The Worst Way to Wake Up (and What to Do Instead)

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Not everyone is naturally inclined to be a morning person, but there are things we can do to make things go more easily for our brains!

Cause for alarm?

Dr. Tracey Marks, psychiatrist, explains the impact of our first moments upon awakening, and what that can do to/for us in terms of sleep inertia (i.e. grogginess).

Sleep inertia is worse when waking from deep sleep—and notably, we don’t naturally wake directly from deep sleep unless we are externally aroused (e.g. by an alarm clock).

Dr. Marks suggests the use of more gradual alarms, including those with soft melodies, perhaps birdsong or other similarly gentle things (artificial sunlight alarms are also good), to ease our transition from sleeping to waking. It might take us a few minutes longer to be woken from sleep, but we’re not going to spend the next hour in a bleary-eyed stupor.

For more details on these things and more (including why not to hit “snooze”), enjoy:

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Want to learn more?

You might also like to read:

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  • 25 Healthy Habits That Will Change Your Life

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    Cori Lefkowith, of “Redefining Strength” and “Strong At Every Age” fame, has compiled a list of the simple habits that make a big difference, and here they are!

    The Tips

    Her recommendations include…

    • The healthy activities you’re most prone to skipping? Do those first
    • Create staple meals… Consciously! This means: instead of getting into a rut of cooking the same few things in rotation because it’s what you have the ingredients in for, consciously and deliberately make a list of at least 7 meals that, between them, constitute a healthy balanced diet, and choose to make them your staples. That doesn’t mean don’t eat anything else (indeed, variety is good!) but having a robust collection of healthy staples to fall back on will help you avoid falling into unhealthy eating traps.
    • Schedule time for healthy activities that you love. Instead of thinking “it would be nice to…”, actually figure out a timeslot, plan in advance, making it recurring, and do it!
    • Have (healthy!) no-spoil food options always available. No-spoil doesn’t have to mean “won’t spoil ever”, but does mean at least that it has a long shelf-life. Nuts are a good example, assuming you’re not allergic. Sundried fruits are good too; not nearly as good as fresh fruit, but a lot better than some random processed snack because it’s what in. If you eat fish, then see if you can get dried fish in; it’s high in protein and keeps for a very long time indeed.
    • Stock up on spices! Not only do they all have great health-giving properties (at least, we can’t think of a refutation by counterexample, Arrakis be damned), but also, they literally spice up our culinary repertoire, and bring joy to cooking and eating healthy food.

    If you like these, check out the rest:

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    Further reading

    For more about actually making habits stick quickly and reliably,enjoy:

    How To Really Pick Up (And Keep!) Those Habits

    Take care!

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  • Semaglutide for Weight Loss?

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    Semaglutide for weight loss?

    Semaglutide is the new kid on the weight-loss block, but it’s looking promising (with some caveats!).

    Most popularly by brand names Ozempic and Wegovy, it was first trialled to help diabetics*, and is now sought-after by the rest of the population too. So far, only Wegovy is FDA-approved for weight loss. It contains more semaglutide than Ozempic, and was developed specifically for weight loss, rather than for diabetes.

    *Specifically: diabetics with type 2 diabetes. Because it works by helping the pancreas to make insulin, it’s of no help whatsoever to T1D folks, sadly. If you’re T1D and reading this though, today’s book of the day is for you!

    First things first: does it work as marketed for diabetes?

    It does! At a cost: a very common side effect is gastrointestinal problems—same as for tirzepatide, which (like semaglutide) is a GLP-1 agonist, meaning it works the same way. Here’s how they measure up:

    As you can see, both of them work wonders for pancreatic function and insulin sensitivity!

    And, both of them were quite unpleasant for around 20% of participants:

    ❝Tirzepatide, oral and SC semaglutide has a favourable efficacy in treating T2DM. Gastrointestinal adverse events were highly recorded in tirzepatide, oral and SC semaglutide groups.❞

    ~ Zaazouee et al., 2022

    What about for weight loss, if not diabetic?

    It works just the same! With just the same likelihood of gastro-intestinal unpleasantries, though. There’s a very good study that was done with 1,961 overweight adults; here it is:

    Once-Weekly Semaglutide in Adults with Overweight or Obesity

    The most interesting things here are the positive results and the side effects:

    ❝The mean change in body weight from baseline to week 68 was −14.9% in the semaglutide group as compared with −2.4% with placebo, for an estimated treatment difference of −12.4 percentage points (95% confidence interval [CI], −13.4 to −11.5; P<0.001).❞

    ~ Wilding et al., 2021

    In other words: if you take this, you’re almost certainly going to get something like 6x better weight loss results than doing the same thing without it.

    ❝Nausea and diarrhea were the most common adverse events with semaglutide; they were typically transient and mild-to-moderate in severity and subsided with time. More participants in the semaglutide group than in the placebo group discontinued treatment owing to gastrointestinal events (59 [4.5%] vs. 5 [0.8%])❞

    ~ ibid.

    In other words: you have about a 3% chance of having unpleasant enough side effects that you don’t want to continue treatment (contrast this with the 20%ish chance of unpleasant side effects of any extent)!

    Any other downsides we should know about?

    If you stop taking it, weight regain is likely. For example, a participant in one of the above-mentioned studies who lost 22% of her body weight with the drug’s help, says:

    ❝Now that I am no longer taking the drug, unfortunately, my weight is returning to what it used to be. It felt effortless losing weight while on the trial, but now it has gone back to feeling like a constant battle with food. I hope that, if the drug can be approved for people like me, my [doctor] will be able to prescribe the drug for me in the future.❞

    ~ Jan, a trial participant at UCLH

    Source: Gamechanger drug for treating obesity cuts body weight by 20% <- University College London Hospitals (NHS)

    Is it injection-only, or is there an oral option?

    An oral option exists, but (so far) is on the market only in the form of Rybelsus, another (slightly older) drug containing semaglutide, and it’s (so far) only FDA-approved for diabetes, not for weight loss. See:

    A new era for oral peptides: SNAC and the development of oral semaglutide for the treatment of type 2 diabetes ← for the science

    FDA approves first oral GLP-1 treatment for type 2 diabetes ← For the FDA statement

    Where can I get these?

    Availability and prescribing regulations vary by country (because the FDA’s authority stops at the US borders), but here is the website for each of them if you’d like to learn more / consider if they might help you:

    Rybelsus / Ozempic / Wegovy

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  • Widen the Window – by Dr. Elizabeth Stanley

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    Firstly, about the title… That “window” that the author bids us “widen” is not a flowery metaphor, but rather, is referring to the window of exhibited resilience to stress/trauma; the “window” in question looks like an “inverted U” bell-curve on the graph.

    In other words: Dr. Stanley’s main premise here is that we respond best to moderate stress (i.e: in that window, the area under the curve!), but if there is too little or too much, we don’t do so well. The key, she argues, is widening that middle part (expanding the area under the curve) in which we perform optimally. That way, we can still function in a motivated fashion without extrinsic threats, and we also don’t collapse under the weight of overwhelm, either.

    The main strength of this book, however, lies in its practical exercises to accomplish that—and more.

    “And more”, because the subtitle also promised recovery from trauma, and the author delivers in that regard too. In this case, it’s about widening that same window, but this time to allow one’s parasympathetic nervous system to recognize that the traumatic event is behind us, and no longer a threat; we are safe now.

    Bottom line: if you would like to respond better to stress, and/or recover from trauma, this book is a very good tool.

    Click here to check out Widen the Window, and widen yours!

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  • Healing Back Pain – by Dr. John Sarno

    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.

    Often when we review books with titles like this one, we preface it with a “what it’s not: a think-yourself-better book”.

    In this case… It is, in fact, a think-yourself-better book. However, its many essay-length rave reviews caught our attention, and upon reading, we can report: its ideas are worth reading.

    The focus of this book is on TMS, or “Tension Myoneural Syndrome”, to give it its full name. The author asserts (we cannot comment on the accuracy) that many cases of TMS are misdiagnosed as other things, from sciatica to lupus. When other treatments fail, or are simply not available (no cure for lupus yet, for example) or are unenticing (risky surgeries, for example), he offers an alternative approach.

    Dr. Sarno lays out the case for TMS being internally fixable, since our muscles and nerves are all at the command of our brain. Rather than taking a physical-first approach, he takes a psychological-first approach, before building into a more holistic model.

    The writing style is… A little dated and salesey and unnecessarily padded, to be honest, but the content makes it worthwhile.

    Bottom line: if you have back pain, then the advice of this book, priced not much more than a box of top brand painkillers, seems a very reasonable thing to try.

    Click here to check out Healing Back Pain, and see if it works for you!

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  • Her Mental Health Treatment Was Helping. That’s Why Insurance Cut Off Her Coverage.

    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.

    Reporting Highlights

    • Progress Denials: Insurers use a patient’s improvement to justify denying mental health coverage.
    • Providers Disagree: Therapists argue with insurers and the doctors they employ to continue covering treatment for their patients.
    • Patient Harm: Some patients backslid when insurers cut off coverage for treatment at key moments.

    These highlights were written by the reporters and editors who worked on this story.

    Geneva Moore’s therapist pulled out her spiral notebook. At the top of the page, she jotted down the date, Jan. 30, 2024, Moore’s initials and the name of the doctor from the insurance company to whom she’d be making her case.

    She had only one chance to persuade him, and by extension Blue Cross and Blue Shield of Texas, to continue covering intensive outpatient care for Moore, a patient she had come to know well over the past few months.

    The therapist, who spoke on the condition of anonymity out of fear of retaliation from insurers, spent the next three hours cramming, as if she were studying for a big exam. She combed through Moore’s weekly suicide and depression assessments, group therapy notes and write-ups from their past few sessions together.

    She filled two pages with her notes: Moore had suicidal thoughts almost every day and a plan for how she would take her own life. Even though she expressed a desire to stop cutting her wrists, she still did as often as three times a week to feel the release of pain. She only had a small group of family and friends to offer support. And she was just beginning to deal with her grief and trauma over sexual and emotional abuse, but she had no healthy coping skills.

    Less than two weeks earlier, the therapist’s supervisor had struck out with another BCBS doctor. During that call, the insurance company psychiatrist concluded Moore had shown enough improvement that she no longer needed intensive treatment. “You have made progress,” the denial letter from BCBS Texas read.

    When the therapist finally got on the phone with a second insurance company doctor, she spoke as fast as she could to get across as many of her points as possible.

    “The biggest concern was the abnormal thoughts — the suicidal ideation, self-harm urges — and extensive trauma history,” the therapist recalled in an interview with ProPublica. “I was really trying to emphasize that those urges were present, and they were consistent.”

    She told the company doctor that if Moore could continue on her treatment plan, she would likely be able to leave the program in 10 weeks. If not, her recovery could be derailed.

    The doctor wasn’t convinced. He told the therapist that he would be upholding the initial denial. Internal notes from the BCBS Texas doctors say that Moore exhibited “an absence of suicidal thoughts,” her symptoms had “stabilized” and she could “participate in a lower level of care.”

    The call lasted just seven minutes.

    Moore was sitting in her car during her lunch break when her therapist called to give her the news. She was shocked and had to pull herself together to resume her shift as a technician at a veterinary clinic.

    “The fact that it was effective immediately,” Moore said later, “I think that was the hardest blow of it all.”

    Many Americans must rely on insurers when they or family members are in need of higher-touch mental health treatment, such as intensive outpatient programs or round-the-clock care in a residential facility. The costs are high, and the stakes for patients often are, too. In 2019 alone, the U.S. spent more than $106.5 billion treating adults with mental illness, of which private insurance paid about a third. One 2024 study found that the average quoted cost for a month at a residential addiction treatment facility for adolescents was more than $26,000.

    Health insurers frequently review patients’ progress to see if they can be moved down to a lower — and almost always cheaper — level of care. That can cut both ways. They sometimes cite a lack of progress as a reason to deny coverage, labeling patients’ conditions as chronic and asserting that they have reached their baseline level of functioning. And if they make progress, which would normally be celebrated, insurers have used that against patients to argue they no longer need the care being provided.

    Their doctors are left to walk a tightrope trying to convince insurers that patients are making enough progress to stay in treatment as long as they actually need it, but not so much that the companies prematurely cut them off from care. And when insurers demand that providers spend their time justifying care, it takes them away from their patients.

    “The issues that we grapple with are in the real world,” said Dr. Robert Trestman, the chair of psychiatry and behavioral medicine at the Virginia Tech Carilion School of Medicine and chair of the American Psychiatric Association’s Council on Healthcare Systems and Financing. “People are sicker with more complex conditions.”

    Mental health care can be particularly prone to these progress-based denials. While certain tests reveal when cancer cells are no longer present and X-rays show when bones have healed, psychiatrists say they have to determine whether someone has returned to a certain level of functioning before they can end or change their treatment. That can be particularly tricky when dealing with mental illness, which can be fluid, with a patient improving slightly one day only to worsen the next.

    Though there is no way to know how often coverage gets cut off mid-treatment, ProPublica has found scores of lawsuits over the past decade in which judges have sharply criticized insurance companies for citing a patient’s improvement to deny mental health coverage. In a number of those cases, federal courts ruled that the insurance companies had broken a federal law designed to provide protections for people who get health insurance through their jobs.

    Reporters reviewed thousands of pages of court documents and interviewed more than 50 insiders, lawyers, patients and providers. Over and over, people said these denials can lead to real — sometimes devastating — harm. An official at an Illinois facility with intensive mental health programs said that this past year, two patients who left before their clinicians felt they were ready due to insurance denials had attempted suicide.

    Dr. Eric Plakun, a Massachusetts psychiatrist with more than 40 years of experience in residential and intensive outpatient programs, and a former board member of the American Psychiatric Association, said the “proprietary standards” insurers use as a basis for denying coverage often simply stabilize patients in crisis and “shortcut real treatment.”

    Plakun offered an analogy: If someone’s house is on fire, he said, putting out the fire doesn’t restore the house. “I got a hole in the roof, and the windows have been smashed in, and all the furniture is charred, and nothing’s working electrically,” he said. “How do we achieve recovery? How do we get back to living in that home?”

    Unable to pay the $350-a-day out-of-pocket cost for additional intensive outpatient treatment, Moore left her program within a week of BCBS Texas’ denial. The insurer would only cover outpatient talk therapy.

    During her final day at the program, records show, Moore’s suicidal thoughts and intent to carry them out had escalated from a 7 to a 10 on a 1-to-10 scale. She was barely eating or sleeping.

    A few hours after the session, Moore drove herself to a hospital and was admitted to the emergency room, accelerating a downward spiral that would eventually cost the insurer tens of thousands of dollars, more than the cost of the treatment she initially requested.

    How Insurers Justify Denials

    Buried in the denial letters that insurance companies send patients are a variety of expressions that convey the same idea: Improvement is a reason to deny coverage.

    “You are better.” “Your child has made progress.” “You have improved.”

    In one instance, a doctor working for Regence Blue Cross and Blue Shield of Oregon wrote that a patient who had been diagnosed with major depression was “sufficiently stable,” even as her own doctors wrote that she “continued to display a pattern of severe impairment” and needed round-the-clock care. A judge ruled that “a preponderance of the evidence” demonstrated that the teen’s continued residential treatment was medically necessary. The insurer said it can’t comment on the case because it ended with a confidential settlement.

    In another, a doctor working for UnitedHealth Group wrote in 2019 that a teenage girl with a history of major depression who had been hospitalized after trying to take her own life by overdosing “was doing better.” The insurer denied ongoing coverage at a residential treatment facility. A judge ruled that the insurer’s determination “lacked any reasoning or citations” from the girl’s medical records and found that the insurer violated federal law. United did not comment on this case but previously argued that the girl no longer had “concerning medical issues” and didn’t need treatment in a 24-hour monitored setting.

    To justify denials, the insurers cite guidelines that they use to determine how well a patient is doing and, ultimately, whether to continue paying for care. Companies, including United, have said these guidelines are independent, widely accepted and evidence-based.

    Insurers most often turn to two sets: MCG (formerly known as Milliman Care Guidelines), developed by a division of the multibillion-dollar media and information company Hearst, and InterQual, produced by a unit of UnitedHealth’s mental health division, Optum. Insurers have also used guidelines they have developed themselves.

    MCG Health did not respond to multiple requests for comment. A spokesperson for the Optum division that works on the InterQual guidelines said that the criteria “is a collection of established scientific evidence and medical practice intended for use as a first level screening tool” and “helps to move patients safely and efficiently through the continuum of care.”

    A separate spokesperson for Optum also said the company’s “priority is ensuring the people we serve receive safe and effective care for their individual needs.” A Regence spokesperson said that the company does “not make coverage decisions based on cost or length of stay,” and that its “number one priority is to ensure our members have access to the care they need when they need it.”

    In interviews, several current and former insurance employees from multiple companies said that they were required to prioritize the proprietary guidelines their company used, even if their own clinical judgment pointed in the opposite direction.

    “It’s very hard when you come up against all these rules that are kind of setting you up to fail the patient,” said Brittainy Lindsey, a licensed mental health counselor who worked at the Anthem subsidiary Beacon and at Humana for a total of six years before leaving the industry in 2022. In her role, Lindsey said, she would suggest approving or denying coverage, which — for the latter — required a staff doctor’s sign-off. She is now a mental health consultant for behavioral health businesses and clinicians.

    A spokesperson for Elevance Health, formerly known as Anthem, said Lindsey’s “recollection is inaccurate, both in terms of the processes that were in place when she was a Beacon employee, and how we operate today.” The spokesperson said “clinical judgment by a physician — which Ms. Lindsey was not — always takes precedence over guidelines.”

    In an emailed statement, a Humana spokesperson said the company’s clinician reviewers “are essential to evaluating the facts and circumstances of each case.” But, the spokesperson said, “having objective criteria is also important to provide checks and balances and consistently comply with” federal requirements.

    The guidelines are a pillar of the health insurance system known as utilization management, which paves the way for coverage denials. The process involves reviewing patients’ cases against relevant criteria every handful of days or so to assess if the company will continue paying for treatment, requiring providers and patients to repeatedly defend the need for ongoing care.

    Federal judges have criticized insurance company doctors for using such guidelines in cases where they were not actually relevant to the treatment being requested or for “solely” basing their decisions on them.

    Wit v. United Behavioral Health, a class-action lawsuit involving a subsidiary of UnitedHealth, has become one of the most consequential mental health cases of this century. In that case, a federal judge in California concluded that a number of United’s in-house guidelines did not adhere to generally accepted standards of care. The judge found that the guidelines allowed the company to wrongly deny coverage for certain mental health and substance use services the moment patients’ immediate problems improved. He ruled that the insurer would need to change its practices. United appealed the ruling on grounds other than the court’s findings about the defects in its guidelines, and a panel of judges partially upheld the decision. The case has been sent back to the district court for further proceedings.

    Largely in response to the Wit case, nine states have passed laws requiring health insurers to use guidelines that align with the leading standards of mental health care, like those developed by nonprofit professional organizations.

    Cigna has said that it “has chosen not to adopt private, proprietary medical necessity criteria” like MCG. But, according to a review of lawsuits, denial letters have continued to reference MCG. One federal judge in Utah called out the company, writing that Cigna doctors “reviewed the claims under medical necessity guidelines it had disavowed.” Cigna did not respond to specific questions about this.

    Timothy Stock, one of the BCBS doctors who denied Moore’s request to cover ongoing care, had cited MCG guidelines when determining she had improved enough — something judges noted he had done before. In 2016, Stock upheld a decision on appeal to deny continued coverage for a teenage girl who was in residential treatment for major depression, post-traumatic stress disorder and anxiety. Pointing to the guidelines, Stock concluded she had shown enough improvement.

    The patient’s family sued the insurer, alleging it had wrongly denied coverage. Blue Cross and Blue Shield of Illinois argued that there was evidence that showed the patient had been improving. But, a federal judge found the insurer misstated its significance. The judge partially ruled in the family’s favor, zeroing in on Stock and another BCBS doctor’s use of improvement to recommend denying additional care.

    “The mere incidence of some improvement does not mean treatment was no longer medically necessary,” the Illinois judge wrote.

    In another case, BCBS Illinois denied coverage for a girl with a long history of mental illness just a few weeks into her stay at a residential treatment facility, noting that she was “making progressive improvements.” Stock upheld the denial after an appeal.

    Less than two weeks after Stock’s decision, court records show, she cut herself on the arm and leg with a broken light bulb. The insurer defended the company’s reasoning by noting that the girl “consistently denied suicidal ideation,” but a judge wrote that medical records show the girl was “not forthcoming” with her doctors about her behaviors. The judge ruled against the insurer, writing that Stock and another BCBS doctor “unreasonably ignored the weight of the medical evidence” showing that the girl required residential treatment.

    Stock declined to comment. A spokesperson for BCBS said the company’s doctors who review requests for mental health coverage are board certified psychiatrists with multiple years of practice experience. The spokesperson added that the psychiatrists review all information received “from the provider, program and members to ensure members are receiving benefits for the right care, at the right place and at the right time.”

    The BCBS spokesperson did not address specific questions related to Moore or Stock. The spokesperson said that the examples ProPublica asked about “are not indicative of the experience of the vast majority of our members,” and that it is committed to providing “access to quality, cost-effective physical and behavioral health care.”

    A Lifelong Struggle

    A former contemporary dancer with a bright smile and infectious laugh, Moore’s love of animals is eclipsed only by her affinity for plants. She moved from Indiana to Austin, Texas, about six years ago and started as a receptionist at a clinic before working her way up to technician.

    Moore’s depression has been a constant in her life. It began as a child, when, she said, she was sexually and emotionally abused. She was able to manage as she grew up, getting through high school and attending Indiana University. But, she said, she fell back into a deep sadness after she learned in 2022 that the church she found comfort in as a college student turned out to be what she and others deemed a cult. In September of last year, she began an intensive outpatient program, which included multiple group and individual therapy sessions every week.

    Moore, 32, had spent much of the past eight months in treatment for severe depression, post-traumatic stress disorder and anxiety when BCBS said it would no longer pay for the program in January.

    The denial had come to her without warning.

    “I was starting to get to the point where I did have some hope, and I was like, maybe I can see an actual end to this,” Moore said. “And it was just cut off prematurely.”

    At the Austin emergency room where she drove herself after her treatment stopped, her heart raced. She was given medication as a sedative for her anxiety. According to hospital records she provided to ProPublica, Moore’s symptoms were brought on after “insurance said they would no longer pay.”

    A hospital social worker frantically tried to get her back into the intensive outpatient program.

    “That’s the sad thing,” said Kandyce Walker, the program’s director of nursing and chief operating officer, who initially argued Moore’s case with BCBS Texas. “To have her go from doing a little bit better to ‘I’m going to kill myself.’ It is so frustrating, and it’s heartbreaking.”

    After the denial and her brief admission to the hospital emergency department in January, Moore began slicing her wrists more frequently, sometimes twice a day. She began to down six to seven glasses of wine a night.

    “I really had thought and hoped that with the amount of work I’d put in, that I at least would have had some fumes to run on,” she said.

    She felt embarrassed when she realized she had nothing to show for months of treatment. The skills she’d just begun to practice seemed to disappear under the weight of her despair. She considered going into debt to cover the cost of ongoing treatment but began to think that she’d rather end her life.

    “In my mind,” she said, “that was the most practical thing to do.”

    Whenever the thought crossed her mind — and it usually did multiple times a day — she remembered that she had promised her therapist that she wouldn’t.

    Moore’s therapist encouraged her to continue calling BCBS Texas to try to restore coverage for more intensive treatment. In late February, about five weeks after Stock’s denial, records show that the company approved a request that sent her back to the same facility and at the same level of care as before.

    But by that time, her condition had deteriorated so severely that it wasn’t enough.

    Eight days later, Moore was admitted to a psychiatric hospital about half an hour from Austin. Medical records paint a harrowing picture of her condition. She had a plan to overdose and the medicine to do it. The doctor wrote that she required monitoring and had “substantial ongoing suicidality.” The denial continued to torment her. She told her doctor that her condition worsened after “insurance stopped covering” her treatment.

    Her few weeks stay at the psychiatric hospital cost $38,945.06. The remaining 10 weeks of treatment at the intensive outpatient program — the treatment BCBS denied — would have cost about $10,000.

    Moore was discharged from the hospital in March and went back into the program Stock had initially said she no longer needed.

    It marked the third time she was admitted to the intensive outpatient program.

    A few months later, as Moore picked at her lunch, her oversized glasses sliding down the bridge of her nose every so often, she wrestled with another painful realization. Had the BCBS doctors not issued the denial, she probably would have completed her treatment by now.

    “I was really looking forward to that,” Moore said softly. As she spoke, she played with the thick stack of bracelets hiding the scars on her wrists.

    A few weeks later, that small facility closed in part because of delays and denials from insurance companies, according to staff and billing records. Moore found herself calling around to treatment facilities to see which ones would accept her insurance. She finally found one, but in October, her depression had become so severe that she needed to be stepped up to a higher level of care.

    Moore was able to get a leave of absence from work to attend treatment, which she worried would affect the promotion she had been working toward. To tide her over until she could go back to work, she used up the money her mother sent for her 30th birthday.

    She smiles less than she did even a few months ago. When her roommates ask her to hang out downstairs, she usually declines. She has taken some steps forward, though. She stopped drinking and cutting her wrists, allowing scar tissue to cover her wounds.

    But she’s still grieving what the denial took from her.

    “I believed I could get better,” she said recently, her voice shaking. “With just a little more time, I could discharge, and I could live life finally.”

    Kirsten Berg contributed research.

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  • Why Zebras Don’t Get Ulcers – by Dr. Robert M. Sapolsky

    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.

    The book does kick off with a section that didn’t age well—he talks of the stress induced globally by the Spanish Flu pandemic of 1918, and how that kind of thing just doesn’t happen any more. Today, we have much less existentially dangerous stressors!

    However, the fact we went and had another pandemic really only adds weight to the general arguments of the book, rather than detracting.

    We are consistently beset by “the slings and arrows of outrageous fortune” as Shakespeare would put it, and there’s a reason (or twenty) why many people go grocery-shopping with the cortisol levels of someone being hunted for sport.

    So, why don’t zebras get ulcers, as they actually are hunted for food?

    They don’t have rent to pay or a mortgage, they don’t have taxes, or traffic, or a broken washing machine, or a project due in the morning. Their problems come one at a time. They have a useful stress response to a stressful situation (say, being chased by lions), and when the danger is over, they go back to grazing. They have time to recover.

    For us, we are (usually) not being chased by lions. But we have everything else, constantly, around the clock. So, how to fix that?

    Dr. Sapolsky comprehensively describes our physiological responses to stress in quite different terms than many. By reframing stress responses as part of the homeostatic system—trying to get the body back into balance—we find a solution, or rather: ways to help our bodies recover.

    The style is “pop-science” and is very accessible for the lay reader while still clearly coming from a top-level academic who is neck-deep in neuroendocrinological research. Best of both worlds!

    Bottom line: if you try to take very day at a time, but sometimes several days gang up on you at once, and you’d like to learn more about what happens inside you as a result and how to fix that, this book is for you!

    Click here to check out “Why Zebras Don’t Get Ulcers” and give yourself a break!

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