Why I Ask How You're Sleeping, What You're Eating and Where It Hurts

Almost every session with me starts the same way: “How are you? How are you feeling today?” And a quick “fine” rarely satisfies me. I'll ask whether you've slept, whether that cold has cleared up, whether the stomach pain has come back, whether you've managed to eat anything today, whether your doctor has changed your dose.

Some people are surprised: “What does that have to do with therapy?” Quite a lot, as it happens. I don't wait for you to bring up the physical side, because most of the time it doesn't come up on its own. Here's why.

You can't leave your body at home when you come to therapy

The mind doesn't run separately from the rest of you. If you've been sleeping four hours a night for months, any conversation about managing your emotions is happening with a nervous system that hasn't had a chance to rest. If something hurts every day, part of your energy goes there, and what looks like “a lack of motivation” may really be exhaustion. And an inflamed gut, especially during stressful stretches, shows up in your mood, your sleep and even in how well your medication is absorbed.

It works the other way too. Weeks of swallowed stress, anger you've held back, the effort of looking fine when you're not: it all builds up in the body, in tight muscles, in your stomach, in your heart rate, in your sleep. There's nothing mystical about it. These are stress hormones, and their effects are very real. The gastroenterologist Emeran Mayer, who has spent forty years studying the link between the brain and the gut, describes it as a two-way conversation: stress changes how your gut works, and what happens in your gut travels back to the brain.

There's a name for this idea in the research: the biopsychosocial model, described by the psychiatrist George Engel in 1980. Put simply, you can only make sense of someone's health and distress if you look at the biological, the psychological and the social parts of their life together. The model has been debated and criticised a great deal since then, but it is still the foundation modern medicine rests on (Bolton and Gillett, 2019). The psychologist Paul Gilbert draws the practical conclusion: therapy only really works if it reaches all three at once. That's what “holistic” means to me. No crystals, no detox programmes, no wellness retreats. Just looking at the whole person rather than one piece of them.

The way stress builds up in the body has a name as well. The biologist Bruce McEwen called it allostatic load: the wear and tear that accumulates when your body has to keep adapting to stress for too long. Your body is built to cope with stress, but in short bursts. When it goes on for months or years, your immune system, hormones, sleep, digestion, blood pressure and muscles all stay on alert. Over time the body loses some of its flexibility and starts to give way in exactly those places. That's why burnout isn't just “mental exhaustion”. It's physical wear and tear too.

And one more reason. To change a pattern in therapy, whether that's seeing an old situation differently or reacting in a new way, your brain needs to be out of alarm mode and able to rest afterwards. In a body that isn't sleeping and is always braced, whatever we work on in a session takes longer to settle in. I've written about how we work with nervous system regulation in my article on neuro-affirming therapy.

What I learned the hard way

The thing that frightened me most was a stretch of two or three weeks when my heart went haywire. My pulse would climb to 150, sometimes 190, when it normally sits at around 56. It felt as though my heart was about to burst out of my chest. It wasn't a heart problem in the usual sense. It was burnout, on top of a lack of sleep that had been building for a long time. Once I calmed down, it passed.

For years I also had panic attacks that seemed to come out of nowhere. It took me a long time to realise they started at a particular moment: when I suddenly became aware of my own pulse. Later I found out I have pulsatile tinnitus, which means I can sometimes hear my blood flowing. My body was doing something harmless, and my mind was reading it as danger.

I learned something else, and it may be the most important part: every time I felt a little better, I went straight back to the same pace that had worn me out. And the burnout came back, harder to climb out of each time.

These days I take far better care of my body. I wear a watch that shows my heart rate and how well I've rested. That's how I discovered that in situations where I was sure I was calm, my body was telling a different story. And after a bad night, it shows in the numbers straight away. Every day, before and after my sessions, I take the dog out for a walk in the park or along the beach. I couldn't keep going without those breaks.

That's why I ask how you're sleeping and how your heart is doing. I know from my own experience how easy it is to overlook these signals when you're caught up in the day.

Why I don't wait for you to mention it

There are four reasons I come across again and again.

Many people don't notice their body's signals in time. For autistic people and people with ADHD, hunger, tiredness or pain often arrive late or blurred. You realise you're hungry only once you have a headache and you're snapping at people, or that you're exhausted only when your body says “that's it, I'm done”. I've written about this in more depth in the burnout series. So when someone asks “anything physical going on?”, the honest answer is “no”, even when that isn't quite the case.

Many people have got used to pain. When you live with chronic pain, you end up comparing it with your everyday pain rather than with a pain-free day. And some kinds of pain have been brushed off for years, sometimes by doctors too. Period pain is the most common example: discomfort is one thing, but being sick or unable to leave the house is something else entirely, and it deserves to be looked into.

Many people have stopped saying anything. After being sent home a few times with “it's just stress”, you start playing everything down. You describe the problem to your doctor as smaller than it is, so you don't come across as dramatic. Then you stop mentioning it in therapy as well.

The diagnosis ends up covering everything. Doctors have a name for this: diagnostic overshadowing, when an existing diagnosis casts a shadow over any new problem. Once you have a label, whether it's autism, ADHD or anxiety, any physical complaint risks being put down to it: “it's your anxiety”, “that's just how autistic people are”. But some medical conditions look a lot like psychological ones:

• an underactive thyroid can look like depression;
• low iron or low vitamin D brings tiredness, brain fog and a low mood that can look like depression;
• sleep apnoea wrecks your concentration and can look like ADHD;
• dysautonomia causes palpitations that feel like a panic attack.

If we only work on the psychological side of something that also has a physical cause, therapy struggles, and you end up believing that you are the problem.

So I ask, directly. And I keep asking from one session to the next.

What the research says

A few findings from the research, along with their limits.

Physical health in general. A 2024 study from England and Wales (Hunt and colleagues) compared 813 autistic adults with 2,781 adults without autism. Of the 28 physical conditions it looked at, 16 were more common in autistic people, including liver and kidney disease, osteoporosis and rheumatoid arthritis.

Hypermobility. In a 2022 study (Csecs and colleagues), joint hypermobility was found in 51% of neurodivergent adults, compared with 20% of the general population. The authors link it to pain and to dysautonomia, where the autonomic nervous system struggles to regulate heart rate, blood pressure or temperature. A typical sign is feeling dizzy when you stand up quickly. When your joints and tendons are looser, your muscles have to work harder to hold everything in place, so your body uses more energy than someone else's for the same activities.

Digestion. A study of 960 children (Chaidez and colleagues, 2014) found that autistic children had almost eight times higher odds than other children of having frequent digestive problems, such as tummy pain, constipation or diarrhoea. There's less data on adults, but in my practice I often see irritable bowel syndrome, food intolerances and inflammatory bowel disease.

Your menstrual cycle. Premenstrual dysphoric disorder (PMDD) is the severe form of PMS: in the days before your period, your mood shifts so much that it affects your work and your relationships. In a 2025 UK survey of 715 young women (Broughton and colleagues), around 31% of those with diagnosed ADHD had it, compared with 9% of those without ADHD. A Dutch study (Dorani and colleagues, 2021) also found that women with ADHD reported more difficulties around perimenopause, although the evidence here is still limited.

Long-term health. A UK study of more than 30,000 adults with ADHD (O'Nions and colleagues, 2025) found a lower life expectancy than in the general population, by around seven years for men and nine for women. That figure sounds heavy, so I want to put it in context. The researchers didn't have information on causes of death, and the authors say the figure may be an overestimate. More importantly, commentators link the gap to things that can change: smoking, sleep, chronic stress, and the fact that the physical health problems of people with ADHD too often go unnoticed and untreated. That's exactly why they're worth putting on the table.

All of these are patterns measured across large groups of people. They don't mean you have any of these conditions. They simply mean it's worth asking.

Sleep and your body clock

Sleep gets its own section, because it's the thing I ask about most often. A review that pooled 42 studies (Ramos-Quiroga and colleagues, 2021) found that autistic adults and adults with ADHD take longer to fall asleep and wake more often in the night than other people. And poor sleep then shows up in the rest of your day: in your focus, your patience, and how quickly noise and people start to overwhelm you.

Timing matters too, not just how many hours you get. Your body runs on an internal clock that sets the rhythm for sleep, hunger, hormones and temperature, guided by light and by when you eat; the researcher Satchin Panda has written a great deal about this. In many adults with ADHD, that clock runs late: the body starts releasing melatonin, the hormone that signals evening, around an hour and a half later than in other people (Van Veen and colleagues, 2010; Bijlenga and colleagues, 2013). So “I can't fall asleep before 2am” is often down to a body clock that runs differently, not a lack of willpower. That's why I don't just ask how long you sleep, but also when you go to bed, when you eat and how much daylight you get in the morning.

What's more, sleep can change your mental state directly. In a UK study of 3,755 students (Freeman and colleagues, 2017), those who followed an online programme for insomnia slept much better, and they also had fewer paranoid thoughts, the sense that other people mean you harm, and fewer hallucinations. The researchers showed that it was the better sleep that brought about the change. A 2021 review that pooled 65 trials with more than 8,600 participants (Scott and colleagues) reached the same conclusion on a much larger scale: when sleep improves, depression, anxiety and rumination ease too. And the more sleep improves, the bigger the effect. If improving sleep can change the way someone thinks, then working on thoughts while leaving sleep to one side means working on only half the problem.

What I actually ask

The questions I ask most often:

• How much did you sleep, and what time did you go to bed? Do you wake up rested? Do you snore or breathe heavily in your sleep?
• Have you eaten today? Once you notice you're hungry, how long can you go before a headache or dizziness kicks in?
• How much coffee, cola or energy drinks do you have, and when? A single coffee or can of cola at the wrong time can push your sleep back by hours. And feeling more alert doesn't mean you're better rested.
• Where does it hurt, since when, and how badly compared with a pain-free day?
• When did you last have blood tests? Iron, vitamin D, thyroid?
• What medication and supplements are you taking? Have you noticed anything different since starting something new?
• How do you feel at different points in your cycle?

Some of these I ask in the first session, others later, when we get to them. And some connections only show up after a few weeks: a mood that always dips in the same week of the month, anxiety that rises after sleepless nights, a medication that seems to stop working when your digestion is upset.

What I do with what I learn

I explain what's going on. Understanding the mechanism often helps a lot: why stress inflames your gut, why your body gives way exactly when you finally stop after a month of pushing, why you can be completely shattered and still unable to fall asleep.

I encourage you to see your doctor, with specific questions. I help you tell them exactly what you're feeling, since when, how often and how badly, rather than a vague “I'm not feeling great”. We write it all down beforehand, because in a ten-minute appointment it's easy to freeze or forget half of it. If you're in the UK and you're autistic or have ADHD, you can ask your GP practice for a longer appointment or other reasonable adjustments.

We also work with the body in sessions, to help regulate your nervous system. But not in just any way. Many relaxation and body-awareness exercises are designed with neurotypical people in mind: sit still, close your eyes, focus on your breath. For an ADHD brain, or for an autistic person with sensory sensitivities, that can be more stressful, not less. The therapist Nyck Walsh, in a book on body-based therapy with neurodivergent clients (2026), starts from the same principle I work from: you are the expert on your own body, nothing is forced, and the exercises adapt to you. They can be active, using movement, sound or objects, rather than only stillness and silence. I've written about how I do that in my article on neuro-affirming therapy and on the Approach page.

Where I draw the line. I'm not a doctor. I don't diagnose, I don't prescribe, and I won't tell you to change or stop any treatment. I can share what I know and what I've seen help other people, but the decision is one you make with your doctor. And if something hurts, I won't put it down to “it's all in your head”. Pain deserves to be checked.

It's not your fault

None of this means “if you just slept better, all your problems would go away”. For many neurodivergent people, the body has spent years paying the price for a life lived at a pace, and in an environment, that never suited it. You're not a robot with self-charging batteries. You need sleep, regular meals, water and breaks, and you probably need them more often than you've let yourself have them.

If any of this sounds familiar, the first conversation lasts 30 minutes and is free. We can start with the same question I always start with: how are you, and how are you feeling today?

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Sources

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• Panda, S. (2018). The Circadian Code. Rodale.
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This article is for information only and is not a substitute for medical advice. If you're worried about your physical health, please speak to your GP.