do it for a day or two, it’s not sustainable. Increase your work in small chunks so that you have time to learn the necessary habits and notice when you are overexerting yourself. When you experience a setback, recalibrate and go more slowly. 

Personal examples: 

• I’m aiming for three hours of deep work today since I only have a few calls. Through trial and error, I know I can expect to hit that goal ~80% of the time if I work hard. So it’s a mild stretch goal that pushes me a little bit.

• Today wasn’t a good day. I woke up feeling like my head was stuffed with cotton, and didn’t end up starting my deep work until 5pm - far later than the planned 9am. 

Cut yourself slack

Finally, here are some ways to think if you’re near your limit.

You don’t need to compare yourself to others. It doesn’t always feel like you should be cutting yourself slack. By which I mean, it’s really hard to know if you're just "not trying" as hard or if you're pushing a heavier boulder up the hill than others. Psychologically, it can help if the problem suddenly starts or you can get an official diagnosis, so you can compare your current experience to recent memory or quantitative medical criteria to know that your experience is not normal. 

In practice, I set thresholds by the above questions on figuring out your limits. If you are testing how much you can do and finding the limits you need to respect so you’re not too tired or in too much pain, then that is the upper bound of what you should expect of yourself. This is true even if someone else doesn’t have those limits. 

You’re not slacking off.

It’s easy to feel bad about your productivity if this is you. You probably aren’t able to work as much as you see others working or as much as you think you should be working. I’ve spent years building habits, improving prioritization, and learning to manage my condition – and I still average fewer hours of work each day than my partner does with far less effort. I still have days where I hit a wall and need to nap for several hours. 

When you see yourself struggling to accomplish what others seem to do easily, it can feel like you are a failure. And that sucks. 

But you are not lazy or slacking off. To return to my earlier analogy, if work is a boulder each person has to push up a hill, your boulder is bigger than theirs. So, cut yourself some slack if you can’t push your boulder up quite as high a hill as someone with a lighter boulder. 

You’re pushing through something that is genuinely difficult. For many people with chronic illness, the everyday experience is the same as a normal person’s sick day. The difference is that when a normal person feels as bad as you do right now, they call in sick and stay in bed. But this is your normal. You can’t let yourself take off every “normal person” bad day, or else you wouldn’t have any days to work. So you push through pain or fatigue or brain fog, and that takes extra effort. 

Personal examples: 

• I schedule client calls with breaks every few hours so that I have time to take a nap if necessary. 

• I score my productivity for the day on a 1-5 scale based on what percent I accomplished of the work I think I could have done given how I felt today. On days when I’m tired or brain foggy, “good enough” translates to much less work than on a good day. I’ve failed at this so many times that I’ve come to respect my warning signs.

Conclusion

Chronic conditions have an up-and-down cycle - sometimes it’s meh, sometimes things seem mostly fine, and sometimes you’re in a really bad place. Managing your productivity is about learning to negotiate that cycle: reduce the downs if you can, make the most of the ups, and practice some self-love as you go. 

Because things can get better. While I still work fewer hours than some of my peers, I’m able to work mostly normal hours. That wasn’t true a few years ago. 

I hope you found these helpful for deciding when to push or cut yourself slack. To reiterate, please be kind to yourself. You’ll be happier and more productive optimizing for sustainable work rather than beating yourself up for having a health problem. 

Resources and acknowledgements 

My resentful story of becoming a medical miracle by Elizabeth Van Nostrand - useful advice on when to stop trying to figure out your illness (since we may just not understand your condition yet), and instead try exposing yourself to a lot of things that might work even if we don’t understand why. “Try solving problems with understanding first, but accept when you’ve hit diminishing returns and consider if your energy isn’t better spent increasing your surface area to luck”.

Living a Healthy Life with Chronic Conditions - I haven’t read it, but I found this book on the CDC’s site for self-management of chronic conditions. It seems to have a broad collection of basic tips. 

Many thanks to Ewelina Tur, Damon Pourtahmaseb-Sasi, Daniel Kestenholz, Nicole Ross, Mary Wang, Rohin Shah, Bill Zito, Jonathan Mustin, and Amanda Ngo for their input.