Oh Jesus, why am I so tired? I mean There's been a lot going on at the moment. I did go to that You know I was shopping my friend earlier, and what's that social event that I wasn't expecting and that fridge downstairs. It's just Man, like it's just it's got this kind of electrical buzz that just it just eats at me every day and I Go to work and there's like that annoying light in the corner that just keeps flickering and You know, I'm not allowed to wear my sensory supports and my earphones and my my shades and stuff indoors It's against company policy. Oh, I just feel like everything's just getting too much and Everyone around me just seems to be doing fine. Why is that? Good day, everybody Thomas in the dressing down coming you today coming you today Coming at you today with another video today. We are talking about Autistic fatigue that feeling of fatigue is something that we all experienced as human beings at some points in our life. Perhaps we have Exerted ourselves too much and found that when we got home We don't have the energy to do all sorts of life things that we said we're gonna do like going to the gym Like you said for new years. I know You self that Today I'm coming at you in my Very fancy dressing down to talk about autistic fatigue. Is it different to the fatigue that everybody experiences? Well, you may be surprised let us get into the caveats for this video to very important caveats Then I'm going to implement on pretty much all of my videos For the time being this will not cover everybody's experiences. Everyone is very individual person very diverse There are variations in their personality experience cultural factors their environment As well as their autistic traits and different neuro divergencies. I'm also not a medical doctor or expert I'm not licensed and so if you come across any advice within this video Or any thing that you're interested in make sure to consult somebody with a few little letters letters next and then you know You need that with those very annoying and consistent caveats out of the way. Let's try to understand Why it might be different in expression this idea of autistic fatigue and also understand the different Contributors to this very very strange phenomenon. Let us start at the beginning sounds like some kind of Storybook children's show kind of esk introduction Welcome kids to autism and fatigue Autistic fatigue is a state of extreme physical emotion or social exhaustion Now you may be thinking yourself That sounds pretty similar to fatigue and you are right the definitions don't seem to deviate very much however The symptoms the signs may look a little bit different and it may be a little bit more intense than usual For most people similar to autistic burnout if you haven't watched the previous video where I covered Autistic burnout the different stages of said burnout and how it impacts people and how to get around it I highly recommend checking out that video But it's similar to burnout, but it's more characterized as the acute version the short-term version Autistic fatigue is something that you might experience for maybe like two three Four days or like a week or something After going really hard at something productivity wise or being exposed to lots of different Sensory social things over a very short time period, but it's less so talking about this idea of autistic burnout which to these long long long spans of time where you're functioning Your mental health Pretty much everything is impaired. This is talking about this little slice of time. It's best characterized by the usual symptoms of fatigue plus overload and Sensory sensitivity it may perhaps look quite different depending on what we struggle with in general If I give this example for myself I do struggle with anxiety and depression meaning that I can have Very very low sort of severe sort of depressive periods now and again and the way that my depression manifests is Typically first in the things that I find the hardest in life due to being autistic and You know the rest kind of follows suit in a sense So like most people might have a more typical way of Their symptoms of expressing and the order at which they do as their functioning decreases Whereas for me the manifestations of me being in a low mental health state tend to look a little bit different because I'm autistic But now that we have sort of a base idea of what exactly autistic fatigue is I know it's not pretty fleshed out at the moment, but we shall get into it with the next slide Which is nothing to do with autistic burnout and just to do a general fatigue Let's talk about some of the possible contributors to general fatigue because Autistic people are humans and humans also experience fatigue. So it's important to factor in General causes of fatigue into this idea of autistic fatigue number one general illness pain specific infections Of course if you're sick, it's gonna have all sorts of systemic effects on you Perhaps decrease your energy levels increase the amount of pain and distraction that you have from from being sick Insomnia, you know sleep is very important to the overall Functioning of a human being if you don't have enough sleep we tend to be a little bit less productive more distracted have high levels of anxiety All those kind of nasty things and if you're not getting hardly any sleep It can really start to impact you long term or short term unhealthy diet and lifestyle now This is a bit of a broad stroke and I have been a part of difference of eating disorder recovery communities and So Seen sort of like body positivity stuff So I understand that you can't necessarily just put the unhealthy label on something without really understanding why But generally if you're not getting sort of a wide diet of a wide variety of diets, and you're typically going for quite calorie dense foods Sugar dense foods, you know white flour all that kind of stuff as well as not really incorporating much Even neat so non-exercise what is neat stand for I know what it is Remember I remember I think it's non-activity associated thermogenesis which basically means like the calories that you burn Sort of like walking somewhere, you know I also have you use of basal metabolic rate Which is just the amount of energy that you require in a day to Function is a human being not necessarily doing anything not so we're walking anywhere Just kind of sat in bed chilling, but along with neat things like walking things like commuting all that kind of stuff There's also like fitness like doing some cardio doing some weights things like that Generally what I find is that if I go for a long period of time eating rubbish and Not going to the gym my energy levels start to plummet Once I get back into the gym. I actually feel even more depleted for like the first week or so, but afterwards it kind of steadily increases my energy levels and All sorts of other lovely lovely things things related to hormonal changes You know if you are if you have a menstrual cycle That could that could be a contributor There are also other other things related to different conditions that people can have Also just natural sort of hormone fluctuations, you know even looking at like guys like testosterone is quite a big Sort of hormone in the male body when you have very very high levels of stress you have a lot of quarters all kind of hanging around in your body and that can sometimes inhibit and Sort of like the the healthy normal your body's healthy normal production of testosterone Pharmaceuticals and substances so obviously if you are on Medications which do sedate you to a certain degree or sort of regulate or anything like anything like that That could be a thing but also even going the other way and you know things like stimulants They could have an impact on feeling fatigue at the end of the day because once they wear off Your body's kind of been working over time your brain's been working over time with all this sort of Excitements and with you need nervous system and so when it comes to the evening you may get even greater Feelings of fatigue it could be stuff related to physical exhaustion. So just hard labor You know perhaps going too hard at the gym emotional exhaustion perhaps interpersonal with friends relationships family As well as mental exhaustion. So if you are spending a lot of time either thinking or trying to solve something or working Those can all be big contributors mental health issues and loneliness are also like Some things that aren't generally like associated with fatigue. I think mental health is because obviously fatigue is quite a common such Symptom of difference on mental health conditions like depression sometimes related to anxiety and also loneliness because they can also be some Quite widespread impacts of not reaching your like needed sort of social interaction with any said like period of time It is quite important Loneliness can can contribute to a lot of negative things in someone's life It's not probably the best thing to say. This is like someone who is Chronically lonely like I was when I was at uni understanding that oh, okay, so I'm not only lonely But now I am affecting my health and longevity and levels of fatigue by Being lonely great. Thanks, Tom Great information that I'm sorry Sorry Executive function let us talk about this because this is a pretty important concept when we talk about fatigue this executive dysfunction is presence in quite a lot of autistic and ADHD is But it can occur with other conditions Particularly depression is like a big one for autistic people. This can be quite a big contributor due to the high energy demand of smaller life tasks So if you have a purpose if you have a job, this would not be considered as that But it's the little things that you have to do for our life whether it be sorting out your like taxes or doing your bills or Cleaning or putting the washing in or making food all of those little sort of life skills that that really do add up and kind of Make your your task list look very chunky Those would be considered to be those sort of smaller life tasks and executive functioning at its basis is a difficulty managing day-to-day tasks and getting things done doesn't mean you can't do something like you don't have the capability or the Intelligence or the skills in order to do something. It's more about looking at it in the long term like are you managing to? Keep on top of the various things that you need to keep on top of as a as an adult human being If not, you might have some form of executive dysfunction, which is pretty common to a lot of autistic people You may even find that Whilst you do get these things done That they very much contribute to your overall levels of fatigue you find yourself constantly sort of Overworked you feel Depleted when you get home when you get home from work and just kind of grind through all the tasks that you need to do But you know, it really does over time start to impact your overall health your sanity or energy levels That could also be a reality executive function is Basically related to how our frontal lobe the frontal lobe in our brain Governs the rest of our brain and body the different processes for autistic people or People in general executive dysfunction could look like issues with planning task initiation time management attention control Metacognitive skills, which I will go on to in the next slide like planning working memory and flexibility It's not really something that I've seen a lot with autistic people But it can be related to perseverance on a certain task as well as self-control, but I tend to see that Being more akin to like the ADHD experience of things autistic people could of course Experienced difficulties with perseverance and self-control. It's just not something that I've heard about a lot From other autistic people. So what about this aspect of metacognition now? I am going into quite heavily into sort of the executive function side of things because it is a really really big difference between Autistic people and allistic people people who aren't autistic This is something that we can struggle with to a greater degree than the neurotypical population But going into this idea of metacognition just to give a little bit more background to this aspect of electricity functioning It's basically the act of thinking about thinking. So it's monitoring and adaptively Controlling cognitive processes within sort of the education kind of work spheres they have isolated some like metacognitive skills like reflection Evaluation planning monitoring personally, I don't feel that my Metacognitive skills are impeded Apart from when looking long-term and managing day-to-day tasks because within a Workplace within a passion within a project. I'm exceptional at this It's only when looking long-term managing lots of small little different things that are a part of my life So we've understood a little bit more about executive functioning and metacognition What are the actual? Contributors to fatigue from executive functioning. What what could these look like? For you if you are experiencing this autistic fatigue This could be difficulty with ordering and managing lots of small different tasks as I said these tasks these things that you have to do tend to be Stored rent-free in your head until you finish said task I know someone in my life who has OCD who has recently talked to me about Their experience of like what they're sort of obsessive thoughts kind of feel like and there is some crossover between autism and OCD For me, I experienced the same thing. It's kind of like Although I have something written down on a task list Perhaps I have like some bullet points of what I need to get done in in the day It's almost like I just can't help myself, but think about everything at once so I have to You know The more things that are on that list the more things that my brain constantly shifts through and recounts and it really gets in The way of me actually getting through them. It's like it kind of overloads my brain. It's It's difficult to just isolate myself into one task and then finish it and then move on to another one without constantly thinking about the other things that I need to get done Which is quite fatiguing over a long period of time when I'm trying to get these things done There can also be this idea of task multiplication, which I heard from another creator called neurodivergen Tea around task branching and they say this idea of task branching is let me think of a good example I've got one. Let's say that I needed to clean the living room. Okay? I have a good. I have a glass table in said living room So when I go to clean things, I might get to a point where I go to that glass table And there are lots of different things on the glass table Some of that stuff might be like books that I need to put away in another room And so I'm like, okay. Well, I might as well get this out of the way So I take the books and I need to get this off the table so I can clean it So I take the books and I go to the other room and I find out that my shelf is full And I'm like, okay. Well, I did say to myself before that I needed to kind of sit through and see which books I need to get rid of so I start looking through them and sort of analyzing like which books do I need Which connect to charity kind of store them somewhere else and so I do that And I like end up on Facebook marketplace saying like well I'm taking pictures of them in pictures that I'm like trying to sell them online and After after all that it's been about an hour and I still haven't cleaned the table. I still haven't cleaned the table This is a side here of task branching or task multiplication very interesting concept hadn't fought a bit that way until I heard it From neurodivergent, but it could be something that you might struggle with. There is also Time prediction quite big contributor, especially in my life This is predicting and assigning Time for certain tasks.  I'm gonna come around for 6 p.m We're gonna go to the gym gonna have steak and do all that stuff. He tells me that I'm like, okay, right? So I've got about 45 minutes. I'm like, oh, I can I can get done like the The template for like one of the videos that I'm gonna make in that time. I'm like, okay, cool Obviously cannot in 45 minutes very Much overestimated the speed at which I can do this and this happens in pretty much every single circumstance And even getting to the point where I okay So one asked me how long you're gonna be to get ready to go out to go to the gym and I'll say I'll be 10 minutes It's not 10 minutes. It's like 20 minutes. This is the ideal in my head I'm not assigning the right amount of time for this. I generally don't mean to do it on purpose It just tends to work out that way. It's my brain works at a very slow pace anyway So compared to most people things do take me longer than usual And I think that there is probably an aspect of me not wanting to say, okay I'm gonna be that long because it might annoy the other person but for the most of it, it's really just like a Overestimation of like how fast I can do things. There is also this idea of choice fatigue This is kind of the experience where there is a lot of different correct answers to a certain predicament to a certain problem That you could go with or a lot of different correct answers on options Of choices that you can make. There is no right answer.  Okay. This is wrong answer This is right answer a lot of it can be right and it really depends on your personal preference and some people with executive dysfunction difficulties can struggle making that decision into a point where you second guess yourself you kind of go over in your brain constantly and You think about what you want to do so much that you spend like a large amount of time thinking about it and stressing yourself up this happens quite a lot for me when I am Debating whether to go to the gym perhaps my work days a bit longer than usual, but I really want to go to the gym But I know that if I don't stick to the usual time that I go It can sometimes cause me quite a bit of stress So I have had a lot of situations where I'm kind of running through choices in my head about whether I'm going to the gym or not And that can happen for like a large amount of time like an hour or so and the longer that I'm thinking about it the more It's kind of pushing me towards one side been in a lot of cases if I was just say, okay, right I'm just gonna go to the gym. It would be all good, but That kind of brain process of weighing up options and considering lots of different angles It can take a long time and it can also drain you quite considerably But what are some of the other executive functioning contributors fatigue? Focusing on the details Something that we are very very good at what most people is are very very good at as autistic people This is this whole idea of perfectionism. This can Really really really eat into your energy supplies. The thing is perfectionism works Somewhat to like a certain degree in some areas of life like in, you know, perhaps if you're an artist like Attention to detail focusing on the details is quite a good thing. It doesn't really matter how fast you get it done Just that you you do it and you do it to a high standard, but in other cases not so much So if we go back to this example of the glass table that I was talking about the reason why I labeled it as being glass It's good glasses Sometimes very difficult to clean like to a standard that I like no matter how many times I go over something with a cloth There's always going to be little pieces of dust on the table there's always going to be like a little smudge from the the Cleaning products that I use on the table and I can spend a lot of time Trying to get rid of a certain smudge on the table Like a ridiculous amount of time to the point where it Impacts my ability to clean other areas of the living room Sometimes I can do it most the time I can but if my executive function is not doing so well my mental health is a bit low I can get really really hyper focused on trying to get that table perfect and It is exhausting even if I managed to sort of move on from it It kind of leaves a feeling of inadequacy in the back of my brain and I continue to think about it That can definitely be a contributor to fatigue And lastly I really want to talk about like a really Big factor that comes into fatigue related to executive function of course and that is energy accounting or spoon fairy Don't know if I've got a spoon on me. That would be pretty cool No spoon Only fork Cuz I had some fish and chips. I do have some toffee peak and roulard left in the fridge I could go get that Maybe later energy accounting or spoon free is basically an eye an idea that that some Autistic people some ADHDers have come up with Which basically visualizes how much energy you have during the day and assigns Different tasks with different spoons different people will have different amounts of spoons and different activities for each person We'll have different costs of spoons. So a Common way that this might occur is You are very very focused at work. You want to be extremely productive. You put a lot of energy. You don't give yourself many breaks During your actual working day to the point where you overreach your daily energy capabilities So much that when you get home you can't do other things you can't Do those sort of small tasks that you need to do the small life tasks that you need to do perhaps you don't even Do things that you enjoy do other hobbies because you are just so tired You're so expended or even if you want to it might take you such a long time to transition Into actually doing that thing that it just kind of screws with your entire day The issue with this as well is is that if you expend yourself so much in like one portion of your day If something unexpected happens interpersonally or in your life In in from any any angle you won't necessarily have the energy in order to to do said thing to fix said thing to actually confront and solve This this kind of new change this new task that has sprung up Which is an issue so it can leave you lead you into a lot of deep water if there's something that comes up That's that you kind of need to fix right now And it's really immediate and it's really urgent you can get into a lot of situations where you might have like a meltdown Or like a panic attack or you're extremely overwhelmed because you just don't have the mental energy Emotional energy the physical energy in order to do that thing because all of your spoons Are being spent at work another aspect of this this idea of expending your spoons is that you may not Be totally aware of the signs of fatigue or all the signs of stress that come To you during your time at work This is exact exacerbated quite heavily by our tendency to hyper-focus on things This idea of autistic inertia where it's hard to get into things But once we're in it train sort of speeds up And it's very hard to stop the train the tasks that we that we engage in the things that we do We don't necessarily always take breaks for them We may get so focused we may get so focused on said task that we ignore our hydration needs our needs for food our need to take breaks to relax to do all sorts of things and We can get to a point where the only thing that really stops us from Focusing so much on this thing is that our anxiety have got such a high level You know, they've surpassed this Autistic inertia this hyper focus and broke into your Conscious mind because the levels of fatigue and anxiety that you're experiencing are just way too much and that that can be an issue Because you pretty much just stopping when you when you're at your max capacity when you're exhausted and not when Would be ideal so that you have energy for the rest of your day Alexa fire mea can also be a fairly fairly big contributor to this Is the idea of not kind of clocking the signs of anxiety and stress and fatigue Then most people would be able to take note of when you relax if I make you tend to have a bit of a higher threshold for noticing Emotions most people might be able to clock when they're about 20-30% anxious maybe take a break go and get some water have some food take a rest Whereas for us it might go up to like 60 70 80 Not even 90% before we actually notice that we're stressed out from what we're doing and that can be an issue Definitely like I've had a lot of situations like that where it is worked and worked and worked and worked and worked and Burnt myself out had a meltdown got overloaded It's not a fun time So we've talked a little bit about the contributors to fatigue from executive function that may look a little bit different For us as autistic people. What about sensory burden something that's a little bit different to Executive function the reason why I turn this century burden is because for a lot of us We can be quite hypersensitive to different things in life that perhaps other individuals Concote with quite well that don't necessarily have as much of an emotional Energy impact on them as it is for us sensory burden can occur in lots of different areas of our life Typically, it's busy sort of public places You know where you might go out to a certain social event talk some friends There might be a lot of noises lights music in the background a lot of people a lot of different sensory things But also at work also different aspects at work uncontrollable Sounds perhaps quite bright overhead lighting all those kind of things can sort of roll up into one and contribute to our sensory burden even to a point where if we go home and Our environment isn't crafted for our sensory system It can also contribute to our sensory burden sensory overload can indeed Have impacts on your energy levels your overall anxiety levels your mental health Your ability to cope with things in the long term if you don't adjust for them one of the reasons for this is if you Lack these kind of sensory adjustments at home in public at work You will be constantly bombarded with this input Which is very over stimulating to your brain and can distract you and can cause all sorts of different Emotional reactions if exposed to enough of it for a certain period of time when I say sensory adjustments I mean little things like changing the hue of your lights putting a dimmer switch on things Switching out electrical appliances that are buzzing. It could be things such as changing the materials That you use for your bedding or for your flaws It could even be having a cluttered space like around you like a visual clutter These could these things can all contribute to like your sensory burden It can also be not using sensory supports and sensory adjustments a little bit different sensory supports You could also call them sensory aids These would be things like sunglasses headphones could be things like soft clothing Stim items earbuds, you know anything that mitigates Environmental stimulation on you, so it's not necessarily changing things at the source, but it's mitigating the impact on you If you don't have the ability to do this at work It's gonna be a problem like if you have those bright overhead lights But you don't have any adjustments that allow you to go somewhere that's not as bright or noisy or sort of open-plan Officy if it's a bit loud at the place that you're socializing out with your friends and you don't move or you don't have Any headphones or earphones to mitigate like the background noise that that can also impact your sensory burden And obviously like if you are engaging in a lot of these social activities these extroverted activities going out to noisy venues being in groups of people walking through the markets and like Sifting through like busy crowds All of this stuff can can very much like imparts your sensory burden and impact the amount of energy that you have over-stimulating you causing all sorts of anxiety and Generally contributing more to fatigue 2000 years later moving on to this idea of social burden You may have realized that I have somewhat changed my attire And this is because when I came to record the first segment of this video I was hit by quite a large wave of Fatigue I noticed that my brain was particularly Increasing in its levels of anxiety and I also felt like The functionality of my brain was not working very well, too So instead of plowing on like I usually do and going for it. I decided to take a little bit Little bit more of a personal look into why I'm doing this video and decided against doing so So here we are a couple of days later ready for the next part of this video Let us talk about this idea of the social battery the social battery is something that everybody has and everybody's capacity everybody's Sort of max charge of this social battery varies from person to person someone who is extroverted Perhaps might have a very very Large capacity for social interaction Whereas someone who might be considered to be a bit more introverted Might be considered to have quite a low Social battery in comparison for autistic people we can often have a much lower social battery than our neurotypical peers I think everyone out there can empathize with the idea of finishing a day of work Which was particularly social heavy and then going to perhaps a social event or a work party or something That's added on to the end of the day with even more socializing having to spend at least like a day or something on your weekend Just to sit be by yourself. Do your own thing reaching this capacity Also does have the potential of eating into your energy supplies of exhausting you in some way Which definitely is a contributor towards fatigue for autistic people it may happen a lot more just because some of the social relationship some of the Social commitments of work the individuals there perhaps might have a bit larger of a social battery And so be a little bit more needy of having more social interaction with you meaning that quite often you might find yourself Typically sort of exhausted in terms of your social battery because of the people that are around you And it's not necessarily saying, okay, these people are eating into your time because quite often we can somewhat I don't know but for myself You know, I'm definitely not opposed and I quite like it when people want to spend time with me communicate with me It's just sometimes I forget to self-advocate for my own space and time over time I have implemented such things as taking like social breaks During those very extroverted activities and also asserting some space from the people around me to make sure that I can Regulate and be by myself So my social battery can recharge as I said work can obviously have variables social and Sensory burdens depending on your workplace and your job Perhaps if you're in a workplace, which there is a lot of extroverted social people who they always want to do things They want to go out on the lunch break for the dinner and sort of go to a restaurant with you or go to for a cafe to get a Coffee you might just be surrounded by a lot of people who like to socialize a lot during work and that can be quite draining but likewise if you have a job, which is very customer focus very Social heavy something like sales something like customer service then you will be I'll be exposed very minorly to social interactions But those social interactions will be so consistent throughout the day that they will definitely make some Dents in your social battery. The last aspect of social burden is really really big one complex social problems, and I don't mean just like The complexity of having a social communication with somebody having a conversation difficult situations Which are very nuanced and perhaps quite emotional such things as Confrontation and interpersonal stressors so confrontation. It could be some difficulty at work with another colleague some difficulty In life with with some some person who has either an issue with you or you have an issue with them and their behavior the interpersonal stressors are definitely quite a big one and that could be sort of related to the Confrontation element But sometimes this might just be a very nuanced emotional topic that you have to kind of wrap your head around as human beings sometimes emotions can be very very complex and there can be situations where We perhaps don't feel like the people around us are making much effort with us Or they don't feel like we're making much effort with them and you have to sort of communicate and reach in agreements on How you can best move forward in that situation These are just examples of course, but when you have to think a lot about social interaction and it takes up a lot of your time to try and Communicates and understand and it empathize that can definitely eat into your social burden, too Let's move on to something perhaps a little bit more nuanced and perhaps a little bit more related to the experience of autistic fatigue as opposed to regular old fatigue Masking and neurotypical expectations Let's talk a little bit about neurotypical expectations first this can be in a lot of highly massed sort of late diagnosed individuals or even anyone to be honest attributing your or attributing personality flaws to difficulties you have Which are different to allistic individuals people who aren't autistic a great example of this is Perhaps you are at an event. You're feeling quite overwhelmed you feel like it's Important for you to network to even make friends or to find some people to do business with or Whatever a lot of the people around you are able to do this pretty well It doesn't really have a well-known. They don't have to take breaks, etc. Etc You find yourself in a very overwhelmed situation and you Sort of tell yourself that it's a bad thing that You're lazy that you're not extroverted or social enough that you're not Any any number of personality traits whereas in reality you are just a different person with a different brain These neurotypical expectations can go a bit further. They can reach into Different aspects of your life. You have this concept called hustle culture Which I think impacts us all to some degree and this is Generally content surrounding sort of productivity. I did watch a very interesting video Recently which went into the impact of like this whole culture around work I think like a Significant sort of majority portion of individuals put productivity high on their list of importance Which is crazy and these are things surpassing, you know things like social interaction And love and family and things like that Productivity seem to be placed very very high on people's sort of hierarchy of needs when you're autistic And you're consuming a piece of content perhaps someone saying What you should achieve at a certain point in your life? What are the things that adults should do perhaps coming in from? Family or friends of making judgments about where you are in life all of that stuff I think for most people it could it could apply But for us our life path tends to deviate quite a bit We tend to have things which we are very very good at and we progress very very fast in and other things which we can struggle with and A lot of the things that we can struggle with Do in my experience tend to be things related to like life progression to life skills to sort of getting your life organized and and Sort of staged and progressed in a certain way some people do this very well Particularly sort of high-masking individuals that I've met But quite often these are not things that we particularly want they're not particularly things that we Find valuable that help us, you know, you could take the example of perhaps getting a car It's kind of like Expected by a lot of parents and perhaps a lot of society that in order to be an adult then you must have a car Whereas you might just find that in your specific Circumstance that you just don't need one like people might say well you can go out and go on you know group trips with people And it's like well if everybody has a car then Where's the issue that and then if you want to go out somewhere close to you you can commute on a bike You can walk you can get a bus if you need to go somewhere further you can get a train generally like It's a it's a it's a good thing and it's a valuable sort of asset to you, but it's not necessarily like So life-changing that affects every single area of your life in a negative way There's definitely other ways of doing it You might find the the whole act of driving the costs of driving and upkeep and all of that to be way too much considering like What you actually need from life how you need to get around in life I think it's important when we are consuming content from other people or We see that people are judging us for different aspects of our life or People give us advice about Different stages that we should should meet in life at a certain age that we temper it a little bit a lot of this Content tends to be geared towards the mainstream crowd Meaning that they don't really consider the fact that you're disabled They don't consider the fact that you're autistic that you have different needs. They have different struggles and All sorts of different things like that making sure that you don't take it as like or you're being lazy is Quite an important thing. It's like It's not necessarily that you have a personality trait that makes you lazy It just means that when it comes to certain areas of life that you just struggle a bit more and you need Perhaps a little bit more support, but that's not really something that people Use as sort of like a caveat to this type of content because it's to a mainstream audience Trying to meet these expectations that people put on us can be extremely extremely exhausting Because we quite often Overreach and try to meet these expectations to our detriment, you know, perhaps it eats into our energy supplies To a very ridiculous degree even though it's not something that we Internally feel like would be good for us Perhaps we have a role model that we see in the media or a content creator who are like I we want to I want to be like this and You kind of constantly shaming yourself for not meeting the expectations that this person is kind of Presenting and in just the way that they live their life tempering your expectations and creating your own expectations Goal path the way that you want to progress is definitely the best way of going about this and that includes talk a conversation with other people or conversation yourself about what you need and what you're good at and trying to craft a path which is ideal for you without exhausting you to To try and meet these expectations that other people are putting on to you There is also a very key component of masking and I won't go into what masking is too much I did do a video which you can check out at the end of this It's in my autism University Playlist if you want to go check out what musky is But it's basically an aspect of social camouflage and social camouflage is the act of hiding The fact that you're different. So as an autistic person, you try to Hide your autistic traits you try to seem like you're not autistic and now there are there are some very clear positives in terms of like Avoiding negative circumstances, perhaps doing a bit well in those very heavy social-based jobs But it just come with a hefty amount of negative Effects, especially in the long term particularly around energy, but also self-identity The reason why the energy aspects can be quite significant is that quite often you don't Self-advocate for your needs for yourself because you're trying to hide your needs because your needs are different your needs are Typically not the needs of other people So you don't tend to self-advocate as much as you should do in order to sort of protect your own energy supplies You know good example Friends invited you to their birthday, you know, you really want to go to that birthday But for the for the entire week, you're at like a couple of work events and you know that you're gonna be Extremely exhausted perhaps if you were on mast and you weren't masking you might say hey look I've had a lot of social things having to this week like I'm autistic I struggle with the constant social demands I Don't really feel able to come or at least I don't feel able to come for a long time Maybe like an hour or something just say hi or before the party You might not do that if you're masking because you don't want people to Identify that you're different and then you have these needs There is also the aspect of when you are actually socializing with people socializing can be quite exhausting in itself You know when we're talking about social battery but it's also sort of increasingly more exhausting when you're masking because the aspects of masking of monitoring yourself monitoring others Changing your outward appearance making sure that you sort of compensate in lots of different areas and sort of assimilate in other areas That can be somewhat multiplicative like it increases the overall energy map energy demand of that social interaction for me One of the biggest benefits of me on masking is that I can socialize more my social battery is a lot better because I'm not constantly trying to Shift the way that I speak or where that I appear and express and behave In order to fit these sort of neurotypical kind of Allistic expectations on how you should converse with another human being the self-identity issues can also be a really really big thing As I said when I was talking about self advocacy quite often a lot of autistic people who go through long periods of their time on this earth masking find that they feel almost very fake and They don't really have a grasp on who they are. They look in the mirror They look in the mirror. They don't really see themselves reflected back It's kind of an almost dissociating sort of existential experience That is something, you know that can obviously like impact your emotional state Maybe not so much when it comes to like overall fatigue but I think in the long term it can can definitely cause some Significant sort of mental health issues if that is so consistent you never drop in the mask You're masking around Everyone in your life that you love and care about even if it's at work You're masking if you're at home.  You're masking significant of you're masking It's so exhausting and it's it's really something but I highly recommend trying to take a look at and seeing in what Areas you can unmask a big aspect of masking which is a little bit more noticeable to most people is this idea of like stim suppression An autistic stimming. It's kind of these repetitive movements that we do Or repetitive sort of vocalizations or noises that we do in order to self-regulate I have done a post recently on autistic stimming sort of the different categories that people can have You have ones that most people do like tap their leg and bite their nails These are things that like everybody does not just autistic people, but we also have ones which are stereotypically a bit more Seen as like an autistic stimming We call these big stems, you know the ones that everybody does the kind of these little stems But if you're stopping yourself from having these little stems doing these big stems Throughout the day you are very very You're not you're not meeting your sensory needs. The reason why we have these is to self-regulate And quite often we can find Emotional regulation to be quite difficult as autistic people. So removing this very key aspect in regulating ourselves Throughout the day is definitely going to impact the amount of fatigue that we feel We don't really have the opportunity to sort of allow these emotions to regulate ourselves And so the fatigue kind of keeps building if you don't stare my highly recommends looking at like sensory profiles Checking out different things that other people do trying different things I've got a lot of resources around sort of sensory systems and stimming I highly recommend you check those out because once you get some really solid stems that really help you out You will see a pretty marked difference in your ability to sort of Regulate and sort of cope on a daily basis. So we've covered all of the Particular factors that I wanted to cover sort of the different categories. I suppose There is also some general factors that I do want to point to one which is lack of routine now as autistic people OCD individuals also also really benefit and desire this we really Feel better when we have a consistent reading We have an idea of what the day is going to pan out like it doesn't necessarily have to be like a weekly schedule Monopoly schedule but knowing what we're doing and when and what time generally helps us stay a lot more Regulated I find for myself when I don't have a routine that my anxiety tends to peak quite a bit I usually find myself moving out of the routine because I get bored and I want some kind of novel experience And I want to do things differently and I don't want to be sort of caged in by myself on what I can do in life But not having a routine is Definitely very sort of detrimental to my overall energy because it's like I'm always thinking about what I need to do next and I'm always Uncertain about what's going to happen and at what time I'm doing what son over time although it's a very minor sort of feeling It can definitely add up one tip that I highly recommend if you are like me and you like trying new things and novel things But you also find this routine to be quite Regulating and sort of safe block up some time Routinely schedule some time in your day or in your week or in your month to not have any reading Sounds a bit strange Does work quite well actually That's one of my big tips there There's also these large routine changes and these are very very big contributors to meltdowns Personally, I don't struggle too much with routine changes To a certain extent so usually I can handle One sort of small routine change or two sort of small routine changes It's only when a feeling of uncertainty comes Into into my body in my brain That I tend to become a bit dysregulated tend to have more of a Likelihood of having a meltdown or a shutdown or feeling overwhelmed or feeling petite and that's when Things change back and forth constantly and I kind of have in my head that I'm going to do something Someone gives me you know says or can we change this? I'm like, oh sure and then someone's like, oh, can we just change this again? I'm sorry. Okay, sure. Well then again. I'm like Is it what are we gonna change? I don't have a Certain idea. It's like everything's just changing. I don't feel safe. I don't feel like anything's certain It's very anxiety-provoking for me. I think there is definitely like a myth I think for a lot of Autistic adults that that we can't cope with any routine changes But especially when they're very very consistent or they're very large routine changes Like we're changing a massive part of our sort of daily routine or a weekly routine that can definitely be a factor towards Disregulating is a lot more and causing a lot more fatigue sort of during that time as well the next factor is Multiple and time-bound transitions. What do I mean? Transitions are basically the times between things that you're doing. So if a routine was the actual things that you're doing and what time The transitions are the spaces in between the things that you're doing autistic people tend to struggle When it comes to transitioning mostly because we have a very monotropic brain meaning that we can spend a lot of time sort of Getting into a certain task so much so that we kind of build up this this sense of autistic inertia where our sort of train Starts very slow. It's quite hard to get into it. But once we are into it, it's very difficult to stop and For most people people can transition quite quickly from one thing to another or in a very sort of short period of time But for us trying to make ourselves transition too quickly Can definitely spike our levels of anxiety and overwhelm and if there were a lot of those these situations Throughout the day and the very very short transitions We don't give ourselves a lot of time to Stop what we're doing kind of wind down and then start something else It can have a lot of sort of detriment detrimental impacts on like our overall Mental health our overall fatigue even it's very very exhausting. It's one of the worst things about Life for me. So on the on a daily basis It's going from like working to going to the gym to coming back from the gym and eating and then Doing my hygiene stuff then going to bed or doing a bit more work and then Stopping work and then going to bed is those transitions the more that these transitions add up in my brain and the shorter You know, the more time bound these transitions are the more difficult I can find it to sort of Keep my energy levels high and also keep my anxiety levels low. The last thing is definitely Something a little perhaps a bit related but not directly related fatigue in some ways this is that this idea of interception and a lot of autistic people can struggle with interception meaning that we find it quite hard to notice or Be aware of our levels of hunger our levels of thirst our Need to sort of do any sort of bodily need it can even be our sense of temperature in some cases It's very different or autistic person to autistic person just because of our differences and the variation in our sensory profiles but if you struggle to keep yourself hydrated on a regular basis and Keep food coming into you.  This is why I have things like this I Sometimes when I'm in the midst of autistic inertia, and I'm sort of Not wanting to transition from one thing to another. I find finding it really hard. I can sometimes Not go down and get myself a drink or not be aware that I need to drink So if I have something like a four liter bottle of juice or four liter bottle of water It makes that a lot easier in the long term There can be lots of little different hacks like that that you can do if perhaps if you struggle to get get some Food into you you might want to consider In the morning when you sort of get up and you get some food To bring some extra snacks with you not necessary to eat on the spot But just to keep next to you just in case you feel the need to eat or you remember to eat And you haven't eaten for a long time. There's little things that you can do and it's obviously going to be very individual Person to person, but it's definitely something to pay attention to When it comes to like your fatigue during the day if you're finding yourself at the end of the day Having like a hurt the stomach that hurts or having like a headache Even though you've not really done anything Like particularly sort of headache inducing it may be that you're quite Dehydrated that you perhaps need to eat a bit more to keep your energy levels up possibly It's happened to me quite a lot of times still continues to happen to me if I don't keep on top of it Could be a very significant factor in that so what about dealing with fatigue The thing is because of the individual variation There is no real sort of right answer to how you can deal with the fatigue There are some things that I would suggest and that could be things like interrogating some stimming understanding your sensory profile Taking social and sensory breaks when you're at work or when you're at a social event establishing a routine of course and making sure to Adjust your transition window so they're not too quick and they're not you know Perhaps try to minimize the amount of transitions that you have during the day by sort of trunking your work Up into little sections rather than sort of covering like three things at once in a day That's been quite helpful for me Of course if you are struggling with mental illness and you find that this fatigue is very long-standing there is definitely like an Importance there of going to see a psychologist or going to see a doctor Especially if you're struggling with things like depression and anxiety any kind of mental illness That can come with fatigue It's definitely a good idea to check in with a professional and of course if you can ask for or you know consider getting some support for your executive functioning consider Finding new ways to sort of save your spoons for the end of the day to make sure that you can cope With sort of wild unpredictable things in your life. I'd highly recommend sort of using some of the slides to think about the things that you struggle with and try to Mitigate some of those triggers of fatigue or sort of support yourself in different ways Everyone's sources of fatigue and brains are very very different So isolate Understands and adjust for the sources of fatigue in your own life and over time like if you make these small changes like one by one You will eventually find that you like the frequency at which you have So these bouts of fatigue or the frequency at which you have Burnouts will tend to drop off quite significantly, but that's this is over time and There is obviously going to be some trial and error changing little things over another and you want to try and change Small things at once. You don't want to try and change lots of different things multiple different things because that's just gonna Throw your routine up really like it's just gonna it's gonna make life a little bit more uncertain than usual I mean very enough if you can handle that and that's good for you, but for me One or two things that tends to be like a good sort of manageable Amount of changes to make to my life So I hope you have enjoyed this video and if you have please make sure to like subscribe Consider becoming a member to get early access to videos badges all of that lovely stuff and Comment down below. What is your experience with fatigue? What are the things that have helped you? I would really like to know and if you are interested in watching some more content by me consider watching this video It's a good top rated No source of bias here watch the video


Okay. Can everyone hear me? Okay, everyone. Vermont Justice and our incarcerated folks and family, thank you for coming out to show support for an important right, timely and appropriate health care while serving time in the Vermont prison system. We are here because since the start of 2023, we have lost seven lives at Southern State Correctional Facility. Our last loss involved a man who reported that he could not breathe and is pleased for help were denied. This very same person, a detainee is or was considered in the eyes of the law innocent until proven guilty. Yet he received the death sentence, the death sentence. I would like to start with a story. When I was a young mom, I filled in as a registered nurse at the Windsor Work Farm to give the nurses who work their time off. The Windsor Work Farm was the Southeast Correctional Facility and was a very progressive form of incarceration. Our folks worked, they milked cows, grew vegetables to sell and they cooked. These daily jobs provided the incarcerated people of our state dignity while they did their time. I recall quite vividly or curmudgeonly over Monter who put his name on the list to be seen. Due to confidentiality, I shall refer to him as Samuel. His job was the floors. He would mop, wax, sweep, etc. He had two issues that needed addressing. His eyeglasses constantly fell down on his nose while he was doing his various floor duties. His second complaint was an inguinal hernia. So here was Sam mopping with his glasses hanging down, sweeping with his hernia popping out. I put him on the list to see the doctor who at the time came every Tuesday and Thursday to interview and examine our incarcerated folks at the work farm. Right away, Samuel got an appointment for an eye exam and new glasses and we referred him to a surgeon at Mount Asgardney Hospital to assess the inguinal hernia. Samuel got his new glasses and he had a simple hernia repair. A few months later when I arrived, Samuel was mopping the floor. He greeted me with a large smile and was proud to show me his new glasses. His care was prompt and appropriate. Samuel felt validated and was able to return to work as a contributing member to his incarcerated community. I had also heard through the prison grapevine that no one did the floors like Samuel. Let us compare and contrast this same story in the for-profit prison healthcare model we practiced today. Samuel would have had to put in a multitude of six slips about his eyes and bulging hernia. Eventually he'd get an eye exam and most likely he would have to put in six slips when the new glasses did not arrive in a timely manner. The hernia, however, would not be attended to. Samuel would have to put in six slip after six slip complaining of his hernia. He would not see a doctor. Eventually he may see a nurse practitioner or a physician's assistant and it may be telehealth. In the outside world a doctor listens to a patient's history of illness and then does a physical exam. This means a hands-on assessment. There is no substitute for a hands-on physical assessment for a diagnosis. That my friends is the art of medicine. In today's prison for profit healthcare system Samuel's new job would be putting in six slip after six slip daily. With enough six slips and I don't know the process for how many one needs to file grievance but it takes persistence and constant nagging similar to the squeaky wheel gets the grease. But eventually and not sure the process Samuel's inguinal hernia complain will get to the defender general's office. You may or may not be aware that the defender general's office is staffed with lawyers not doctors. The defender general's office has to then litigate Samuel's hernia with the for-profit healthcare company. For-profit prison healthcare companies have a lot of money to hire experts to say yep Samuel does not need to have his hernia repaired. This well-paid expert doctor who will not do a physical exam on Samuel instead he will use his fancy medical jargon to prove that Samuel does not in fact need a hernia repair. All the while Samuel is sitting in his cell hoping that at some point the for- profit medical care company will do what our state law says. This is 28 VSA 801 A the department shall not the department may the department shall provide healthcare for inmates in accordance with the prevailing medical standards. Since when does the prevailing medical standard include litigating for healthcare? Not only is this time consuming there are medical or surgical conditions that continue to deteriorate without timely care. In the case of Samuel being denied access to a specialist could result in a rupture of the bowel, peritonitis, a huge surgery, a colostomy and even loss of life. If this were to happen would the present for-profit healthcare staff recognize that Samuel's pink slip for abdominal pain was urgent and not his regular sick slip complaining of a hernia. Present for-profit healthcare has a skeletal crew of practitioners. I am not a practitioner I'm a registered nurse and LPN and an LNA are not practitioners. We do not do physical exams, write orders or prescribe meds. I would like to know how many practitioners are for-profit healthcare provider actually have. Are the current providers seeing and examining our incarcerated folks or are they getting a report over the phone and making medical decisions while skipping the very art of medicine a physical exam. Our incarcerated folks deserve boots on the ground in the case of Samuel our current system does not easily allow access to specialists. Money spent on a specialist would decrease corporate profit. Our incarcerated folks are easy targets. Their voices may be heard inside those walls but not validated through actions. Actions translate into decreased profit. Recently I saw the commissioner of the department corrections on the news stating how sick our inmate population is. Our demographics have changed. Allegedly 90% are taking five or more medications. To me that sounds exactly like victim blaming.  According to the source civic science 70% of Americans take at least one prescription medication a day. That is our nation's demographic and yes that demographic has changed as well. The amount of medications taken a day is not an excuse for poor medical care. Our incarcerated folks are receiving or not receiving. Rather I would ask the commissioner what can be done to oversee the new for-profit healthcare provider? Well path LLC. There should be weekly oversight. Is well path providing their own medical director and if so is that person drinking the Kool-Aid of their for-profit medical model? How many institutions is this medical director providing oversight for? Is this person located in Tennessee as well? These are important considerations if we want true healthcare for our incarcerated folks. I also read that we will be paying for this new for-profit provider $33 million and change a year. Will there be boots on the ground? Will we have MDs in house? Will we have any nurse practitioners or physicians assistants in house? Will our incarcerated folks still have to fill out multiple six steps until they get the prevailing medical standard of care as provided by Vermont law? I would urge the commissioner of the Department of Corrections to ask such questions. What will the staffing be?  I didn't see any jobs posted by well path LLC for our state. Is this new provider using the same skeletal vital core stuff sort of like the phrase same blank different day? I also urge our lawmakers to bring back in-state care. I would have to think with a $33 million budget for about 13 incarcerated folks. We could build our own. We have medical students at UVM and Dartmouth-Hitchcock. We have nursing students at Colby Sawyer UVM Vermont Technical College. We could offer them internships. Maybe some would stay on for loan forgiveness. We have doctors graduating from both hospitals. Perhaps we could offer some student loan payments as a perk. What about retired medical people that may be willing to pitch in handing over a $33 million check to a for-profit Tennessee based health care company without any oversight in our state? Just seems like a recipe for the same same old. Minimal health care for maximum profit. Off the backs of people who sit and wait to be cared for. These same people who dream of the day. They don't need to fill out multiple six flips for simple things and not so simple things. Waiting for the dairy to feel validated. Finally, Mr. Commissioner, there is an old adage. A stitch in time saves nine. It is time to make sure with oversight that our new health care for profit provider uses that stitch and another family doesn't have to lose their loved one because they didn't get that care. They didn't get that stitch. And to our governor, the legislature, the Department of Corrections Commissioner, the people of our state, the people we hold inside a locked facility, our group Vermont Justice Justice has our collective hands on the pulse of criminal legal reform. Time to clean house. Time to step up. Time to answer that call. We are at a tipping point. Together we are Vermont strong. Take the profit out of prison health care and prevent another death sentence. Thank you all. Next up, we're going to hear from Janet who has a personal story to share about the actual care her loved one has received in the prison health care system. To Vermont Justice Justice for asking me to speak today. And I thank you all for being here today. I have two things I want to talk about. One is adequate health care. My spouse fought MRSA infections for two years before the DOC's health care got a handle on it. Two years of six slips, grievances, scars, pain and illness. My loved one had to endure. He would let nursing staff know at the beginning of an infection, using infection and highly contagious to others before they would address it. Is this adequate health care? It was only after a provider came in and cut him open in shackles and cuffs in the correctional facility's medical office as he repeatedly asked her to stop because he could feel every cut, every push, squeeze and medical device she was shoving into him, creating a bloody horror show that disturbed nurses and correction staff alike that he started getting better care. His grievance for that event was never answered, addressed or apologized for. Is this adequate health care? I have an audio recording of his accounts of the event if anyone is interested in hearing it as well. This brings me to my next issue with health care, mental health. When we get into an argument at home and someone gets upset and cusses, do we drag our spouse or teenager to a locked room, take away everything from them, strip them naked, strip them of their dignity? Do we as a civilized people do this? The DOC does this. Are these the deescalating tools that were discussed on the news last week?  The DOC does this. I would think we would call 911 and take them to the hospital as a civilized society. I personally am not against correctional facilities. It was one of my most rewarding jobs I had in my life. There is a place for it. My problem is that there is no proper training in trauma-informed care or mental health for COs, which I know for an absolute fact and this supposed adequate health care is absolutely medieval. The medical staff is jaded and complacent. This is cause of deaths and long term trauma for our families. How will they come home to us? Dead or more mentally and emotionally traumatized than they were when they went to prison? What is the state of Vermont going to do about this? What is the nation going to do about this because it isn't just Vermont? It is happening all over the country. Demand prison reform. So prison death isn't the norm. Thank you. Good afternoon. My name is Tim Burgess. I'm a former inmate, a justice impacted person and the leader, the current leader of the Citizens United for the Rehabilitation of Irons. In 1927, Governor Weeks famously said Vermont will take care of its own. While that's been a philosophy that sticks with Vermonters today, it's a failed notion for our justice impacted people. Those incarcerated, those who sent away to private prisons, their families and their loved ones suffer the consequences. Specifically, those in our prisons who are elderly and those with substance abuse suffer from poor health care in the state of Vermont. It's become common place to hear that someone in our correctional system is sick, dying or has died because of either negligence or indifference. In 2022, we had nine citizens of Vermont die in custody. Already in 2023, seven people, seven Vermonters have died by incarceration. To paraphrase a famous moving line, Vermont, we have a problem. As of today's headcount for the Vermont Department of Corrections, Vermont has 1329 people in its care and custody. In state, there are 110 females, 100, I'm sorry, 1094 males, 420 detainees, and 25, 125 are held in out of state for profit prisons. Over 1300 miles away from where we stand today. Our legislature is prepared to spend another $8 million on an unnecessary prison while the health care and our current institutions is abysmal. Our state continues to use for-profit prisons, for-profit health care providers, while Vermonters die in public facilities. Vermonters are being denied adequate health care, health services, and are being denied family contacts and being treated indecently and inhumane. If we as a state continually allow Vermonters who are ill to get sicker because of crimes they committed, many of their worst moments in time, some under the influence of substances and with cognitive issues, we must remember all incarcerated lives matter. Some here today may have heard the quote from Dostoevsky. You can judge a society by how well it treats its prisoners. How is Vermont treating its prisoners? That's apparent. By continuing to separate families by sending them more than a thousand miles from home, we must do better. We can do better. And we demand better from the state. When a person commits a crime in Vermont, they're held to account for their crimes. When the state puts them in prison, the state must too account for their actions or lack of action for keeping them healthy. That's their job. As Leslie pointed out earlier, that's statutory. That's the law. In my time in corrections, my serious health issues were belittled, when unattended and when unheard and were never properly addressed. After speaking with people running the Vermont Department of Corrections, I'm told that they're working to address these issues. I can say now that they're that these issues are being brought into the daylight and in the beginning stages of how to address the problems are being examined. The state of Vermont needs to be transparent. And what is being done and how? In conclusion, thank you for all of you who gathered here today came out to address this issue with us. The family and loved ones of David Mitchell, Vermont Just Justice is with you. To the families of loved ones who have passed while incarcerated, we're with you. I have been in your shoes if you're incarcerated. I know the pain you're dealing with every day. How you're berated, how you're put in segregation for complaining about problems. You're not alone anymore. Vermonters are here to support you. Thank you for coming out today. Dude, my name is Will Hunter and many years ago I sat up in that building. There's a lot of talk in Vermont about looking out for the most vulnerable. We hear all politicians say, we got to look out for the most vulnerable. They don't really define who that is, but I think that it's safe to say that somebody on an oxygen tank in a prison who's had his liberty taken away is pretty far up on the list of the most vulnerable. And we didn't do a very good job taking care of David Mitchell. We didn't do a very good job of taking care of a lot of other people and the stories that I hear over and over and over again from people who have loved ones who have medical conditions is that they have to try and try and try to be the squeaky wheel to get the grease that they ought to be getting by statute, by right. In a decent caring society in a decent caring facility, you shouldn't have to advocate for yourself when you're in the most vulnerable position imaginable.  I've got a question for the people up in this building. If our population that's incarcerated is so sick and feeble, why do we have them in facilities that are designed to make sure Clint Eastwood can't escape from Alcatraz? Why don't we use our head and design a system that puts people in appropriate places? Now, there's another building that's within sight of here that has something to do with David Mitchell's death. And that's right over there, the Supreme Court building, because David Mitchell was being held as a pretrial detainee. He had a whole bunch of cases pending, some of them almost three years old. The backlog, and I know that everybody will hide behind COVID, the backlog in our court system is atrocious.  They're not getting better on their own. They're being locked up in a building that's run by a department that we used to call the Department of Corrections. I think they like to call themselves DOC and forget what the C stands for. One of the biggest things that DOC is concerned about right now is how to keep its employees happy. And that's a good thing for anybody to be concerned about. But it's become a central focus because their product is so bad, people don't want to work there. There are a lot of good people who work in the Department of Corrections. And if you talk to them over and over and over again, you hear how unhappy they are because their hands are tied. They can't function the way they think they ought to, to work on correcting the behavior of the people. This is often in the community when they're probation parole officers. We've gotten so fixated on charts and trends and talking about how we don't lock up as many people as somebody 10 years ago thought we might be locking up by now. But we're not focused on figuring out how to deal with the population we have locked up so that we can correct behavior and so that people can come out healthy productive members of society. We've only got 1300 inmates in Vermont. This is a small state with a small correction population and we can look at them as individuals. They don't have to be statistics. But while I'm mentioning statistics, think about 33 million dollars that we're going to be sending to private equity for 1300 people. $25,000 per inmate. The healthcare is costing and it's as atrocious as this. Something is really wrong here and it's that private equity firms got into this business because they knew there was going to be a guaranteed check coming from the government and the patients were going to be the most vulnerable who nobody pays attention to. That's why private equity wants to be in this business. But as Leslie said, we ought to be thinking about how we can recruit people in this state to be providing the healthcare. How we can make the product of our correctional system something that attracts people so people want to come be part of this thing that is transforming lives and improving things. The Department of Corrections needs to work on correction starting with itself. Thank you all for being here. Thank you for standing up for the most vulnerable and let's have our voices be heard. So I'm going to read the list of people who have died in the custody of the Department of Corrections since January 2022 and we will have a moment of silence and I have a sheet of paper that's wafting in the wind. David Mitchell, 46. Anthony Gallella, 85. Romeo Reum, the third, 53. Jeffrey Hall, 55. David Baglioli, 73. Kenneth Jackson, 60. Raymond Gadrow, 73. Matthew Castellini, 35. David Goldstein, 56. Ronald Roy, 71. Dan Griswold, 67. Charles Mold, 64. Thank you everybody for being here today. We have some information up here about remote justice. Also, we have some handouts from the Free Hair Organization who we have a representative of here today and please keep in touch with us, keep following us online on Facebook, looking at our blogs, sign up for our email blast and let's see if we can make some changes about this. Thank you.


So, hello everyone. I'm a Itamar Holder. I'm a senior software engineer working for AdHat, and I'm a Qvert developer. And today I'm going to talk about the journey through supporting VMs with dedicated CPUs on Kubernetes. And the reason that I put the journey word into the title is because this was a true journey for me. And during trying to solve this problem, I've stumbled upon many cool technologies and cool facts about them, how Kubernetes is implemented under the hood. And basically, this talk is going to be divided into two. The first part is introductions to many technologies, cool facts about them. The second part is the actual problem that I'm trying to solve. So, we're going to talk about CPU manager, Kubernetes resource allocation, C groups, dedicated CPUs, pod isolation, and many other interesting stuff. So, let's begin. So, first of all, an introduction to Qvert. So let's say that you need to run both containerized and VM workloads. And I'll talk about use cases in a second. So, on the right here, you have your Kubernetes stack, which is designed to run containers. But as you probably know, containers and VM are designed completely differently. And you can't just run VMs on plain Kubernetes. So, traditionally, you would have a different platform to run your VMs on. So, that's a huge disadvantage, because now you'd have to gain knowledge in two platforms, need to maintain them both, implement logging, monitoring between them, make them communicate with one another, which is a huge burden. And we would much prefer that we would have only one stack to run all of our workloads on. So, that's basically what Qvert is. It's an extension to Kubernetes that lets you run VM workloads alongside container workloads on Kubernetes in a cloud native way. And when I say a cloud native way, I basically mean that these VM objects behave just like any other Kubernetes objects. So, but what are the use cases to run VMs today? So, three main use cases. The first is legacy workload. So, let's say that you have a big business with many VM-based solutions, and you want to make a transition into making all your workloads containerized. This transition might take a lot of time. And for big companies that are making this transition, we want to support these legacy workloads and to run everything on the same platform. Another use case is VM-bound workloads, and what I mean by that is that some workloads need to emulate their own kernel or need to emulate their own hardware, so they simply don't fit to the containerized model. Another interesting use case, which is pretty new, is a project that's called Cap-K, which stands for cluster API provider Qvert, which basically lets you bring up VMs, Qvert VMs, install Kubernetes on top of them, and then you have Kubernetes inside Kubernetes. So, that's another cool use case. And I'm not going to dive into the architecture of Qvert too much, but the basic idea that you need to understand is that the trick is that we're running a VM inside a container. So, inside the container, we would have a hypervisor running the guest, and this is all wrapped inside a container. So, why do we care about VMs with dedicated CPUs? So, it's crucial for certain use cases like real-time VMs or VMs that depend on low latency. And the key point that we need to understand here is that we need to avoid context-switching the guest. So, if you depend on very low latency, you don't want your guest to be context-switched out, and then when something happens and you need to respond really, really fast, there's an overhead of context-switching the guest back, and we want to avoid that. And another thing is that it's widely supported by most regular hypervisors, and we want to bring it into Kubernetes as well. So, a question. Does anybody recognize this or know what this means? Okay, great. And how many of you actually know exactly how it's implemented behind the scenes? Right. Okay, so this is relevant. So, first of all, let's talk about what are containers. So, containers is basically an idea. It's an abstract concept, which can be implemented in many ways. And if you go to the kernel and ask it, like, do you know what containers are, it would say, I don't know, because from the kernel's perspective, there is no such thing as containers. There are building blocks, and if you're using those building blocks, you can implement a container with them. So, let's talk about these building blocks. The three main building blocks for containers are C-groups, S-Linux, and namespaces. And very briefly speaking, C-groups is responsible for resource allocations, S-Linux for security, and namespaces for isolation. So, let's dive into C-groups for a second. So, basically, C-groups lets you split the resources of the node between groups of processes. And the architecture is there's a tree of resources. So, in this example, you can see, for example, let's say that on our system, we have 100 CPUs. We can split them into children, and then, eventually, every process is attached to one C-group. So, for example, these group of processes would be limited to 10 CPUs. Another thing to know is that in C-groups, there are subsystems. So, for example, this is the CPU subsystem. We also have subsystems for memory, IO, huge tables, and a bunch of others. And in the Kubernetes model, each container, sorry, gets one C-group. So, just a word about C-groups V1 and V2. So, C-group V2 is the new version. It was introduced in March 14th, which is marked just because it happens to be my birthday, but never mind. There is no backward compatibility whatsoever to V1. And the basic idea is that V1 was too generic. It didn't restrict you at all, and therefore, it was really error-prone. It was very easy to misconfigure it, and therefore, they're very hard to debug it if you do so. So, the idea in V2 is that you have much more restrictions. It's less generic, but it would be less error-prone. Another thing is that we have a unified hierarchy. So, you remember when I talked about the subsystems? In V1, basically, there is a different hierarchy for every subsystem. And that also might cause a lot of trouble, because the different subsystems are not aware of each other. In V2, we have a unified hierarchy, and in every C-group, we define all of the different subsystems. Therefore, they're more aware of each other, and, again, less error-prone. Currently, both versions are supported, and V2 was GA in Kubernetes 125, so it's still relatively new. Let's talk specifically about the threads model in V2. So, in V1, we have no restrictions whatsoever on threads. You can do whatever you want with them. And it was pretty nasty, and nasty is not my word. It's from the actual official kernel documentation. That's what they said. So, basically, I want to talk about two limitations when it comes to threads. So, first of all, threads must live under the process subtree. We can just take two threads of a process and split them between different groups. They have to be under the process subtree. Another thing is that, if your C-group is threaded, then you can use only threaded subsystems, which means, basically, that you cannot use a lot of the subsystems, which is a huge limitation. Okay. So, in Kubernetes, all of the values are always absolute. So, for example, when you're defining a container, you would define it with 100 mCPUs, which equals to 0.1 CPUs, 1.3, whatever, but these are all absolute values. In C-groups, we have relative shares that call CPU shares. And, basically, as opposite to Kubernetes, they're entirely relative. So, let's say that we have only two containers or two processes running on a node, one with one CPU share and one with two CPU shares. So, the one with two CPU shares is going to have twice a CPU time. It doesn't matter how many CPUs we have in our system. That's completely relative. So, how does Kubernetes convert between the absolute values and the relative CPU shares? So, we can say that one CPU is 1,024 shares, just because it's the default. So, if someone needs 200 mCPUs, which is basically one-fifth of a CPU, all we need to do is divide 1,24 by 5, and then we get approximately 205 shares. But, remember that shares are still relative. So, there's a nice side effect here, because, for example, if all of our pods request only 50% of the CPU on the system, the other 50% is going to be split relatively to the container's request. So, basically, request is the minimum amount that's allocated. Let's talk about Kubernetes QoS for a second. So, we have three quality-of-service levels in Kubernetes. The first one is best effort, which basically means that you don't provide any request or limits, not for CPU and not for memory. If we'll talk about the guaranteed QoS, it's kind of completely the opposite. You specify both requests and limits, both to memory and CPU, and they have to be equal to one another. And anything that's not best effort or guaranteed is burstable. So, burstable is that you can specify only requests, only limits, you can specify them both, but they're not equal every other case. And, basically, the idea here is that there's a trade between predictability and stability.  And, of course, you have to keep your promises. So, for example, if you limit yourself to a certain amount of memory and you cross that limit, the container is going to die. So, yeah. So, let's talk about dedicated CPUs in Kubernetes. So, we have CPU manager, which basically is responsible for allocating dedicated CPUs in Kubernetes, and there are two requirements for that. So, the pod has to be of guaranteed QoS, and the CPU request, which equals the limit, has to be an integer. So, another fact is that not all the containers in the pod need to be allocated with dedicated CPUs, but the whole pod as a whole still needs to be guaranteed. Okay. So, let's now talk about namespaces for a second. So, namespaces is a part that's responsible for isolating different group of processes from one another. So, for example, we have the PAD namespace, we have a mount namespace, a group namespace, a lot of that. So, for example, if you're from within a container, if you execute a command like ps to see all the processes, you're going to see only the processes within your namespace. And a cool fact that I didn't know before I dove into that is that we can actually share the PAD namespace between the different containers. That's supported by Kubernetes. And that's pretty cool because we can have processes communicating with one another from different containers. And as a side effect, the file system are also shared if you use that. The trick is going into a slash proc slash PAD slash root, and then you get to the root file system of a process that lives in another container, which is pretty cool and sometimes useful. Now a word about KVM. So, basically, there are two kinds of hypervisors. Type one, which is also called a bare metal hypervisor and a type two hypervisor. So, with a bare metal hypervisor, we basically install the hypervisor straight on the bare metal. And with type two hypervisors, we install an OS on top of the bare metal and then the hypervisor on top of the OS. Now, type one hypervisors are much, much faster. And KVM is great because it's a kernel model that basically turns Linux into a type one hypervisor. So, with Kubert and KVM, we can reach near to native performance. And another thing is that KVM is basically responsible for CPU virtualization, which is the performance part. For other stuff, it uses, we're using QEMU. So, for example, for stuff like IO and similar. And in the KVM model, each CPU from the guest perspective is implemented as a kernel thread. So, for example, if you're creating a VM with four CPUs, then from the kernel's perspective, these are four VCPUs guest threads that basically run your guest workload. So, going back to Kubert. To talk a little bit more about the architectures, when I said that we run a VM inside a container, so basically we have the virtual launcher pod, which actually runs the guest. And inside, we have different containers, but the main container is called the compute container. Now, let's talk about the attempts to support dedicated CPUs. So, first attempt was pretty simple. We can simply allocate dedicated CPUs to that container. It's possible with CPU manager as we talked before. We need it to be guaranteed. We need the requests and limits that are equal to be an integer. And that's it. We're done, right? So, not really. So, let's dive into that a bit. So, inside the compute container, we basically have three levels. The first level is the Kubert management layers. Basically, these are processes, the Kubert processes that basically start all of the other processes, monitors them, and also access a bridge to Kubernetes. So, for example, in terms of Kubernetes logs and stuff like that, and also communication to other components that we have. So, this is the first layer. Another layer is the virtualization management layer, which is basically consists of libvert, which means libvertD, vrtlogD, etc. And the third layer is the emulation layer, which means basically QEMU, the vCPUs, which is basically the guest itself. So, these are some of our processes and all of the threads. Now, you don't have to understand everything that's going on here. What's important is that here are the vCPU threads that I was mentioning before. We have two CPUs here. They're just regular threads, as I said. But the problem here, as you remember in one of the first slides, I was saying that the key point is avoiding preemption, avoiding context switches. And here we have tons of threads. So, we basically took a container, allocated it with dedicated CPUs, and now all of these different threads are running on these CPUs. So, what happens is that we would have to preempt or context switch the vCPU threads in order to run different threads. And this becomes even more complicated, because all of these threads have very different priorities. And some of sibling threads of the same process have different priorities. So, if we're going to look about the QEMU process, for example, there are the vCPU threads that I mentioned. Of course, they have the highest priority. But, you know, vNCWorker, for example, doesn't need to run on dedicated CPUs. But IO threads is a bit more important. So, we have many different priorities between all of these threads. So, what we did is basically lie to the guests. These aren't really dedicated CPUs, right? Because we're going to context switch out the guests all the time. So, second attempt. Basically, the field in the VMI object, in the virtual machine instance object, was introduced. It's called Isolate Emulator Thread. The basic idea here is, if the user asks for xCPUs, we're going to allocate x plus one CPU. So, one extra dedicated core to run all of the non-vCPU threads. And basically what we're doing here is using leverage configuration to say pin all of the non-vCPU threads of the QEMU process into this dedicated core. So, again, if you look over here, we have the first vCPU running on first dedicated CPU, the second one the same, and all of the other threads are running on a third dedicated CPUs. So, there are two problems here. One that we waste one dedicated core in order to achieve that. The other one is that what about all of the different threads here? You know, there are a lot of different threads that we didn't even do anything with. So, this doesn't really solve the problem. Again, these threads are going to be context-switched into this dedicated CPU. So, third attempt is the housekeeping approach. So, the idea is that we create a child C-group for lower priority threads. This is called the housekeeping C-group. Again, just like before, we would allocate one extra core. So, if the user asks for xCPUs, we'll allocate x plus one. Then what we'll do is move all of the non-vCPU threads into this housekeeping C-group. And then the vCPUs would run on dedicated CPUs. So, this is basically how it looks like. We have the vert launcher pod, and then the compute container with x plus one dedicated CPUs will create a child C-group, the housekeeping C-group, with one dedicated core, which basically runs all of the threads but vCPU threads. And the vCPU threads themselves would run on x dedicated CPUs. And while this approach is a huge step forward, because this is the first time when we actually support dedicated CPUs, there are still a lot of problems with it. So, one problem is that we still waste one dedicated core. And ideally, we would have said to Kubernetes, we need x dedicated core, of course, plus 0.2 shared CPUs, because we don't really want all of the low priority threads to run on a dedicated CPU. But as we said, this is impossible in Kubernetes, because if you'll write something like 3.2 CPUs, you don't feel the requirements to having dedicated CPUs. So, Kubernetes goes for an all-or-nothing approach. Either all of your CPUs are dedicated, or none of them are dedicated. Another problem, which is the following two problems are more related to design than actually performance, because we're doing something twisted here. We say we need the vCPUs to run on dedicated cores, so we configure every other thread to run, we configure every other thread, and it should be reversed. We need to configure only what we care about. We need to configure only the vCPUs and leave everything else as is. And another problem is that I've talked about, you know, this C-group runs threads. So, this is a threaded C-group. And as I said before, threaded C-groups are exposed to many limitations. And basically, now, we can't use many subsystems on almost all of our threads, all of the threads except for the vCPU threads. So, that's another problem. So, fourth attempt is the emulator container approach. So, the idea is that the compute container will stay as usual. And when I'm saying as usual, it would not be allocated with dedicated CPUs at all. It still needs to be of guaranteed QoS, but no dedicated cores. Instead, we will create another blank container with X dedicated CPUs. This will create a new C-group for us, because in Kubernetes, every container gets a new C-group. And when I say blank container, by the way, I mean that, you know, one process that's slipping forever, something like that. Then, we can move only the vCPU threads to this C-group. So, let's see how it looks like. So, now we have the virtual launcher pod. We have the compute container with Y shared CPUs, and they're shared CPUs and not dedicated. And we have the emulator container with X dedicated CPU. And what we can do is simply move the vCPU threads into the emulator container. And now, only the vCPU threads are running on X dedicated cores. Everything else is running with Y shared CPUs. So, there are great advantages to this approach. Basically, we solve all of the problems for before. Only the relevant threads are being configured. The compute container and all of the threads inside stay exactly the same. The housekeeping tasks are running on shared CPUs now. We avoid allocating one extra dedicated core, which is a high-expensive resource. And we keep things open for extension in the future in the sense that we're not, we don't have the limitations for thread C-groups for all of our threads, only for the vCPU threads. But, oh, first question. So, how can we even move threads into another container? That sounds completely weird, right? But we didn't really move them into another container. We didn't move them only to another C-group, which is different. And remember what I said. From the kernel's perspective, there isn't such a thing as a container. We really only change C-groups. And should we share the PID namespace? That's what I thought originally. But the answer is no, because we didn't change the namespace at all. So, the vCPU threads that are running now on a different container share the PID namespace with all of the threads and processes from the compute container. But this doesn't work with C-groups v2. So, with C-groups v1, that's entirely possible. With v2, that's a problem because of the threaded model that I was mentioning. And basically, all of the threads need to live under their process subtree. But the process, the CPU, the QMU process is in the compute container. We're moving some threads into a sibling container. And that's illegal with C-group v2. So, that forces us to move all of the QMU process with all of its threads into another C-group. But this is not such a huge problem. And maybe it's an opportunity. Because what we can do is the following. So, just as before, we would have another container. But it turns out that the C-group for the pot itself is owned by Kubernetes. We cannot change it at all. But we can mess around with the C-groups of our containers that's allowed in Kubernetes. So, what we can do is the following trick. We can edit the CPU set of this container to having both X-dedicated CPUs and Y-shared CPUs. Again, this is not legal in Kubernetes. But it is possible in C-groups. And then what we would do is move the QMU process with all of its threads. Only the vCPU threads would run on X-dedicated CPUs. All of the other threads would run with Y-shared CPUs. Now, just in this C-group, nothing really runs here. Because all of the threads are split between one of the two children. So, that's basically just a C-group hierarchy. But, yeah. And this is how it looks like. But let's look at it again. Because as I said earlier, there are two layers of basically management. And the third layer of emulation. Now, in essence, the management layers are really different from the emulation layer. We can have, like, since they're different, we could treat them differently. We can have different permissions, different resources, different, I don't know, different definitions for the management layers and the emulation layers. Because they're different in essence. So, if we look at it again, what we did is basically reflect our model a lot better. Because now we have basically the compute container for the management layers. And the emulator container for the emulation layers. And we can now configure the both containers differently according to our needs. And also, this opens the door for further extensions in the future. Because now we have no limitations about both of our threads. We can also extend this hierarchy even more. So, let's say, for example, that we want to limit IO for the ZCPUs on certain scenarios. We want to limit, I don't know, memory for the management layer. So, we can even extend this C-group hierarchy in the future. So, that leaves the door open for many extensions. So, summary and takeaway. There are where a lot of introductions here. And we've seen a lot of cool technologies, CPUs allocation, C-group, dedicated CPUs, namespaces, KVM, Kuvert. And again, my hope is that beyond the problem and solution that I was trying to solve, that you would take some of these cool facts and cool technologies and use them in your journeys in whatever you're interested in. Yeah, and that's it. Thank you very much. So, are there any questions? Yes. Yeah. So, the question was, how much of it is a heck? And how much, like, basically, if I understand you correctly, what you want to ask is, how do we know that Kubernetes won't be surprised by these changes, right? And so, to be honest, this is still work in progress, and we still have to test it with a bunch of scenarios, to be sure. But from whatever I tested it, it was completely fine. And from what I understand is that Kubernetes is owning the pod C-group, but everything that beneath that, it doesn't care about. They're only configuring it while the container is being created. But after it's been created, then don't touch it at all. So, I don't see a reason right now why Kubernetes would be surprised. But again, this is work in progress, and I might be wrong here. Yeah. Sorry, I didn't hear you. CPU pinning with different size to cores? You're referring to NUMA, right? Okay. So, the question is, how does NUMA get into all of that? And yeah, I'll be honest that this is still under investigation. Again, we don't see a reason why it wouldn't be supported. And Kuvert already supports NUMA. So, I guess, I don't think there's a problem in this area, but again, work in progress, I don't want to guarantee anything. Any other questions? Okay. Thank you very much.