Being productive with pain and sleep issues
September 16, 2016 7:24 AM   Subscribe

How have you done it?

My ratio of productive to unproductive days isn't amazing. I have a few medical issues, some of which look like they're on their way to being managed, or at least understood, possibly. Also have pain, some that's chronic, some that's intermittent (and unpredictable). (It's a collection of minor MSK problems in multiple areas, that sum up and make doing things annoying. Foot situation still not solved, working on it.) Still working on ways to manage pain, nothing settled in a reliable way yet.

Energy levels are more regular (& better) since supplementation with iron & vitamin B complex (had technically-normal-but-not-really ferritin, this is being corrected), but still not as optimal as would be ideal, thanks to inconsistent sleep. (Am waking up on time, just not sleeping on time, though getting better about that too. Doing sleep hygiene more or less always, but am still sometimes just wired [and judiciously use medication, just when it's bad], and pain sometimes gets in the way. Sleep is still I think the major determiner of my wellbeing.)

Sometimes, I'm just out of it (again mostly due to the lack of sleep, I think). Still need to get things done. This related Ask was great - any more advice along those lines?

I've heard the spoon theory, and I feel like it might help, but am not sure how to apply it, practically - any thoughts on this?

posted by cotton dress sock to Health & Fitness (8 answers total) 21 users marked this as a favorite
I had a four-column of things I could manage when I felt awful, lousy, mediocre, and good. On good days, I didn't need to look at it, but on horrible days when I had a foggy brain and no planning skills, it was really useful in helping me grind through some of the mundane necessities and feel like I'd accomplished something with my day. I could order the month's groceries and toiletries online even on awful days, and do laundry or straighten out my digital files on lousy days. That way, when a relatively good day came along, I could make the most of it by doing the physically and cognitively difficult stuff I could not always manage, without wasting time restocking paper towels or whatever.
posted by xylothek at 7:58 AM on September 16, 2016 [16 favorites]

I know this is easier said than done, but I would seriously prioritize getting really good, really consistent sleep. Nothing replaces sleep, and nothing works as well or feels as good if you aren't getting enough or if it's poor quality. End of story. If your sleep is crap, your productivity will suffer, your energy levels will be poor, your pain will be worse, and you'll be stressed out. Everything will be worse if you're not sleeping well.

Make getting good, consistent, sufficient sleep your #1 priority for a week and see if I'm not right. Use medication consistently, not just when it's really bad and you've already lost a bunch of hours. Schedule your sleep time and stick to it at all costs. If you're not already on something stronger, take a benadryl and a melatonin an hour before you're supposed to be unconscious, so that they're already kicking in when it's time for lights out. Continue practicing good sleep hygeine. Seriously, make sleep your #1 thing.
posted by Anticipation Of A New Lover's Arrival, The at 8:02 AM on September 16, 2016 [7 favorites]

When my chronic pain is acting up, I make a list for the day divided into Must Do, Should Do, and Want To Do. If I get through the Must Do, I try to give the Want To Do as much weight as the Should Do so that I wasn't using all my energy on work.

I also find it helpful to think at the end of the day about one worthwhile thing I managed to do. Worthwhile things could include doing something I enjoyed, something that connected me to some or all of my family, attention to a pet, something that supported my core values and goals, something that was helpful to our family (as small as, "I unloaded the dishwasher."), and so on. Something that had value to me. Yesterday and the day before were bad days for me, during which I took hardcore meds and slept a lot. But I watched American Gothic with my 12-year-old, which was a great, fun way to connect with him: worthwhile! I paid bills! I managed to find money in the budget for the 15-year-old to get some hobby supplies! And I was there for a friend in crisis who needed to talk.

I slept 14 hours on Tuesday and 13 hours on Wednesday. But I managed those four worthwhile things during my waking hours. I try to focus on that, and not on the phone call that's two weeks overdue or the mess on my desk and dining room table, which I've been wanting to deal with for weeks.

I like xylothek's to-do list model as well. I've been moodling around with the idea of creating a planner for people with chronic conditions and xylothek's to-do lists would be a great part of that.

The spoon theory is helpful, to me, for reminding me that I really do have finite energy. It's also been a very useful model for talking to friends and family about how I'm doing on any given day.

Another concept I picked up from the blog of a person with chronic fatigue was the idea of staying "inside your energy envelope," which means not always pushing to do as much as you can, but recognizing that your long-term well-being can be better supported by holding a little in reserve, doing a bit less than you could conceivably do. It's so easy, when you feel you're falling behind, to push on the good days, but it can be a better choice to resist that impulse.
posted by not that girl at 8:11 AM on September 16, 2016 [9 favorites]

Sleep quality: is it only that you have trouble getting to sleep, or that your actual sleep is not good when you're sleeping? I use an app (SleepCycle, but there are lots of others) that gives me a decent quality range.

Things that help me include a wool mattress pad (better temperature regulation, so I wake up from being too hot or too cold a lot less), really comfy flannel sheets, a body pillow, and a buckwheat pillow for my head. Your mileage varies, almost certainly, but finding the stuff that worked for me and investing in it has made a huge difference.

Resting even if I'm not sleeping: I've found that being horizontal and resting, even if I don't get as much sleep as I'd like, helps me the next day. It's not ideal, but it's better than not. (Even though this is counter to some sleep hygiene advice.) I have a set of low-key books I read (with night settings on my ebook reader app) that I enjoy but won't be tempted to stay up to keep reading for nights like that. Some people like undemanding podcasts or music for this.

Spoon theory: The application is really that if you get limited spoons, how are you going to spend them? I get regular exercise, but I avoid climbing stairs because it is particularly hard on my body and wipes my brain focus / ability to get mental stuff done out, way out of proportion of the actual exertion involved. Too many spoons used for no real benefit if there's an elevator!

I also do things to simplify the stuff I have to do (I mostly wear a very simple 'uniform' for most days - colored plain T-shirt, black skirt, cardigan if I need one - that can all get washed together on the same setting, dried, and put away without fuss.) because my life does not need me to fuss about clothing. I have food that doesn't take much energy to manage around. I use a grocery delivery service on really bad weeks, or when I'm unusually busy.

I also limit how much stuff I plan to do in a given week: these days, I'm generally fine with work, 2-3 days of exercise, and one weeknight thing and one weekend thing, if I have a completely unscheduled weekend at least once a month, and I'm careful about how many other plans involve a lot of exertion, driving in new places, or schedules I don't have much say in. Your limits are probably different, but knowing that this mostly works for me helps me plan more (and tell friends and family what to plan for.)

And just being able to go "Yeah, completely out of spoons." to someone is helpful rather than having to explain specifics.
posted by modernhypatia at 8:27 AM on September 16, 2016 [3 favorites]

Thank you so much, everyone! Your answers are incredibly helpful!

I've been moodling around with the idea of creating a planner for people with chronic conditions and xylothek's to-do lists would be a great part of that.

This is an amazing idea, please do it!!! If I may say, something I think might be helpful - and something I need to learn how to do, part of this question, really - is devise some way to rate and rank activities by difficulty. That rating should change depending on any number of things (e.g. hours of sleep; which pains are kicking in, how many) - one issue I have is that I am often misjudging the difficulty of certain activities on different days. As you suggest, not that girl, sometimes it's pushing myself too far on good days and not appreciating the cost of them later. Sometimes it's using the "good day" barometer for activity X on bad days. (E.g. seeing family - the trip takes 50-60 mins on good days, closer to 2 hours on bad ones [because I have to wait for elevators, walking takes longer, end up missing trains, being wiped at the end of it, etc]. That one I've now got accounted for, but so much else is still ??, and it's annoying to calculate because there are so many variables). Is there some kind of existing planning tool for even just this part of it?
posted by cotton dress sock at 10:26 AM on September 16, 2016

Sleep hygiene is an incredibly pervasive idea, but it doesn't seem to have a lot to back it up. It also doesn't make a lot of sense, as having an entire room devoted only for sleep (and an exciting activity like sex, only because the architects of the "sleep hygiene" hypothesis realised it was unrealistic to tell people not to screw in their beds, so sex is tickety-boo while things like reading are not, which makes little to no sense) has not been the norm throughout human history; it does not stand to reason that we need one now, and one does not really hear reports of people in places with high costs of living or extreme poverty where a single-room dwelling is the norm having more sleep problems than people in bigger houses.

I would give yourself permission to pick and choose what works for you on that one and definitely not think of it as some inviolable guaranteed-to-work scheme.

Somewhat ironically, when slightly sleep deprived (but enough for it to limit function) a benzodiazepine restores me to relative normality. (Every time I have mentioned this to doctors I have heard back either "Of course," or, "You must be confused; those drugs would just put you to sleep, that's not how they work." But if you are jittery and on edge and nervous from sleep deprivation, of course that will work.)

Take your sleep deprivation seriously and force others to as well. Do not drive while sleep deprived; you're as good as drunk. Do not hesitate to tell people "I'm sorry, I won't make it to X -- I didn't get a good night's sleep and have not recovered from that."

Don't compare your productivity to people who sleep like proverbial logs and tick off everything on their calendars. Did you get the most urgent things sorted? Good! Great! It was a very good day, for you -- it doesn't matter what other people might have been able to do; it's what you are able to do that matters, so celebrate successes, and do not look at lazy days of fatigue and pain and a lot of time on the sofa as failures.

Re "spoons" (great article, but such a weird object to pick) -- feel free to hoard them on un-busy days. If I know I will need to be running a lot of errands on Thursday, I do balls all on Wednesday -- and if it's a seriously busy Thursday, Friday is also booked off for recuperation if needed. When I neglect to do that, I pay for it far more than I do if I plan for it and refuse to exert myself (exception: very light stretching exercises).
posted by kmennie at 11:14 AM on September 16, 2016 [1 favorite]

I plan for about 80% of my usual day, adjusting downward if I know I'm having a really bad stretch. If I get more done, yay. If I get less done, that percent is usually low enough the 'didn't get this done' doesn't get overwhelming. I keep a bunch of projects around where I can do some stuff on them even if I'm not running on all cylinders mentally - simple knitting I enjoy, for example, as well as writing projects that take more focus.

On managing tasks : I don't do this all the time because the upkeep is annoying, but when I have a string of bad weeks, I start labelling things both by amount of focus they take, and by the amount of activity they involve.

I do a set of tags for work things (outlook, work) as opposed to ones for things at home (email, computer). I do a set for energy (sitting, active, and sometimes I tag for inertia problem issues), for focus or mentally undemanding tasks (usually 'easy' though I've played with terms for this.)

Then I filter as I need to, taking due dates into consideration. I'm a librarian, so some of my things are immediate (answer this reference question or communicate about a next step and I'm usually fine keeping up on thing where I'm reacting to something like that), but a lot of my other tasks are things I can move around based on my energy that day/week, and if I don't have focus one day, there are a lot of lower demand but still necessary things I need to do sometime.

Technology: I use Todoist with a premium subscription. I consider the premium worth it for two pieces: being able to add an email or website at as a task (great for 'I need to reply to this email' or 'I want to reply to this forum post') and for being able to do complex filtering of labels (with premium, you can combine filters and save them, so I can get everything that is at work, low focus, low energy, for example.) Also, you can rearrange tasks easily, sync to and from devices, so I can add things people ask me when I'm not near my desk at work, and there's a variety of reminders and they're settable by task.

There are tons of todo apps and sites out there, I spent a lot of time poking at various of them but I keep coming back to Todoist for that combo.

Broader view: One of the things it took me a long time to get into my head was that I need to treat some kinds of errands as 'this is my weekday activity this week'. I make exceptions only for things very near home that don't require any kind of navigating traffic or figuring out parking (drug store across the street, dinner with friends who live a mile away). So if I have a doctor's appointment, or I have to take my car for service, that's my thing that week, and I either need to cancel other things, or know I'm going to be paying for it.

Ditto with travel: I do much better with predictable things. My commute varies in time, but at this point, I have a pretty clear idea about what the variations are and how to manage them. I mostly take a route that can back up sometimes, but doesn't require navigating really annoying intersections that can totally wear me out. If I'm travelling, I plan to take it easy the first day I'm there, because airports are so unpredictable (how far you have to traipse to get out!) even if the travel goes smoothly. I've learned that I really need to not schedule anything extra (besides work and exercise) the week before and after I go somewhere, because I'll regret it if I do.

Basically, once I learned the "Stuff I do less often takes more energy than I assume" mantra, sorting out my planning got a lot easier.
posted by modernhypatia at 4:17 PM on September 16, 2016 [1 favorite]

For me, I find that even when I'm unwell, I can keep it together for like an hour or two under most circumstances. In fact, sometimes the distraction can help. So, if I have something that I really want to do, or don't want to cancel on, I may like if make a compact with myself, "I do this, then I go home to bed."

And I think it works for me, cause once I accept its going to hurt / be kind of sucky it's like it doesnt matter as much, weirdly?

Like the pain kind of becomes beside the point, doing it is what becomes important, and I know that the finish line is in sight, I'm not trying to get through the whole day or a bunch of tasks or whatever. That's what works for me, good luck.
posted by smoke at 4:19 PM on September 16, 2016 [1 favorite]

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