Are you dashing through the season like a comet? Are the festivities blitzen your sleep? Has your budget pranced through the roof? Your diet danced down the chimney? Ho ho ho! You're on the sleigh ride of holiday stress!

It's very easy for the season of joy to turn into the holiday from hell. The spiritual and personal significance of Thanksgiving, Hanukkah, Christmas and New Year's can be trampled into pieces by a whirlwind schedule, overspending, travel catastrophes, out-of-control eating and drinking, family conflict or other not-so-welcome holiday gifts.

For those with neuromuscular diseases, unchecked holiday stress can lead to muscle fatigue and pain, a weakened immune system and even setbacks in ability. The end-of-year holidays may also bring tidings of discomfort and sadness.

OVERACTIVITY & FATIGUE

Stressful schedules often mean inadequate sleep and overexertion of mental and physical resources—in other words, fatigue. Since people with neuromuscular disease already experience muscle fatigue, they can tire very rapidly when they're more active than usual.

Gregory Carter, co-director of MDA's clinics in Olympia and Tacoma, Wash., says, "People have expectations of what a person can deliver in terms of holiday parties and family get-togethers. There's no question it's harder for people with physical impairment to keep up with those expectations, so they have to put limitations on what they can do."

Severe muscle fatigue may be experienced as pain or loss of strength or ability. "With adults, it might be activity intolerance, so that they can't do a physical function that they might have been able to do previously," Carter says. Though these effects usually aren't permanent, the discomfort and need for more help can put a damper on the holidays.

Overeating, excessive consumption of alcohol or caffeine, and emotional stress can also contribute to fatigue.

People with neuromuscular disease, parents and caregivers should watch for behavioral signs of tiredness such as impatience, moodiness, irritability or concentration problems. In teens, the effects of fatigue may appear as withdrawal or hostility.

FIXING FATIGUE

Excessive fatigue can best be avoided by sticking closely to your routine. Try to allow the usual time for your daily care and to get the normal amount of sleep. If your routine is disrupted, take breaks when you need them or get in a nap when you can.

When you become fatigued, limit your activity so you can regain your function. Joanne Janas, co-director of MDA's clinic at Scottish Rite Children's Medical Center in Atlanta, says parents can reduce a child's activity without cutting into the fun.

"Without punishing them for their disability by saying, 'Oh, you can't do that,' let them do it for a briefer period of time. You're letting the child have a great time but you're not letting it spoil [the holiday] because they're just so exhausted they can't go on to the next day's activity."

Carter suggests that caregivers (whether hired assistants or family members) "need to cut their clients a little more slack around the holidays." Caregivers should recognize that irritability is probably a result of fatigue and not make an issue of it. Caregivers can also help explain to others why you need to rest or can't go to every activity.

THE IMMUNE SYSTEM & RESPIRATORY DISTRESS

When you experience stress—from fatigue, conflict or whatever the source—your body responds the same way it does when you're in danger. It produces stress hormones such as adrenaline and cortisol to help you deal with the immediate threat. Those hormones tell your body to give all its attention to the threat, diverting it from normal "housekeeping functions," including the immune system's job of protecting you from bacteria, viruses and other unhealthy "invaders."

For people with neuromuscular diseases, the Thanksgiving-through-New Year's period is the worst time of year to have an ineffective immune system. Holiday travel and social events expose you to more people carrying viruses. Being indoors also makes it easier to catch the flu because of the lack of fresh air, Carter says.

"The winter months are the peak of the flu and viral illnesses anyhow. That can have major consequences on the breathing system," Carter explains. "People with neuromuscular diseases generally will have some impaired strength in their breathing muscles, which makes them more susceptible to getting pneumonia. And then pneumonia can be life-threatening in that population."

The immune system can be damaged by stress in another way. It communicates closely with the nervous system in ways scientists don't yet fully understand. But studies have repeatedly shown that having negative thoughts and emotions in our brains, such as worry, tension, anger or depression, makes the immune system less effective.

PROTECTING YOUR HEALTH

How can you make sure your immune or respiratory system isn't a holiday casualty? First, by protecting yourself with a flu shot and limiting exposure to viruses as much as possible.

Janas advises that parents keep a close watch on children who have borderline respiratory function and who get ill easily. "Notice if your child's cold symptoms are getting worse. Are they getting too tired? Are they getting sick?" Carter warns neuromuscular disease patients who get sick during the holidays not to put off seeing a doctor.

It may be wise for people with very weak respiratory systems or allergies to limit their exposure to fireplace smoke, candles, incense, cigarette smoke or aerosol sprays, Janas says.

Just as the immune system is weakened by negative emotions, it seems to work better when you feel happy or satisfied. A little excitement and extra enjoyable activity around the holidays may actually be good for you.

Keeping the holidays meaningful can also have health benefits. Study after study has shown that spiritual or emotional support strengthens a person's immune system, and that stress is alleviated by the presence of caring people.

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