Understanding what makes your symptoms better or worse can be helpful when you’re managing a long-term condition. Identifying triggers can help you to:

• understand your gMG so that you can manage it in a personalized way
• feel more empowered and confident about managing gMG
• be more proactive in managing your symptoms day to day

Tracking can help you to identify your triggers. This means regularly keeping a note of your symptoms and anything that makes them better or worse. It’s often easier to see these patterns when you have a record you can look at.
You can track in any way that works for you, for example:

• keeping notes in a standard diary
• using your calendar app
• typing notes on your computer or phone
• using a speech-to-text app – this could be helpful if writing or typing is difficult

The notes don’t have to be long and can include your symptoms — noting when you experience them, what you’ve been doing – for example, any physical activity, what you’ve eaten, your mood, or any external factors you’ve noticed like hot/cold temperatures, illness, or lack of sleep.

You can’t always avoid triggers, but you can often take steps to limit some of them. Here are some quick tips for managing common triggers.

• Prevent poor sleep with some good bedtime habits. Try to get up and go to bed
  at regular times and make sure your bedroom is quiet, dark, relaxing and at a
  comfortable temperature.
• While you can’t always avoid catching a cold or flu, ask your healthcare team
  about the steps you can take to lower infection risk. These may include having
  an annual flu vaccine and other vaccines your healthcare team advises. Always
  get their advice before you have a live vaccine, which is one that contains
  weakened viruses or bacteria.
• Find ways to cope with stress. Stress is a common trigger in gMG and often an
  unavoidable part of life. Worsening symptoms can be a cause of stress, creating
  a vicious cycle. It can be managed through mindful approaches and proactive
  coping strategies. Here are a few techniques for coping with stress that you may
  find useful:
  • Tackle one source of stress at a time – Identify and manage the most apparent 
    source of current stress; once dealt with, move onto the next. This is much 
    easier than trying to deal with everything at once.
  • Indulge in your favorite creative outlets – Put aside time for a creative hobby
    you enjoy, or start a new one. It’s not about simply filling time. A hobby can be a
    powerful form of escapism. Find a relaxing activity you’re passionate about, such
    as art, music, reading or watching sport – it can be extremely calming and self-
    affirming.
  • Tap into your support network – Being around the people who support you and
    are important in your life can be hugely beneficial. They may be open to talking
    about your stresses but their companionship alone can be enough to reduce
    stress and shift your focus towards the positive.
  • Speak with a counselor – Having a sounding board to unload some stress can
    really help. Friends and family members may instinctively try to offer solutions,
    which is not always what you need. Sometimes it’s good to just get things off
    your chest with a counselor who is an expert listener.
  • Humor – It would be too easy to suggest that you can simply laugh away your
    stress, but laughter really is good for the soul. Having a sense of humor and
    seeing the funny side of daily events is more powerful than you may think.

Talk to your healthcare team about any extra support you need with managing
sleep, stress, or other triggers. If you’re finding it difficult to manage stress, or you
have any other questions, speak to your healthcare team as you may need some
extra support. Support groups for people with gMG can be really valuable, too.

A myasthenic crisis is a potentially life-threatening complication of gMG. It 
happens when muscle weakness gets worse and makes breathing difficult, so 
you need support in hospital to breathe. It’s estimated that approximately 
15-20% of people with gMG have a myasthenic crisis at least once in their lives.
Here are some important points to know:

• Manage your triggers 
  Anything that makes your symptoms worse can potentially lead to a myasthenic
  crisis. Infections are the most common triggers. It’s helpful to know your triggers
  and manage them where possible, although there’s no obvious cause for
  myasthenic crisis in one-third to one-half of people.
• Know the signs
  Your healthcare team can tell you about serious warning signs. Make sure you
  know how to get emergency help.
• Get support for symptoms
  Myasthenic crisis typically develops after days or weeks of worsening symptoms,
  so always speak to your healthcare team if you think your symptoms are getting
  worse.
• Stay on track
  Work with your healthcare team to keep to your treatment plan. They can
  support you to lower your risk of both flare-ups and myasthenic crisis.