Will Rest Make Me Less Productive?
By Bruce Campbell
Some people tell us that they worry that rest is reducing the amount that they get done. If they try taking a rest break, they keep thinking of all they could be doing and wonder whether it would be better just to keep working on their To Do list.
In our experience, most people with ME/CFS and FM get more done if they integrate rest breaks into their day and the reason is PEM. Let me explain why.
The Price of Overdoing: Post-Exertional Malaise (PEM)
Working without taking rest usually results in overdoing, which produces an intensification of symptoms that is called Post-Exertional Malaise or PEM. The key fact about PEM is that it is out of proportion to the overdoing.
Let me explain using the idea of energy dollars, a concept borrowed from our friend Dr. Lapp. He talks about limits by saying that people with ME/CFS and fibromyalgia get a certain number of "energy dollars" every day to spend on various activities.
If the average healthy person gets $100 a day to spend on various activities, the average person with ME/CFS or FM gets around $25. (That estimate is based on the average person in our program rating herself at 25% of normal when she starts our introductory class.)
If a healthy person overspends by $5, she is $5 in the hole, an amount she can pay back with a little rest. But if someone with ME/CFS or FM overdoes it a little, say by spending $30 in a day, that puts them at -$5, but they also get charged a $30 PEM "overdraft fee," putting them $35 in the hole. They have to deposit $35 to get back to zero.
Examples of PEM
Here are three examples of how post-exertional malaise plays out in the lives of people in our program.
John functions about 45% of normal and is able to spend an hour a day gardening without intensifying his symptoms. But when he gardened for an extra hour one day, the extra time put him in bed for the rest of the day and triggered a relapse that lasted ten days.
Toni Bernhard, a person who has very severe ME/CFS, says in the preface to her book How to Be Sick that when she was writing the book, "some days I would get so involved in a chapter that I'd work too long. The result would be an exacerbation of my symptoms that would leave me unable to write at all for several days or even weeks."
Rose is a person bedbound with ME/CFS. She used to experience significant relapses after a one-week stay by her family or other houseguests. Each year, it took her up to six months to get back to where she was before the visit. There is a happy ending to the story, however. Rose used rest and two other Strategies for Special Events the next time she had house guests and as a result was able to return to her normal activity level two days after her guests left.
So while post-exertional malaise exacts a penalty out of proportion to the infraction, there is some good news as well. If you can avoid PEM, think of the suffering you can avoid! John could have missed a 10-day relapse; Toni could have completed her book sooner; Rose avoided a half-year of suffering.
Can You Rest Too Much?
So, if rest is generally useful because it helps you to avoid the suffering of post-exertional malaise, can you rest too much? Yes, it's possible to rest more than you need to. This is the major exception to the idea that rest breaks make you more productive.
We advise that you experiment to find what combination of rest periods work for you. Often, several short breaks can produce the same beneficial effects as longer breaks. I remember one person in our program who said she was used to spending six hours a day lying down, two naps of three hours each, one in the morning and one in the afternoon.
She was intrigued with the idea of brief pre-emptive rests and decided to experiment by breaking up her day into one- and two-hour blocks, taking a 10 to 15 minute rest during each block. Over a period of two months, she reduce her total rest time by an hour and a half. After six months, she had reduced it by an additional hour and a half, thus adding three hours of activity to her day without increasing her symptoms.
Other people have reported similar results. From their accounts and my own experience, I would say that the key is to shut off the mind and get into a state of deep physical and mental relaxation, using the Relaxation Response or another relaxation technique. This can be done as a regular daily practice.
A few days after I mentioned the idea of brief rests in an online class, someone wrote to say, "I've been trying the 10-minute power nap. The recharge is amazing. The key is what you say: we have to shut our minds down too. Or send them into relaxing thoughts. It gets easier each day. I also like that it shortens my afternoon nap, which I once called a ‘two-hour coma.'"
Brief rests can also be used to avoid PEM if they are taken as soon as symptoms appear. I stumbled upon this strategy one day when I was cooking chili.
After standing at the stove for 45 minutes, I suddenly felt tired, weak and lightheaded. My first thought was: "If I can just work for another 10 minutes, I can finish this job." Remembering how many times I had ignored the warning signs of a relapse and had been forced to take several hours' rest, I decided to turn off the heat under the chili and lie down.
After about 15 minutes, I got up feeling fine and returned to finish the cooking. I needed no more rest during the remainder of the day: loss of three hours avoided.
You may not be able to change the fact that you have ME/CFS or FM, but there are many things you can do to reduce suffering and improve your quality of life.
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