I'm so frustrated! As this disease has progressed for me My tolerance to exertion has greatly reduced. Now it's at the point that sometimes even sitting up the wrong way triggers PEM. But my PEM is not malaise- it's the opposite. I get very revved up, like my finger is in a light socket; nerve pain, wide awake, shaking, buzzing, tinnitus etc..- and it always happens when I'm falling asleep. Now because of this not only am I not sleeping but the PEM itself is exerting energy! Then because i just exerted so much energy I over exerted and it causes another PEM episode and so on.... I do NOTHING all day to try and rest but can't break this cycle. I'm just descending further into ME hell and it's perpetuating itself.