Leaflet 8: Managing your energy levels

Breathlessness Intervention Service

The information given below is designed to help you manage your stable long-term breathlessness. If your breathing is getting worse, or you are experiencing breathlessness as a new feeling, it is important to seek medical advice from your GP.

Why do I feel more tired?

Tiredness (fatigue) can be a common symptom in many long-term conditions, especially when you are experiencing breathlessness too.

Tiredness can make it harder to feel motivated to stay active, which means that you may avoid activities. Being less active can then make you feel more tired and more breathless, and when you have a condition that affects your lungs the extra effort of breathing uses up more energy too.

We cannot necessarily take away your tiredness completely, but there are a number of ways in which you can manage it. These in turn may help you to continue to do some of the things that you would like to do and stay active.

What can I do to help my energy levels?

• Understand and monitor energy levels
• Conserve energy
• Keep active

Energy levels

Think about how much energy you have to use each day. Some people imagine having a jug of energy, or liken their energy levels to a battery. Consider what you would like to use your energy on, but always leave something in the jug/battery so that it is never empty. Even if you make the best plans, there is always a chance that something unexpected might crop up that uses more energy, so it is always good to keep some energy in reserve.

Monitoring your energy

It is useful to keep track of the activities that you do within your day and week and monitor how you are feeling at different times. This will enable you to see any patterns, and identify any times of the day or week which are better or worse for you.

It can also be helpful to note down what kind of activities you do, such as which activities give you energy (energy givers) and which activities drain you (energy depleters) and see how many of these activities you do in your day or week. Monitoring this can help you to plan for a good balance of these and assist in managing your energy.

Try to avoid all-or-nothing or 'boom and bust' patterns of activity. Overdoing it leads the body to require more recovery time, as shown in this diagram.

Try to hold back on a good day to enable you to do more on a less good day.

We have an ‘Activity Diary’ tool available to support you to monitor your energy as detailed above. Please speak to one of the team if you would like to discuss or use this.

Energy conservation

It is important to keep a balance between activity and rest, and to alternate the type of activities that you do in your day so that you are not trying to do too many strenuous things all at once. Conserving your energy can help you to manage tiredness and breathlessness to improve your quality of life. Small changes to what you do or how you do things can help you to use your energy more efficiently, which in turn can help you to do the things you want to do. When thinking about how to save your energy, it is useful to consider the following five principles:

• Prioritising: When you have a fixed amount of energy to use, it is worth considering which activities are most important to you, so that you can achieve your goals. Sometimes it can help to write everything down that you would like, or need, to do, then think about whether these activities are high, medium or low priority for you. It is important to prioritise some activities that you want to do, and that will give you a boost, and not just activities that you have to do.
• Planning: This can help you to be in control of what you do and when, and help to avoid overdoing things. Consider which times of the day are best for you and plan activities around this. Try to space activities out during the day and week, and try to plan a balance of heavy (high energy) and light (low energy) activities, as well as rest.
• Pacing: Doing an activity at a slow and steady pace uses less energy and effort, which means you will feel less tired and breathless by the end of it. Slow down when you talk and eat as these actions can affect your breathing pattern. Try to break down your activities into smaller tasks that are more manageable. Allow yourself time to take regular rest breaks to relax, and try to rest after meals. Remember that it is better to take a little extra time to complete a task and be able to continue, than to finish that task quickly and feel too tired to do anything else.
• Positioning: This relates to your posture as well as your environment. Try to avoid too much bending and twisting which can be tiring and make you more breathless. Try to bend at the knees rather than the waist, or use long-handled aids to reach things. Sit rather than stand to do activities if possible, as this uses less energy. Think about trying to organise your home so that things are easily accessible (for example in the kitchen and bathroom, have frequently used items to hand). Push or slide objects rather than lifting them. Remember that making small adjustments can mean that you use your energy more efficiently which makes activities easier to do.
• Permission: If you place high expectations on yourself, it is worth having a think about allowing yourself to do things in a different way, one that helps with your energy levels. Try to be patient with yourself and give yourself time to do things. Whilst it is usual to reflect at times, it is not so helpful to think about the things that you could do or the way in which you could do them before your energy levels were limited. Try to recognise the things that you are achieving now. Remember that it is ok to ask for help or to say ‘no’ sometimes.

Keeping active

Regular exercise has been shown to help with energy levels and breathlessness and prevents your muscles becoming weaker. It is important to stay as active as you can. A little regular gentle exercise each day can make all the difference and can be done alongside the principles of energy conservation. Please see Leaflet 7 Physical activity and exercise for further information.

Putting it into practise

Self care

• Keep things you use frequently close to hand.
• Have a telephone point close to your bed or armchair.
• When bathing or shaving, try to gather all you need before you start, and sit down to wash and groom if possible.
• Use an electric toothbrush/shaver.
• Put on a towelling robe after washing to dry yourself, rather than using heavy bath towels.
• Reduce steam in the bathroom by running cold water before hot water, and keeping a window or door open if possible.
• Choose clothes with front fastenings, and bring your knees/feet up to dress your lower half if possible, to avoid excessive bending.

Walking and climbing stairs

• Pace your breathing to your steps: breathe in over one step, breathe out over the next two steps.
• Move at a comfortable pace and avoid holding your breath.
• Use walking aids if they help you. You can discuss this with your physiotherapist or occupational therapist.
• Stop and rest whenever you need to.
• Have resting points at the top and bottom of the stairs and use the handrail.

Eating and drinking

• Try frequent small meals, and take smaller mouthfuls.
• Avoid foods that are difficult to chew, and add sauces when possible.
• Drink sips of fluid frequently to stay hydrated.
• Consider using frozen vegetables/mixes or pre-prepared foods, and freeze leftover food to be used another day.
• Try to cook vegetables together to avoid using lots of saucepans and use a vegetable basket to drain water rather than lifting heavy pans.
• Sit down whenever possible, such as when preparing vegetables.

Shopping and cleaning

• When shopping, use a trolley rather than a basket, even for a few items.
• Plan your food shopping list by aisles, or consider Internet shopping/delivery.
• If you are tired after shopping, put the perishable items away first, then rest before finishing the task.
• Accept help from the cashier with packing.
• When cleaning, use lightweight appliances that do the work for you.
• Sit down whenever possible, such as when ironing.
• Use a long-handled dustpan and brush and consider having a set of cleaning equipment for each floor of your house.
• Request an assisted bin collection via your local council if you struggle to take your wheelie bins out to the road.

Sleeping

• Try to have a regular pattern of going to bed and getting up at the same time each day.
• Try to avoid sleeping too much during the day (ideally rest and relax or take short naps).
• Being active during the day promotes a good balance between activity and rest and may assist with sleeping.
• Wind down before bed.
• Avoid caffeine, alcohol and too much sugar before bedtime.
• Your bedroom ideally needs to be dark, quiet, tidy and at a temperature of between 18°C and 24°C.
• You may find that sleeping in an elevated or supported position eases your breathlessness.

General

• Try to rest before, during and after an activity. Rest before you feel too tired and remember that frequent short rest breaks can be better than a few long ones.
• Use equipment or small aids to help conserve energy where possible. Discuss this with your occupational therapist or physiotherapist.
• Try to stay positive and remain engaged in the activities that you enjoy the most, even if you have to adapt the activity or the way you engage with it.

Further information

For further help or advice contact the Breathlessness Intervention Service on 01223 274404, 09:00 (9am) to 17:00 (5pm) Monday to Friday.