There's a particular kind of tired that has nothing to do with your heart rate. It's the tiredness of standing at a meeting with your knees locked, smiling, counting the seconds until you can sit without anyone noticing. It's crossing your legs under the desk so your feet stop going purple. It's saying I'm fine, just didn't sleep well for the fourth time this month. Many people with POTS will tell you that the illness is exhausting. Fewer will say the quieter part: that pretending not to have it can be the most exhausting thing of all.

This article is about that second kind of fatigue, and about the conversation most people with POTS put off for months or years: asking work for what your body needs.

The hidden cost of passing as well

Psychologists have a name for conditions like POTS. They're called concealable stigmatized identities: things about you that others can't see, that you can choose to reveal or hide, and that carry some risk of being judged. Researchers such as Diane Quinn and Stephenie Chaudoir have studied how carrying one of these identities affects wellbeing, and John Pachankis proposed a cognitive-affective model of what concealment actually does to a person.

The core insight is simple and a little uncomfortable: hiding something isn't passive. It's work. To conceal well, you have to watch yourself constantly. Did anyone notice I grabbed the wall? Does my face look pale? Will they think I'm lazy if I sit? This self-monitoring runs in the background like an app draining your battery. It takes attention, it keeps your stress response on alert, and it leaves less room for the job you were hired to do.

For most people, that drain is a nuisance. For someone with POTS, where energy is already rationed and adrenaline is already over-firing, it's a tax you can't afford. Your autonomic nervous system is struggling to keep blood flowing to your brain while you stand. Adding a layer of social vigilance doesn't make the symptoms disappear. It just means you're managing two emergencies instead of one.

There's a related workplace idea called presenteeism: showing up but working well below capacity because you're unwell. Many people with POTS are champions of presenteeism. They never call in sick and never miss a deadline, and by Wednesday afternoon they're running on fumes and quietly wondering whether they can keep this job at all.

Accommodations aren't special treatment. They're how you stop paying the concealment tax.

Why asking feels so much harder than it should

If accommodations are this useful, why do so many people avoid asking?

Part of it is the shape of POTS itself. You look fine, and some days you are fine. Symptoms swing with heat, hydration, sleep, your menstrual cycle, and the time of day. That inconsistency makes it easy to talk yourself out of it: If I could stand through yesterday's meeting, what right do I have to ask for a chair today?

Part of it is history. Many people with POTS spent years being told it was anxiety, deconditioning, or attention-seeking before anyone took them seriously. When you've been doubted by doctors, it's natural to brace for doubt from a manager too.

And part of it is self-worth. Underneath a lot of hesitation is a fear that needing anything makes you a burden, or less valuable than the colleague who never has to ask. That fear deserves gentleness, and also a reality check. Your employer hired you for your skills, judgment, and work. Whether you stand up to do it was never part of the deal.

Ask for the function, not the diagnosis

The most useful idea in this whole conversation is this: you don't need anyone at work to understand POTS. You need them to understand what you need to do your job well.

In the United States, the Americans with Disabilities Act requires many employers to provide reasonable accommodations and to engage in what's called an interactive process: a good-faith back-and-forth about what would help. The UK's Equality Act 2010 sets out a similar duty to make reasonable adjustments, and many other countries have comparable protections. The details vary, so check what applies where you live. Across most of these systems the focus is the same: your functional limitations and the changes that address them, not your medical chart.

That changes the conversation. Compare these two approaches:

  • I have POTS, which is a form of dysautonomia where my autonomic nervous system doesn't regulate heart rate and blood pressure properly when I'm upright...
  • I have a medical condition that makes standing still for long periods difficult. Having a stool at the front desk would let me cover the full shift reliably.

The first one invites skepticism, questions, and amateur medical opinions. The second one is concrete, solvable, and hard to argue with. You can always explain more if you want to, but you're not obliged to give your colleagues a physiology lecture.

Think about where POTS actually gets in your way during the workday, then match each friction point to a fix:

  • Prolonged standing (registers, labs, retail floors, standing meetings): a stool or perch seat, permission to sit during meetings, or rotating standing and seated tasks.
  • Morning symptoms that ease as the day goes on: a later or flexible start time.
  • Heat sensitivity: a desk away from windows or radiators, a personal fan, or relaxed dress codes so you can wear compression garments or cooler clothes.
  • Hydration and salt needs: water and salty snacks at your workstation, plus easy access to the bathroom without having to explain yourself.
  • Unpredictable flares: remote work on bad days, short rest breaks, or a private place to lie down for ten minutes.
  • Commuting and energy limits: hybrid schedules, or meetings grouped so you aren't walking the building all day.

Notice that most of these cost almost nothing. A stool. A fan. Starting at ten instead of eight. Small changes can do a lot.

Disclosure is a dial, not a switch

Another reason people freeze is that they imagine disclosure as all-or-nothing: either everyone knows everything, or no one knows anything. In reality you have far more control than that.

You might tell HR the formal details and give your manager only the practical version. You might tell one trusted colleague so someone knows what's happening if you get lightheaded, and say nothing to the rest of the team. You might use the word POTS openly, or simply say a heart rate and blood pressure condition. All of those choices are legitimate. The goal isn't radical openness. It's to stop spending energy on secrecy you don't need, while keeping whatever privacy matters to you.

One more thing: a written request is usually better than a hallway chat. It creates a record, gives the other person time to respond thoughtfully, and keeps you from getting flustered mid-sentence. If your hands are shaking during the meeting, at least your email isn't.

Your next moves

  • Write down three moments from last week when POTS got in the way at work. Be specific: the time of day, what you were doing, and what happened (Thursday, 9:30, standing in the stand-up, had to grip the chair). These become your evidence and your talking points.
  • Turn each moment into one accommodation request. For each friction point, write a single sentence: I'd work more reliably if... Start with the cheapest, simplest fix. It's the easiest yes and builds momentum.
  • Ask your doctor for a short letter about function, not diagnosis. Request that it describe your limitations (for example, difficulty with prolonged standing; symptoms worse in heat and early morning) and the supports that help. A good letter is often one paragraph.
  • Look up your local framework today. In the US, the Job Accommodation Network (askjan.org) has free, practical guidance on requesting accommodations. Elsewhere, search for your country's equivalent of reasonable adjustment rules or your employer's HR policy.
  • Draft the email now, even if you don't send it this week. Keep it to four or five sentences: you have a medical condition, here's the limitation, here's the specific request, you're glad to discuss. Getting it written takes away most of the dread.

The quiet relief of not pretending

Many people who finally ask for accommodations describe the same surprise afterward. The stool or the later start helps, sure. But the bigger change is internal: they no longer spend half their attention guarding a secret. That freed-up energy goes back into the work, the commute home, and the evening they used to spend recovering on the couch.

The hardest part of asking is usually knowing what to ask for, and having something solid to point to when you do. That's where a clear record helps. Stable is a POTS tracker built to make your patterns visible: when your symptoms peak, what standing does to your heart rate, and how heat, sleep, and hydration change your day. When you can show that your mornings are consistently harder, or that your pulse climbs every time you stand for more than a few minutes, the request stops feeling like a favor and starts looking like what it is: a reasonable fix for a real, documented problem. If that would help, you can try it at stable.lumenlabs.works.