Yes @forestglip sleep is a massive factor for me and I think it needs properly investigating why PEM affects people’s sleep
I agree. As sleep is the ultimate 'recovery process' and it feels that is where at least one significant issue is then it will either be affected by having more work to do because other processes that happen in normal people aren't and it's picking up the slack or/and is affected by the same thing.Yes @forestglip sleep is a massive factor for me and I think it needs properly investigating why PEM affects people’s sleep
I agree. As sleep is the ultimate 'recovery process' and it feels that is where at least one significant issue is then it will either be affected by having more work to do because other processes that happen in normal people aren't and it's picking up the slack or/and is affected by the same thing.
And researchers starting to see sleep as a canary in the coalmine symptom, and like other things being prepared to listen to the intricacies of those patients who can describe quite detailed differences in 'what happens' to their sleep, because there are different things going on here.
For example I'm pretty sure that as some point I described at least to myself that something closer to an equation of what I'd done for the day was the amount of sleep I needed, rather than what normal people have of this regular amount and maybe they can slowly catch up if they'd had a big whatever with a little bit extra here or there.
And I can tell for sure (my body was always creaking at the seams and in pain when I was trying to hold down a job) that I was cumulatively not just beyond my limit where I was getting slowly iller (that was a given I was stuck with for years) but likely to 'burst' (ie even the week off to recover wasn't going to work) when my sleep which was basically having to not have an evening after I got home in the weekdays was starting to be more unrefreshing and go all over the place
Although before that it was all over the place anyway because of the jobs I was trying to do and not having good knowledge of that PEM paradigm so had no control.
I think my point is that surely as apps are now getting better surely the shameful position of those who call themselves sleep experts but got away with just talking about sleep hygiene and soothing baths have no excuse but to start acknowledging there is more to it than just looking at it like an isolated behaviour from the rest of the body and timetable (picking it up hr before bed) or 'about routine'. I mean they should always have known that most healthy people when they get an illness find it changes their sleep so...
Emotional is different to cognitive and I'm not sure on the emotional one. Anger for example is something we have to control because it does make us over-exert. I'm more likely to need to distract myself or the situation more likely to need to do something if something bad or sad is going on.I've always wondered how come both physical and cognitive exertion can cause PEM. I'd have thought that moving around would have used very different biological mechanisms and energy expenditures than thinking, on the whole.
There has been talk of 'emotional exertion' causing PEM, even though emotions don't really seem to fit the bill as 'exertion'.
I also wonder whether PwME who have OI and simply remain upright for too long can have PEM (I suspect I can).
Does it indicate anything about the mechanism of ME/CFS that both physical and cognitive exertion can cause PEM?
Is it worth trying to clearly identify other possible triggers of PEM to help point at mechanism?
@Jonathan Edwards (As always!)
Over exertion causing insomnia is well know to pwME as 'tired but wired'. For me it often a sign PEM is about to strike.
these are scrappy bits of thoughts but I've just remembered there is something in the 'load' aspect regarding size of immediate cognitive fatiguability/egg-timer issue and I'm realising that I'm assuming this relates in a straight line to cognitive PEM (but I'm actually not sure)As far as I understand the discussion on the forum, we don't know any clear answers to the following questions and various different people have offered a wide range of anecdotes:
-Are the symptoms experienced during PEM from exercise exactly the same in PEM experienced from cognitive exertion? Are there specific symptoms related to cognitive exertion that don't occur during physical exertion and vice versa?
-Does PEM experienced from exercise follow the same time course as PEM experienced from cognitive exertion?
-Does the one resolve quicker than the other?
-In the above examples are we sure that things are decoupled from OI?
-What about different severities?
Or perhaps more simpler said
What entails "physical exertion" and "physical PEM" and what entails "cognitive exertion" and "cognitive PEM"? Are they the same for all severities or are there differences? What do these terms mean? As far as I know there has been little to none research on this.
I wander whether it may initially be easier to first discuss "purely cognitive exertion and PEM" (like reading an enjoyable book of thinking about a problem), before discussing "emotional exertion" where things might be even harder to untangle.
I also think different people might sometimes mean different things when the refer to "cognitive exertion" and I don't know how interchangeable those always are. I don't think that thinking harder about something should require more energy than thinking little about something even though it may be draining in a certain sense even for healthy people, so I think the energy metaphor in a physical sense (and in relation to ATP, mitochondria etc) appears to be somewhat of for "cognitive exertion".
I think Rob Wüst has also mentioned that he doesn't have a clear grasp how "cognitive exertion" could for example cause symptoms in the legs.
I didn't know if it was worth mentioning, but I've wondered if cognitive PEM might just be prolonged use of eye muscles. At least for me, most cognitive crashes come from activities involving long focus on a page or screen.For me, I think reading and scrolling affect the muscles in the eye, causing PEM?. I remember in my severer years scrolling was just awful, so something about movement as well. I would separate this from cognitive use which is another PEM inducer as well. I'm not sure whether there should be separation though.
Some googling told me that FFI results in an accumulation of misfolded cellular prion proteins (PrPc).
On a related note, maybe 25 years ago I proposed on a science forum that mitochondrial oxidative stress, and in particular a lack of glutathione, could result in misfolded proteins. A protein encoded in the nucleus is imported unfolded into the mitochondria, and folded there. If something interferes with that the mitochondrial protein, particularly if it requires disulphide bonds, would result in accumulation of misfolded proteins. More recently it became a possibility that if mTOR is more active in some of us, we might fail to remove the misfolded proteins. Its also possible that lack of activity might drive synthesis of even more proteins, resulting in more misfolding, and without fixing the issues.misfolded cellular
Regarding the eyes, there is a 'ME look' in some patients. I've recognized it in others and have seen it in my eyes. What contributes to this, I don't know.
On a related note, maybe 25 years ago I proposed on a science forum that mitochondrial oxidative stress, and in particular a lack of glutathione, could result in misfolded proteins. A protein encoded in the nucleus is imported unfolded into the mitochondria, and folded there. If something interferes with that the mitochondrial protein, particularly if it requires disulphide bonds, would result in accumulation of misfolded proteins. More recently it became a possibility that if mTOR is more active in some of us, we might fail to remove the misfolded proteins. Its also possible that lack of activity might drive synthesis of even more proteins, resulting in more misfolding, and without fixing the issues.
This does not fit with the spontaneous temporary remission many of us have experienced though.
Let’s assume that misfolded proteins are at the heart of this. These are more or less random thoughts:
What causes and or drives the misfolding? Can it be multiple drivers?
Can misfolded proteins in themselves lead to more misfolded proteins?
Are the misfolded proteins a precursor to something else? I read something about PrPc being converted to PrPcs (toxic) by PrPcs itself, in patients with FFI.
The idea is a bit like exercise (which also increase ROS): If the body can deal with it builds back stronger, but the system can be overextended.I also have a vague memory of reading that ROS is usually good for you in normal levels, but that very high levels of ROS makes it bad for you.
When I was still working, a colleague I did a lot of joint work with used to say she could see in my eyes the point in time, usually in the afternoon, when my useful contributions were about to dramatically slow.