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The Little Envelopes

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By Bruce Campbell

(From the series Pacing: What It Is and How To Do It.)
The last article focused on the idea of overall limits, which we often call the Energy Envelope. That’s a good place to start to understand limits, but you can gain further insight by looking at your life on a more granular level, analyzing each part of your life. By doing so, you can gain further control over your illness.
We have found it helpful to focus on seven areas that we call the Little Envelopes:
  • Physical activity
  • Mental activity
  • Social activity
  • Sensory limits
  • Stress
  • Emotions
  • Heart Rate
Physical Activity

We have limits for activities such as bathing and dressing, cooking, cleaning, doing laundry, gardening, shopping, walking, driving and, for those who are able, work.

In the next article, I’ll describe how you can determine your envelope for each by focusing on one activity at a time and experimenting with different lengths of time. And after that, we’ll explore strategies for reducing the toll taken by physical activity as we look at pacing strategies.
Mental Activity

This area refers to activities that require concentration, such as reading and working on the computer. People with ME/CFS and fibro have different limits on the total amount of mental activity they can do in a day without worsening symptoms and also limits on the amount in an individual session. The next article will describe how you can use experimentation to find this set of limits.
Social Activity

The third area is the time you spend interacting with other people, either in person, on the phone or via email. Your social limit may depend on the specific people involved and the situation. (Some people are more draining than others.) Also, the setting may be important.

Meeting in public or with a large group may be stressful, but meeting privately or with a small group may be OK. By noting your reactions to different types of socializing and different situations, you can get a picture of this envelope.
Sensory Limits

In addition to the limits just described, there are four other kinds of limits you’ll likely find it helpful to track, the first of which is vulnerability to sensory overload, which can take several forms: sensitivity to food and other substances (including medications), vulnerability to noise and light, and sensitivity to weather and the seasons.

Sensory overload is a significant part of many people's experience of ME/CFS and FM. When we ask our groups to tell us what things make their symptoms worse, sense overload usually ranks in the top four.

Stress is increased and its effects intensified by long-term illness. Finances can be great sources of stress due to loss of income, worries about disability payments or feeling forced to work even when symptoms are intense. Long-term illness changes relationships, creating new obligations and also new strains and frustrations.

Family and friends may not understand. Analyzing the sources of stress is important, as is honing strategies for managing stress. We rate managing stress as second in importance, behind only pacing, for reducing symptoms and regaining control.

Strong feelings, such as sadness, worry, frustration and guilt, are common and understandable reactions to all the changes and uncertainties brought by illness. Some situations may trigger stronger reactions in us now than when we were healthy.

These reactions may intensify symptoms because emotionally charged events – both stressful and joyful-- can trigger the release of adrenaline, which often worsens symptoms. As noted earlier, energy spent on emotions are not available for other purposes.

Heart Rate

For people with ME/CFS and fibro, a heart rate beyond a level called the anaerobic threshold (AT) triggers an increase in symptoms. If the rate is kept below the threshold, relapses can be prevented.

Using a heart rate monitor as described in this article helps many people stay below their AT, and is especially helpful for people with more severe forms of the two conditions.

Example of Limits
As I mentioned in the previous article, I used the idea of the Energy Envelope and found it very helpful. After a year of so, I thought I could gain greater control if I understood my limits in different areas of my life. I began by asking myself a series of questions in order to get a fix on my limits, such as:
  • How long and how far can I walk without intensifying my symptoms?
  • How much mental activity can I do in a day? How much in one session?
  • What are the stressors in my life?
  • How much sleep do I need at night? How much daytime rest?
  • How long can I drive safely?
  • How long can I stand at one time without intensifying my symptoms?
Over time, I ended up with a list of about a dozen items, most related to the categories described above. I included activity limits (how long I could do various activities like driving, housework, reading, and spending time with people), stressors in my life, food sensitivities, sensitivity to light and noise, and emotions.
It took me at least a year to develop this more detailed understanding, but I felt rewarded all along the way because every limit I defined helped me gain more control.
Here's a sample of my detailed Energy Envelope from 1998, when I had been ill for about a year and a half.
7 1/2 hours, starting by 11 pm
Daytime Rest
10-30 minutes on most days, sometimes more
Usually OK for activities like errands & housework, in moderation
30 minutes walking OK on level ground
Reading & Computer
Reading OK most of time, but must limit time on computer, especially at night
Limit about 2 hours, sometimes tired after 30 minutes
Limit 1 hour, whether walking, shopping, cooking
Usually OK with one person or small group but respond strongly to some people and vulnerable to stressful encounters
Other Illnesses
Make CFS symptoms 30-50% worse. Secondary illnesses are more severe now than before
More easily upset than before. Strong emotions trigger CFS symptoms
Life mostly stable at present, thankfully
Haven't found any food sensitivities so far. Diet same as before
Sense Data
Noisy settings and loud noises are very bothersome, e.g. restaurants
Later I added a section to the end of my definition, in which I noted my major limits and my greatest vulnerabilities. This section was a helpful summary of my current situation and also suggested where work might give the biggest payoff in reduction of symptoms.
I learned a lot from studying my detailed envelope. One surprising realization was that my limits were more restrictive in some areas than in others. For example, when my overall functional level had returned to about 75% of normal, I could do only about 35% as much exercise.
I found it very helpful to share my envelope definition with selected others. Getting outsiders' views of my situation helped me to be more realistic in my self-assessment and also helped educate others about ME/CFS.
We use this approach in our program and formalized it by developing the Energy Envelope worksheet, available for downloading and printing on our Logs, Forms and Worksheets page.
In addition to areas for the Little Envelopes mentioned above, the worksheet has space for describing illness severity and other illnesses, needs for sleep and rest, plus three other categories:
  1. Summary gives you a space to summarize briefly how you are doing at present
  2. Vulnerabilities asks you to focus on the factors that make your symptoms worse and those that trigger relapses
  3. Goals gives you a place to identify the areas you intend to work on in the near future