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I have had gMG since 2017. The first year or so I was taking 60mg pyridostigmine 4 times per day. The frequent night time leg and foot cramps were horrible, and I had to stand up to relieve the tension in my muscles. Then, I read a post on this forum that was written by a fellow who converted to cellcept. Now, I take 2 pyridostigmine before noon, and 2 cellcept (500mg) in the afternoon. This combination works wonders for me. A daily rest/nap period helps too. Since each patient is unique, some experimentation regarding medication and performance of daily activities is probably necessary to determine “what is best for you”. Yes, as Charlie Harper would say, “I understand”.