1. Sleep & Relaxation
Many patients have sleep difficulties underlying or exacerbating their pain and fatigue. Poor habits (“sleep hygiene”) can add to sleep difficulties. Good sleep habits include:
- Minimize caffeine intake and avoid both caffeine and alcohol 4-5 hours before bedtime.
- Avoid intense exercise 4–5 hours before your desired bedtime.
- Avoid large meals and large quantities of liquid before bedtime.
- Follow a regular sleep/wake schedule each day even on weekends and during vacations. Avoid napping, and shift-work.
- If unable to fall asleep, go to another room and start a quiet and not too engaging activity. Return to bed only when you feel sleepy.
- Minimize light in your bedroom from windows, alarm clocks, night lights, TV, laptops, tables, cell phones, etc.
- Minimize sound in your bedroom from pets, music, and other disturbances. Use earplugs or white noise like a fan or air filter if sound cannot be minimized.
- Maintain a moderate temperature and good ventilation in your bedroom.
- Do not work or watch TV in your bedroom. Use the bed only for sleep and physical romance.
- If you have trouble breathing through your nose or snore, address common allergies (dust, mold, pets), and use nasal strips or nasal dilators to help you breathe. Air filters may be helpful.
- If you suspect obstructive sleep apnea (stopping breathing during sleep when the tongue slips back blocking your throat), have a sleep study done and use the CPAP machine nightly if it is prescribed.
- If you have trouble falling asleep, consider trying an Epsom salt bath or melatonin (0.5–5.0 mg) 30–60 minutes before bedtime. If you have trouble staying asleep, consider trying a time-release form of melatonin. Oral magnesium (100–300 mg of a chelated form) may also be helpful.
- If you frequently become wide awake in the middle of the night, consider a small snack with protein and fat before bed. If that does not help, consider a trial of phosphatidylserine 500–1000 mg an hour before bed to reduce night time cortisol spikes.
- Most patients report that rest is the best therapy. You will recover more quickly if you structure your life so you can listen and attend to your body when your body tells you to rest.
- Each day you have a finite amount of energy available. Trial and error will help you fine-tune that inner sense of how much energy you have each day and when you are better off stopping.
- You will feel and do your best by pushing almost to the limit of your daily energy allowance. Be careful to moderate your activity to stay within your daily energy allowance.
2. Exercise & Movement
Exercise is perhaps the most effective component in managing fatigue and pain syndromes. Physical activity prevents muscle wasting, increases mood and coping capacity, and can reduce both fatigue and pain.
- The best programs combine aerobic, flexibility and strength-training, but anything is usually better than nothing provided that the program is “graded.” Grading the program means that you should start easy to see what you can handle and then slowly building up the intensity over time. Patients who try intense exercise too early can expect to experience a discouraging increase in pain.
- Daily exercise of some kind is important to prevent deconditioning, and it may enhance your immune system and mood. However, it is vitally important to not exercise so much that you exceed your daily energy limit as this can deplete your reserves the next day or longer.
- If you are able to, embark on a daily walking program. Begin with what you can handle without extra fatigue — even if it is for just a few minutes.
- After a few weeks or months of walking you may be ready to add bicycling, swimming or water aerobics or low-impact aerobics to your regimen.
- Resistance exercises with light weights can help to improve muscle tone and increase endurance.
- Flexibility exercises like yoga can reduce muscle and joint pain. Some people find great pain relief and increased flexibility with warm or hot yoga.
Health and energy requires good nutrition. Ensuring you have a healthy diet is important for healing from any chronic disease.
- Ensure that your diet is high in colorful (phytonutrient rich) vegetables and fruit, that you are getting enough clean protein, as well as getting adequate amounts of omega-3 fatty acids.
- Other supplements may be needed to help support your body.These may include a multivitamin/multimineral, additional omega-3s, antioxidant and/or detox support, gastrointestinal support, or other supplements. Your healthcare provider will help tailor a plan that meets your needs. For example:
- CoQ10: 100–300 mg 2–3 times/day
- R-Lipoic Acid: 100–200 mg 2–3 times/day
- L-Carnitine: 500 mg 2–3 times/day
Managing stress is important. Having a chronic disease is stressful, not only emotionally, but physically. Finding ways to help your body get rid of stress is important for healing.
- Find a stress relief technique that works for you and practice it every day. Some examples include: meditation, prayer, deep-breathing techniques, listening to relaxation/guided meditation recordings, singing, walking, sitting in a peaceful area, contact with pets, or anything that brings you joy and allows you to relax.
- Avoid stressful people and situations as much as possible. Mental strain and emotional stress sap your adrenal reserves (cortisol) and lower your daily energy allowance.
- If chronic stress has been a feature of your life, consider working with a qualified healthcare provider to have your cortisol, DHEA, thyroid (TSH, FT4, FT3,TT3, RT3) and pregnenolone levels tested.
- Adaptogenic herbs may be helpful in increasing your endurance and tolerance to stress. Examples include: rhodiola, ashwagandha, astragalus, schisandra berry, and holy basil.
Having supportive relationships in your life is important. At the same time, be aware that having people in your life who encourage and reward complaining or an inflexible focus on the negative may inhibit your recovery.
- Spend your time and energy with people who are understanding of your situation or willing to help when you need it. Avoid unsupportive, abusive, or overly negative people. Remove yourself from those social situations.
- Finding a support group can be a positive resource and social outlet. It can help connect you to others in the same situation, who can share tips and experiences. It is also a reason to get out of the house and connect with others who truly understand your situation.
- Professional counseling can help. A counselor can help address any feelings of anxiety, depression, grief, anger, guilt, or any other emotional concerns you may be experiencing.