A cartoon of a woman nurse working at a desk with health insurance rejections.

Woman Petitions Health Insurer After Company Approves — Then Rejects — Her Infusions

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When KFF Health News published an article in August about the “prior authorization hell” Sally Nix said she went through to secure approval from her insurance company for the expensive monthly infusions she needs, we thought her story had a happy ending.

That’s because, after KFF Health News sent questions to Nix’s insurance company, Blue Cross Blue Shield of Illinois, it retroactively approved $36,000 worth of treatments she thought she owed. Even better, she also learned she would qualify for the infusions moving forward.

Good news all around — except it didn’t last for long. After all, this is the U.S. health care system, where even patients with good insurance aren’t guaranteed affordable care.

To recap: For more than a decade, Nix, of Statesville, North Carolina, has suffered from autoimmune diseases, chronic pain, and fatigue, as well as a condition called trigeminal neuralgia, which is marked by bouts of electric shock-like pain that’s so intense it’s commonly known as the “suicide disease.”

“It is a pain that sends me to my knees,” Nix said in October. “My entire family’s life is controlled by the betrayal of my body. We haven’t lived normally in 10 years.”

Late in 2022, Nix started receiving intravenous immunoglobulin infusions to treat her diseases. She started walking two miles a day with her service dog. She could picture herself celebrating, free from pain, at her daughter’s summer 2024 wedding.

“I was so hopeful,” she said.

But a few months after starting those infusions, she found out that her insurance company wouldn’t cover their cost anymore. That’s when she started “raising Cain about it” on Instagram and Facebook.

You probably know someone like Sally Nix — someone with a chronic or life-threatening illness whose doctor says they need a drug, procedure, or scan, and whose insurance company has replied: No.

Prior authorization was conceived decades ago to rein in health care costs by eliminating duplicative and ineffective treatment. Not only does overtreatment waste billions of dollars every year, but doctors acknowledge it also potentially harms patients.

However, critics worry that prior authorization has now become a way for health insurance companies to save money, sometimes at the expense of patients’ lives. KFF Health News has heard from hundreds of people in the past year relating their prior authorization horror stories.

When we first met Nix, she was battling her insurance company to regain authorization for her infusions. She’d been forced to pause her treatments, unable to afford $13,000 out-of-pocket for each infusion.

Finally, it seemed like months of her hard work had paid off. In July, Nix was told by staff at both her doctor’s office and her hospital that Blue Cross Blue Shield of Illinois would allow her to restart treatment. Her balance was marked “paid” and disappeared from the insurer’s online portal.

But the day after the KFF Health News story was published, Nix said, she learned the message had changed. After restarting treatment, she received a letter from the insurer saying her diagnoses didn’t actually qualify her for the infusions. It felt like health insurance whiplash.

“They’re robbing me of my life,” she said. “They’re robbing me of so much, all because of profit.”

Dave Van de Walle, a spokesperson for Blue Cross Blue Shield of Illinois, said the company would not discuss individual patients’ cases.

“Prior authorization is often a requirement for certain treatments,” Van de Walle said in a written statement, “and BCBSIL administers benefits according to medical policy and the employer’s benefit.”

But Nix is a Southern woman of the “Steel Magnolia” variety. In other words, she’s not going down without a fight.

In September, she called out her insurance company’s tactics in a http://change.org/ campaign that has garnered more than 21,000 signatures. She has also filed complaints against her insurance company with the U.S. Department of Health and Human Services, U.S. Department of Labor, Illinois Department of Insurance, and Illinois attorney general.

Even so, Nix said, she feels defeated.

Not only is she still waiting for prior authorization to restart her immunoglobulin infusions, but her insurance company recently required Nix to secure preapproval for another treatment — routine numbing injections she has received for nearly 10 years to treat the nerve pain caused by trigeminal neuralgia.

“It is reprehensible what they’re doing. But they’re not only doing it to me,” said Nix, who is now reluctantly taking prescription opioids to ease her pain. “They’re doing it to other patients. And it’s got to stop.”

Do you have an experience with prior authorization you’d like to share? Click here to tell your story.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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  • Men have a biological clock too. Here’s what’s more likely when dads are over 50

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    We hear a lot about women’s biological clock and how age affects the chance of pregnancy.

    New research shows men’s fertility is also affected by age. When dads are over 50, the risk of pregnancy complications increases.

    Data from more than 46 million births in the United States between 2011 and 2022 compared fathers in their 30s with fathers in their 50s.

    While taking into account the age of the mother and other factors known to affect pregnancy outcomes, the researchers found every ten-year increase in paternal age was linked to more complications.

    The researchers found that compared to couples where the father was aged 30–39, for couples where the dad was in his 50s, there was a:

    • 16% increased risk of preterm birth
    • 14% increased risk of low birth weight
    • 13% increase in gestational diabetes.

    The older fathers were also twice as likely to have used assisted reproductive technology, including IVF, to conceive than their younger counterparts.

    Steven van Loy/Unsplash

    Dads are getting older

    In this US study, the mean age of all fathers increased from 30.8 years in 2011 to 32.1 years in 2022.

    In that same period, the proportion of men aged 50 years or older fathering a child increased from 1.1% to 1.3%.

    We don’t know the proportion of men over 50 years who father children in Australia, but data shows the average age of fathers has increased.

    In 1975 the median age of Australian dads was 28.6 years. This jumped to 33.7 years in 2022.

    How male age affects getting pregnant

    As we know from media reports of celebrity dads, men produce sperm from puberty throughout life and can father children well into old age.

    However, there is a noticeable decline in sperm quality from about age 40.

    Female partners of older men take longer to achieve pregnancy than those with younger partners.

    A study of the effect of male age on time to pregnancy showed women with male partners aged 45 or older were almost five times more likely to take more than a year to conceive compared to those with partners aged 25 or under. More than three quarters (76.8%) of men under the age of 25 years impregnated their female partners within six months, compared with just over half (52.9%) of men over the age of 45.

    Pooled data from ten studies showed that partners of older men are also more likely to experience miscarriage. Compared to couples where the male was aged 25 to 29 years, paternal age over 45 years increased the risk of miscarriage by 43%.

    Older men are more likely to need IVF

    Outcomes of assisted reproductive technology, such as IVF, are also influenced by the age of the male partner.

    A review of studies in couples using assisted reproductive technologies found paternal age under 40 years reduced the risk of miscarriage by about 25% compared to couples with men aged over 40.

    Having a male under 40 years also almost doubled the chance of a live birth per treatment cycle. With a man over 40, 17.6% of treatment rounds resulted in a live birth, compared to 28.4% when the male was under 40.

    How does male age affect the health outcomes of children?

    As a result of age-related changes in sperm DNA, the children of older fathers have increased risk of a number of conditions. Autism, schizophrenia, bipolar disorders and leukaemia have been linked to the father’s advanced years.

    A review of studies assessing the impact of advanced paternal age reported that children of older fathers have increased rates of psychiatric disease and behavioural impairments.

    But while the increased risk of adverse health outcomes linked to older paternal age is real, the magnitude of the effect is modest. It’s important to remember that an increase in a very small risk is still a small risk and most children of older fathers are born healthy and develop well.

    Improving your health can improve your fertility

    In addition to the effects of older age, some chronic conditions that affect fertility and reproductive outcomes become more common as men get older. They include obesity and diabetes which affect sperm quality by lowering testosterone levels.

    While we can’t change our age, some lifestyle factors that increase the risk of pregnancy complications and reduce fertility, can be tackled. They include:

    Get the facts about the male biological clock

    Research shows men want children as much as women do. And most men want at least two children.

    Yet most men lack knowledge about the limitations of female and male fertility and overestimate the chance of getting pregnant, with and without assisted reproductive technologies.

    We need better public education, starting at school, to improve awareness of the impact of male and female age on reproductive outcomes and help people have healthy babies.

    For men wanting to improve their chance of conceiving, the government-funded sites Healthy Male and Your Fertility are a good place to start. These offer evidence-based and accessible information about reproductive health, and tips to improve your reproductive health and give your children the best start in life.

    Karin Hammarberg, Senior Research Fellow, Global and Women’s Health, School of Public Health & Preventive Medicine, Monash University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • No, sugar doesn’t make your kids hyperactive

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    It’s a Saturday afternoon at a kids’ birthday party. Hordes of children are swarming between the spread of birthday treats and party games. Half-eaten cupcakes, biscuits and lollies litter the floor, and the kids seem to have gained superhuman speed and bounce-off-the-wall energy. But is sugar to blame?

    The belief that eating sugary foods and drinks leads to hyperactivity has steadfastly persisted for decades. And parents have curtailed their children’s intake accordingly.

    Balanced nutrition is critical during childhood. As a neuroscientist who has studied the negative effects of high sugar “junk food” diets on brain function, I can confidently say excessive sugar consumption does not have benefits to the young mind. In fact, neuroimaging studies show the brains of children who eat more processed snack foods are smaller in volume, particularly in the frontal cortices, than those of children who eat a more healthful diet.

    But today’s scientific evidence does not support the claim sugar makes kids hyperactive.

    Sharomka/Shutterstock

    The hyperactivity myth

    Sugar is a rapid source of fuel for the body. The myth of sugar-induced hyperactivity can be traced to a handful of studies conducted in the 1970s and early 1980s. These were focused on the Feingold Diet as a treatment for what we now call Attention Deficit Hyperactivity Disorder (ADHD), a neurodivergent profile where problems with inattention and/or hyperactivity and impulsivity can negatively affect school, work or relationships.

    Devised by American paediatric allergist Benjamin Feingold, the diet is extremely restrictive. Artificial colours, sweeteners (including sugar) and flavourings, salicylates including aspirin, and three preservatives (butylated hydroxyanisole, butylated hydroxytoluene, and tert-Butrylhdryquinone) are eliminated.

    Salicylates occur naturally in many healthy foods, including apples, berries, tomatoes, broccoli, cucumbers, capsicums, nuts, seeds, spices and some grains. So, as well as eliminating processed foods containing artificial colours, flavours, preservatives and sweeteners, the Feingold diet eliminates many nutritious foods helpful for healthy development.

    However, Feingold believed avoiding these ingredients improved focus and behaviour. He conducted some small studies, which he claimed showed a large proportion of hyperactive children responded favourably to his diet.

    bowls of lollies on table
    Even it doesn’t make kids hyperactive, they shouldn’t have too much sugar. DenisMArt/Shutterstock

    Flawed by design

    The methods used in the studies were flawed, particularly with respect to adequate control groups (who did not restrict foods) and failed to establish a causal link between sugar consumption and hyperactive behaviour.

    Subsequent studies suggested less than 2% responded to restrictions rather than Feingold’s claimed 75%. But the idea still took hold in the public consciousness and was perpetuated by anecdotal experiences.

    Fast forward to the present day. The scientific landscape looks vastly different. Rigorous research conducted by experts has consistently failed to find a connection between sugar and hyperactivity. Numerous placebo-controlled studies have demonstrated sugar does not significantly impact children’s behaviour or attention span.

    One landmark meta-analysis study, published almost 20 years ago, compared the effects of sugar versus a placebo on children’s behaviour across multiple studies. The results were clear: in the vast majority of studies, sugar consumption did not lead to increased hyperactivity or disruptive behaviour.

    Subsequent research has reinforced these findings, providing further evidence sugar does not cause hyperactivity in children, even in those diagnosed with ADHD.

    While Feingold’s original claims were overstated, a small proportion of children do experience allergies to artificial food flavourings and dyes.

    Pre-school aged children may be more sensitive to food additives than older children. This is potentially due to their smaller body size, or their still-developing brain and body.

    Hooked on dopamine?

    Although the link between sugar and hyperactivity is murky at best, there is a proven link between the neurotransmitter dopamine and increased activity.

    The brain releases dopamine when a reward is encountered – such as an unexpected sweet treat. A surge of dopamine also invigorates movement – we see this increased activity after taking psychostimulant drugs like amphetamine. The excited behaviour of children towards sugary foods may be attributed to a burst of dopamine released in expectation of a reward, although the level of dopamine release is much less than that of a psychostimulant drug.

    Dopamine function is also critically linked to ADHD, which is thought to be due to diminished dopamine receptor function in the brain. Some ADHD treatments such as methylphenidate (labelled Ritalin or Concerta) and lisdexamfetamine (sold as Vyvanse) are also psychostimulants. But in the ADHD brain the increased dopamine from these drugs recalibrates brain function to aid focus and behavioural control.

    girl in yellow top licks large lollipop while holding a pink icecream
    Maybe it’s less of a sugar rush and more of a dopamine rush? Anastasiya Tsiasemnikava/Shutterstock

    Why does the myth persist?

    The complex interplay between diet, behaviour and societal beliefs endures. Expecting sugar to change your child’s behaviour can influence how you interpret what you see. In a study where parents were told their child had either received a sugary drink, or a placebo drink (with a non-sugar sweetener), those parents who expected their child to be hyperactive after having sugar perceived this effect, even when they’d only had the sugar-free placebo.

    The allure of a simple explanation – blaming sugar for hyperactivity – can also be appealing in a world filled with many choices and conflicting voices.

    Healthy foods, healthy brains

    Sugar itself may not make your child hyperactive, but it can affect your child’s mental and physical health. Rather than demonising sugar, we should encourage moderation and balanced nutrition, teaching children healthy eating habits and fostering a positive relationship with food.

    In both children and adults, the World Health Organization (WHO) recommends limiting free sugar consumption to less than 10% of energy intake, and a reduction to 5% for further health benefits. Free sugars include sugars added to foods during manufacturing, and naturally present sugars in honey, syrups, fruit juices and fruit juice concentrates.

    Treating sugary foods as rewards can result in them becoming highly valued by children. Non-sugar rewards also have this effect, so it’s a good idea to use stickers, toys or a fun activity as incentives for positive behaviour instead.

    While sugar may provide a temporary energy boost, it does not turn children into hyperactive whirlwinds.

    Amy Reichelt, Senior Lecturer (Adjunct), Nutritional neuroscientist, University of Adelaide

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Reflexology: What The Science Says

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    How Does Reflexology Work, Really?

    In Wednesday’s newsletter, we asked you for your opinion of reflexology, and got the above-depicted, below-described set of responses:

    • About 63% said “It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely”
    • About 26% said “It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health“
    • About 11% said “It works by placebo, at best, and has no evidence for any efficacy beyond that”

    So, what does the science say?

    It works by realigning the body’s energies (e.g. qi, ki, prana, etc), removing blockages and improving health: True or False?

    False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

    Further, there is no reliable scientific evidence for the existence of qi, ki, prana, soma, mana, or whatever we want to call it.

    To save doubling up, we did discuss this in some more detail, exploring the notion of qi as bioelectrical energy, including a look at some unreliable clinical evidence for it (a study that used shoddy methodology, but it’s important to understand what they did wrong, to watch out for such), when we looked at [the legitimately very healthful practice of] qigong, a couple of weeks ago:

    Qigong: A Breath Of Fresh Air?

    As for reflexology specifically: in terms of blockages of qi causing disease (and thus being a putative therapeutic mechanism of action for attenuating disease), it’s an interesting hypothesis but in terms of scientific merit, it was pre-emptively supplanted by germ theory and other similarly observable-and-measurable phenomena.

    We say “pre-emptively”, because despite orientalist marketing, unless we want to count some ancient pictures of people getting a foot massage and say it is reflexology, there is no record of reflexology being a thing before 1913 (and that was in the US, by a laryngologist working with a spiritualist to produce a book that they published in 1917).

    It works by specific nerves connecting the feet and hands to various specific organs, triggering healing remotely: True or False?

    False, or since we can’t prove a negative: there is no reliable scientific evidence for this.

    A very large independent review of available scientific literature found the current medical consensus on reflexology is that:

    • Reflexology is effective for: anxiety (but short lasting), edema, mild insomnia, quality of sleep, and relieving pain (short term: 2–3 hours)
    • Reflexology is not effective for: inflammatory bowel disease, fertility treatment, neuropathy and polyneuropathy, acute low back pain, sub acute low back pain, chronic low back pain, radicular pain syndromes (including sciatica), post-operative low back pain, spinal stenosis, spinal fractures, sacroiliitis, spondylolisthesis, complex regional pain syndrome, trigger points / myofascial pain, chronic persistent pain, chronic low back pain, depression, work related injuries of the hip and pelvis

    Source: Reflexology – a scientific literary review compilation

    (the above is a fascinating read, by the way, and its 50 pages go into a lot more detail than we have room to here)

    Now, those items that they found it effective for, looks suspiciously like a short list of things that placebo is often good for, and/or any relaxing activity.

    Another review was not so generous:

    ❝The best evidence available to date does not demonstrate convincingly that reflexology is an effective treatment for any medical condition❞

    ~ Dr. Edzard Ernst (MD, PhD, FMedSci)

    Source: Is reflexology an effective intervention? A systematic review of randomised controlled trials

    In short, from the available scientific literature, we can surmise:

    • Some researchers have found it to have some usefulness against chiefly psychosomatic conditions
    • Other researchers have found the evidence for even that much to be uncompelling

    It works by placebo, at best, and has no evidence for any efficacy beyond that: True or False?

    Mostly True; of course reflexology runs into similar problems as acupuncture when it comes to testing against placebo:

    How Does One Test Acupuncture Against Placebo Anyway?

    …but not quite as bad, since it is easier to give a random foot massage while pretending it is a clinical treatment, than to fake putting needles into key locations.

    However, as the paper we cited just above (in answer to the previous True/False question) shows, reflexology does not appear to meaningfully outperform placebo—which points to the possibility that it does work by placebo, and is just a placebo treatment on the high end of placebo (because the placebo effect is real, does work, isn’t “nothing”, and some placebos work better than others).

    For more on the fascinating science and useful (applicable in daily life!) practicalities of how placebo does work, check out:

    How To Leverage Placebo Effect For Yourself

    Take care!

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  • Not all ultra-processed foods are bad for your health, whatever you might have heard

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    In recent years, there’s been increasing hype about the potential health risks associated with so-called “ultra-processed” foods.

    But new evidence published this week found not all “ultra-processed” foods are linked to poor health. That includes the mass-produced wholegrain bread you buy from the supermarket.

    While this newly published research and associated editorial are unlikely to end the wrangling about how best to define unhealthy foods and diets, it’s critical those debates don’t delay the implementation of policies that are likely to actually improve our diets.

    What are ultra-processed foods?

    Ultra-processed foods are industrially produced using a variety of processing techniques. They typically include ingredients that can’t be found in a home kitchen, such as preservatives, emulsifiers, sweeteners and/or artificial colours.

    Common examples of ultra-processed foods include packaged chips, flavoured yoghurts, soft drinks, sausages and mass-produced packaged wholegrain bread.

    In many other countries, ultra-processed foods make up a large proportion of what people eat. A recent study estimated they make up an average of 42% of total energy intake in Australia.

    How do ultra-processed foods affect our health?

    Previous studies have linked increased consumption of ultra-processed food with poorer health. High consumption of ultra-processed food, for example, has been associated with a higher risk of type 2 diabetes, and death from heart disease and stroke.

    Ultra-processed foods are typically high in energy, added sugars, salt and/or unhealthy fats. These have long been recognised as risk factors for a range of diseases.

    Bowl of chips
    Ultra-processed foods are usually high is energy, salt, fat, or sugar. Olga Dubravina/Shutterstock

    It has also been suggested that structural changes that happen to ultra-processed foods as part of the manufacturing process may lead you to eat more than you should. Potential explanations are that, due to the way they’re made, the foods are quicker to eat and more palatable.

    It’s also possible certain food additives may impair normal body functions, such as the way our cells reproduce.

    Is it harmful? It depends on the food’s nutrients

    The new paper just published used 30 years of data from two large US cohort studies to evaluate the relationship between ultra-processed food consumption and long-term health. The study tried to disentangle the effects of the manufacturing process itself from the nutrient profile of foods.

    The study found a small increase in the risk of early death with higher ultra-processed food consumption.

    But importantly, the authors also looked at diet quality. They found that for people who had high quality diets (high in fruit, vegetables, wholegrains, as well as healthy fats, and low in sugary drinks, salt, and red and processed meat), there was no clear association between the amount of ultra-processed food they ate and risk of premature death.

    This suggests overall diet quality has a stronger influence on long-term health than ultra-processed food consumption.

    Man cooks
    People who consume a healthy diet overall but still eat ultra-processed foods aren’t at greater risk of early death. Grusho Anna/Shutterstock

    When the researchers analysed ultra-processed foods by sub-category, mass-produced wholegrain products, such as supermarket wholegrain breads and wholegrain breakfast cereals, were not associated with poorer health.

    This finding matches another recent study that suggests ultra-processed wholegrain foods are not a driver of poor health.

    The authors concluded, while there was some support for limiting consumption of certain types of ultra-processed food for long-term health, not all ultra-processed food products should be universally restricted.

    Should dietary guidelines advise against ultra-processed foods?

    Existing national dietary guidelines have been developed and refined based on decades of nutrition evidence.

    Much of the recent evidence related to ultra-processed foods tells us what we already knew: that products like soft drinks, alcohol and processed meats are bad for health.

    Dietary guidelines generally already advise to eat mostly whole foods and to limit consumption of highly processed foods that are high in refined grains, saturated fat, sugar and salt.

    But some nutrition researchers have called for dietary guidelines to be amended to recommend avoiding ultra-processed foods.

    Based on the available evidence, it would be difficult to justify adding a sweeping statement about avoiding all ultra-processed foods.

    Advice to avoid all ultra-processed foods would likely unfairly impact people on low-incomes, as many ultra-processed foods, such as supermarket breads, are relatively affordable and convenient.

    Wholegrain breads also provide important nutrients, such as fibre. In many countries, bread is the biggest contributor to fibre intake. So it would be problematic to recommend avoiding supermarket wholegrain bread just because it’s ultra-processed.

    So how can we improve our diets?

    There is strong consensus on the need to implement evidence-based policies to improve population diets. This includes legislation to restrict children’s exposure to the marketing of unhealthy foods and brands, mandatory Health Star Rating nutrition labelling and taxes on sugary drinks.

    Softdrink on supermarket shelf
    Taxes on sugary drinks would reduce their consumption. MDV Edwards/Shutterstock

    These policies are underpinned by well-established systems for classifying the healthiness of foods. If new evidence unfolds about mechanisms by which ultra-processed foods drive health harms, these classification systems can be updated to reflect such evidence. If specific additives are found to be harmful to health, for example, this evidence can be incorporated into existing nutrient profiling systems, such as the Health Star Rating food labelling scheme.

    Accordingly, policymakers can confidently progress food policy implementation using the tools for classifying the healthiness of foods that we already have.

    Unhealthy diets and obesity are among the largest contributors to poor health. We can’t let the hype and academic debate around “ultra-processed” foods delay implementation of globally recommended policies for improving population diets.

    Gary Sacks, Professor of Public Health Policy, Deakin University; Kathryn Backholer, Co-Director, Global Centre for Preventive Health and Nutrition, Deakin University; Kathryn Bradbury, Senior Research Fellow in the School of Population Health, University of Auckland, Waipapa Taumata Rau, and Sally Mackay, Senior Lecturer Epidemiology and Biostatistics, University of Auckland, Waipapa Taumata Rau

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

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  • Healthy Relationship, Healthy Life

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    Only One Kind Of Relationship Promotes Longevity This Much!

    One of the well-established keys of a long healthy life is being in a fulfilling relationship. That’s not to say that one can’t be single and happy and fulfilled—one totally can. But statistically, those who live longest, do so in happy, fulfilling, committed relationships.

    Note: happy, fulfilling, committed relationships. Less than that won’t do. Your insurance company might care about your marital status for its own sake, but your actual health doesn’t—it’s about the emotional safety and security that a good, healthy, happy, fulfilling relationship offers.

    How to keep the “love coals” warm

    When “new relationship energy” subsides and we’ve made our way hand-in-hand through the “honeymoon period”, what next? For many, a life of routine. And that’s not intrinsically bad—routine itself can be comforting! But for love to work, according to relational psychologists, it also needs something a little more.

    What things? Let’s break it down…

    Bids for connection—and responsiveness to same

    There’s an oft-quoted story about a person who knew their marriage was over when their spouse wouldn’t come look at their tomatoes. That may seem overblown, but…

    When we care about someone, we want to share our life with them. Not just in the sense of cohabitation and taxes, but in the sense of:

    • Little moments of joy
    • Things we learned
    • Things we saw
    • Things we did

    …and there’s someone we’re first to go to share these things with. And when we do, that’s a “bid for connection”. It’s important that we:

    • Make bids for connection frequently
    • Respond appropriately to our partner’s bids for connection

    Of course, we cannot always give everything our full attention. But whenever we can, we should show as much genuine interest as we can.

    Keep asking the important questions

    Not just “what shall we have for dinner?”, but:

    • “What’s a life dream that you have at the moment?”
    • “What are the most important things in life?”
    • “What would you regret not doing, if you never got the chance?”

    …and so forth. Even after many years with a partner, the answers can sometimes surprise us. Not because we don’t know our partners, but because the answers can change with time, and sometimes we can even surprise ourselves, if it’s a question we haven’t considered for a while.

    It’s good to learn and grow like this together—and to keep doing so!

    Express gratitude/appreciation

    For the little things as well as the big:

    • Thank you for staying by my side during life’s storms
    • Thank you for bringing me a coffee
    • Thank you for taking on these responsibilities with me
    • I really appreciate your DIY skills
    • I really appreciate your understanding nature

    On which note…

    Compliment, often and sincerely

    Most importantly, compliment things intrinsic to their character, not just peripheral attributes like appearance, and also not just what they do for you.

    • You’re such a patient person; I really admire that
    • I really hit the jackpot to get someone I can trust so completely as you
    • You are the kindest and sweetest soul I have ever encountered in life
    • I love that you have such a blend of strength and compassion
    • Your unwavering dedication to your personal values makes me so proud

    …whatever goes for your partner and how you see them and what you love about them!

    Express your needs, and ask about theirs

    We’re none of us mind-readers, and it’s easy to languish in “if they really cared, I wouldn’t have to ask”, or conversely, “if they wanted something, they would surely say so”.

    Communicate. Effectively. Life is too short to waste in miscommunication and unsaid things!

    We covered much more detailed how-tos of this in a previous issue, but good double-whammy of top tier communication is:

    • “I need…” / “Please will you…”
    • “What do you need?” / “How can I help?”

    Touch. Often.

    It takes about 20 seconds of sustained contact for oxytocin to take effect, so remember that when you hug your partner, hold hands when walking, or cuddle up the sofa.

    Have regular date nights

    It doesn’t have to be fancy. A date night can be cooking together, it can be watching a movie together at home. It can be having a scheduled time to each bring a “big question” or five, from what we talked about above!

    Most importantly: it’s a planned shared experience where the intent is to enjoy each other’s romantic company, and have a focus on each other. Having a regularly recurring date night, be it the last day of each month, or every second Saturday, or every Friday night, whatever your schedules allow, makes such a big difference to feel you are indeed “dating” and in the full flushes of love—not merely cohabiting pleasantly.

    Want ideas?

    Check out these:

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  • Get Better Sleep: Beyond “Sleep Hygiene”

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    Better Sleep, Better Life!

    This is Arianna Huffington. Yes, that Huffington, of the Huffington Post. But! She’s also the CEO of Thrive Global, a behavior change tech company with the mission of changing the way we work and live—in particular, by challenging the idea that burnout is the required price of success.

    The power of better sleep

    Sleep is a very important, but most often neglected, part of good health. Here are some of Huffington’s top insights from her tech company Thrive, and as per her “Sleep Revolution” initiative.

    Follow your circadian rhythm

    Are you a night owl or a morning lark? Whichever it is, roll with it, and plan around that if your lifestyle allows for such. While it is possible to change from one to the other, we do have a predisposition towards one or the other, and will generally function best when not fighting it.

    This came about, by the way, because we evolved to have half of us awake in the mornings and half in the evenings, to keep us all safe. Socially we’ve marched onwards from that point in evolutionary history, but our bodies are about a hundred generations behind the times, and that’s just what we have to work with!

    Don’t be afraid (or ashamed!) to take naps

    Naps, done right, can be very good for the health—especially if we had a bad night’s sleep the previous night.

    Thrive found that workers are more productive when they have nap rooms, and (following on a little from the previous point) are allowed to sleep in or work from home.

    See also: How To Nap Like A Pro (No More “Sleep Hangovers”!)

    Make sure you have personal space available in bed

    The correlation between relationship satisfaction and sleeping close to one’s partner has been found to be so high that it’s even proportional: the further away a couple sleeps from each other, the less happy they are. But…

    Partners who got good sleep the previous night, will be more likely to want intimacy on any given night—at a rate of an extra 14% per extra hour of sleep the previous night. So, there’s a trade-off, as having more room in bed tends to result in better sleep. Time to get a bigger bed?

    What gets measured, gets done

    This goes for sleep, too! Not only does dream-journaling in the morning cue your subconscious to prepare to dream well the following night, but also, sleep trackers and sleep monitoring apps go a very long way to improving sleep quality, even if no extra steps are consciously taken to “score better”.

    We’ve previously reviewed some of the most popular sleep apps; you can check out for yourself how they measured up:

    Time For Some Pillow Talk: The Head-To-Head Of Google and Apple’s Top Apps For Getting Your Head Down

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