Differences in PEM from different kinds of exertion: physical, cognitive, emotional



  • I think people often overlook the fact that there are many kinds of exertion...

    Physical: e.g. going for a walk, washing dishes, sitting upright for too long, or doing something sedentary that raises your heart rate like having a hot bath (I also think lack of sleep might count)
    Cognitive: e.g. reading or writing, playing a game, learning something new, conversation
    Emotional: any experience that leads to strong emotions, whether positive or negative

    I find that the onset and duration of PEM for me depends heavily on the kind of exertion that triggered it. Does anyone else notice this?
    Interestingly I seem to be able to recover a lot quicker from physical overexertion than any other kind (given optimal conditions where I can rest 24/7, take all my meds, no other stress, etc).



  • I think of PEM as the result of physical exertion. It is that 24 hour or so later payback for me, that sets off all my CFS symptoms, or makes them much worse.

    The other dreadful response I have is when I get an adrenaline rush and that is usually from an emotional shock, or frustration or anger or distress. Then I feel the blood fall out of my head and I am weak and nauseous and I need to lie down. If it is ongoing, I am too jittery to lie down. I need to drink lots of water and (damn) really need to go for a walk to work the adrenaline off - which then results in PEM.

    Cognitively I just get really tired and brain fog gets foggier. Then I start making mistakes and bad decisions, and THAT might lead to overdoing it physically and yes, PEM.

    (This is the first time I have written out what I think about it, so I might come back in the morning for take two).



  • I've remembered the other thing that effects me badly, being upright too long, especially standing still. My orthostatic intolerence seems to be my blood pressure slowly falling and it generally takes it out of me for a couple of days. Since it mostly happens when I am stuck in a queue and getting increasingly frustrated because I realise I would only cause more damage to my life if I leave and try again another time, then I also get the awful adrenaline reaction. Disaster.



  • @river I see PEM as an overstimulation, whether it be physical, emotional or cognitive. So does it come down to the sympathetic nervous system? I think so. I always have a couple of days of PEM after shopping. I never sleep well the night before (I have suffered from insomnia since the start of CFS) and the night after is even worse, because of still being “wired”. I’ve had a problem with my neighbour this week which meant lots of texting but keeping civil, and because of this, I’m going through the payback now. It’s taking longer to get my energy back. And I also put PEM and a relapse into two different categories. I’ve had three relapses and they last about 8 weeks pretty much bed bound and I never “bounce” back to where I was previously. The relapses come about after an out of control situation where I have had to push myself past my limits.



  • PS to my last post: Now I have remembered that if I have to stand too long, adrenaline seems to kick in to try to keep my blood circulating. Is that right, or is that just what it feels like?

    Exertion is defined as both mental and physical effort or strain. But I don't think I get tired from thinking with effort, it is only when it involves outside stress (including time pressure) that I am affected badly.

    Shopping can be a shocker @Glimmer and I hate it when I've been too sick to shop for ages and then it is stressful and physically demanding and I am trying to be super efficient so I won't have to shop again for ages but I leave my list at home, all the disability parks are taken and the essential shops are at opposite ends of the shopping centre!



  • @Dot your sympathetic nervous system will definitely ramp up the longer you're upright. My heart rate rises steadily and I start sweating and overheating. It's good cause it keeps you from passing out, but your body can only sustain that for so long



  • @river, Thankyou, that makes sense.
    And I am keeping an eye on my cognitive strain to notice my reactions better... wouldn't mind if I have none of it this week though!


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