Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Managing Your Energy
Two techniques can help you manage your energy when you have myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). They are:
- Staying within your energy envelope.
- Pacing yourself.
These techniques can give you better control over your symptoms so that you can be as active as possible. They may also lead to fewer times when you feel so ill that you can't do anything at all. This worsening of symptoms is called post-exertional malaise. People who have ME/CFS often call it a "crash."
What is your energy envelope?
You can think of the amount of energy you have to spend in a day as your "energy envelope." You stay within your energy envelope when you use about the same amount of energy as you have in a day—not more and not less.
What is pacing yourself?
With pacing, you plan your activities so that you can rest when you need to. No matter what kind of activity you are doing—physical, mental, social—you stop to rest. Have a plan for how long you will do the activity before you take a break (for example, every 15 minutes). Even if you are still feeling well, it is important to stop and rest. It may help to set an alarm so that you don't lose track of time.
How can you stay in your energy envelope?
- Each morning, estimate how much energy you feel you have for the day. Give it a number from 0 to 100.
- A 0 (zero) would be no energy at all. People who rate their energy as a 0 might not be able to get out of bed.
- A 100 would be lots of energy. People who rate their energy as a 100 might feel like a time when they were the most well and active before they had ME/CFS.
- For each activity you want to do, think about how much energy it will take. Give it a number between 1 and 100. Do this for physical activities like walking, driving, or doing dishes; mental activities like reading a book or handling email; and social activities like talking with friends or sharing a meal.
- At the end of the day, add up the numbers for the total energy you used on activities that day.
- Compare this total activities number to your daily energy number. If the energy you used about equals your energy number for the day, then you stayed within your energy envelope.
How can you pace yourself?
Before you start an activity, check in with your body and think about how much energy you have that day (your "energy envelope"). You may be tempted to think about all of the things you want or need to do that day, but focus on one activity. Now, ask yourself how much energy that activity will take. Also ask yourself how long you think you'll be able to do that activity.
If you are planning to do an activity for a long period of time, decide when you will take a break to rest. Rest may include elevating your feet, lying down, meditating, or taking a nap if needed.
You will also need to think about what you'll do if you start to feel bad while you are doing your activity or when it is time to take a break. Make sure you have a safe and easy place to lie down, especially if you're not at home. For example, if you have driven somewhere, this could include lying down in the back seat of the car.
Once the set time you have decided for the activity is up, stop the activity. It is best to take another break before starting a new activity. Remember you'll want to run through this process again for any new activity you want to do that day.
How can you practice these techniques?
Pacing yourself and staying within your energy envelope take practice. You may find that keeping a diary helps. You could start out by simply estimating how much energy certain activities take. For example, ask yourself how much energy does it take to drive to the store or do the dishes? How much does it take to spend 10 minutes reading a book, writing emails, paying bills, or talking to a friend?
You can also use your diary to write down how much energy you thought you would have in a day. Then list your activities. Write down how much energy you thought each one would take, and how much each one actually took.
You may also try using a fitness tracker to track your activities. This can help you learn to estimate how much energy your activities take.
You may want to break your activities down into chunks. For example, you may want to weed your garden. You could divide your area into small sections. Then you can estimate how much energy you would use for each section. Plan to do only the amount of weeding you can do without going outside your energy envelope.
It may also help to think about having planned breaks. Again, in this example about weeding, you would stop and rest after a certain amount of time (like every 10-15 minutes). Try setting a timer or alarm to go off when it's time to take a break.
Using these two techniques can be hard to do. When you are having a good day, it's tempting to overdo it. You might think that you should try to get everything done to make up for days when you had less energy. You might think you should push yourself even when you start to feel tired. But if you do too much in a day or force yourself to keep going when your body needs rest, you could then crash and need several days to recover.
But with practice, it will get easier. Soon you'll get better at knowing how much you can do in a day and when you need to rest, so you can do more of what you want to do.
Current as of: November 20, 2019
Author: Healthwise Staff
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Adam Husney MD - Family Medicine