Text 18. Sleep disorders Read the text and find out the cause of sleep disorders.

What is it? A sleep disorder is a brain disorder. The brain regulates sleep and is the only organ known to require or benefit from sleep. There are more than 100 sleep disorders affecting about 40 million Americans. Most sleep disorders are very common and can be treated. Unfortunately, 95 percent of these disorders are never diagnosed.

The nature of sleep. Several processes in your body control how sleepy or alert you are. The two most important processes are “homeostatic” and “chronobiologic.”The homeostatic process controls how long you stay awake. The longer we are awake, the greater the pressure is for us to fall asleep. The chronobiologic process determines our sleep cycles. Each of us has a “biologic clock” that follows the changes of daylight to darkness.

Other things that affect sleep are age, medications, diet, and environmental conditions.

Sleep/wake cycles are determined primarily by genetics and physical needs. Most people require 7 to10 hours of sleep per day. You may be a “lark” (“early to bed, early to rise”) or an “owl” (“late to bed, late to rise”).

Children and teenagers require 9 to 10 hours of sleep. However, teens have a biologic tendency to delay falling asleep as long as possible. With aging, most people tend to go to sleep earlier and their sleep is less intense. This often means waking earlier than is desirable.

Major sleep disorders. The International Classification of Sleep Disorders lists approximately 100 known sleep disorders. Most sleep complaints fall into one of these categories:

• Hypersomnia

• Obstructive Sleep Apnea Syndrome

• Narcolepsy

• Idiopathic Central Nervous System Hypersomnia

• Insomnia

• Circadian Rhythm Disturbances

Hypersomnia. Hypersomnia is extreme sleepiness during the day even with adequate sleep the night before. Hypersomnia has been mistakenly blamed on depression, laziness, boredom, or other negative personality traits.

Obstructive Sleep Apnea. Sleep apnea is a breathing disorder where you briefly wake up because your breathing has been interrupted. This often results in snoring. There are two types of sleep apnea: central and obstructive.

Central sleep apnea is less common and occurs when the brain fails to send the right signals to the muscles to start breathing.

Obstructive sleep apnea (OSA) is far more common. It occurs when air cannot flow into or out of the person’s nose or mouth as they breathe.

As many as 18 million Americans have sleep apnea. OSA is as common as asthma or diabetes. It is experienced by both sexes, all age groups and in people who do not snore. The high incidence of OSA in children is just becoming known.

Narcolepsy. Narcolepsy causes uncontrollable sleepiness. It affects one in 1,000 people. Many people with narcolepsy have other symptoms such as:

• Cataplexy: Sudden muscle weakness caused by emotional events. For example, falling when you hear terrible news.

• Sleep paralysis: Waking up to find your body is paralyzed except for breathing and eye movement. In other words, your brain is awake but your body is still asleep.

Hypnogogic hallucinations: Frightening dreams as you are falling asleep. Idiopathic Central Nervous System Hypersomnia. This condition causes excessive sleepiness as its only symptom. Excessive sleepiness is also a symptom of another sleep disorder called narcolepsy – but narcolepsy has other symptoms as well.

Insomnia. Insomnia is ongoing difficulty in falling asleep, staying asleep, or restless sleep. Technically, insomnia is a symptom of a sleep disorder. Chronic insomnia is common and affects 15 - 20 percent of adults. Occasional trouble sleeping is not insomnia.

Circadian Rhythm Disturbances. Circadian rhythm disturbances occur when sleep/wake cycles are interrupted. They often affect shift workers whose biological clocks are disrupted by conflicting sleep and work schedules. People who take long plane trips may experience “jet lag.” This is another form of circadian rhythm disburbance.

What is the cause?

Hypersomnia. The most common cause of sleepiness is not getting enough sleep. It is now known that even small reductions in sleep can cause reduced performance. This can be in the classroom, at work, or behind the wheel.

Obstructive Sleep Apnea. Obstructive sleep apnea occurs when the upper airway is closed off as your tongue and throat muscles relax during sleep. As breathing is blocked, the brain senses it is not getting enough oxygen and wakes you up. Because sleep is frequently interrupted, you feel very sleepy during the day. Obstructive sleep apnea often occurs in people who are loud snorers. Alcohol and sleeping pills can also increase the number and length of breathing pauses.

Narcolepsy. Narcolepsy happens more often in families with a history of excessive sleepiness. This genetic link is not fully understood. It appears genetics combine with an unknown environmental factor to cause narcolepsy.

Idiopathic Central Nervous System Hypersomnia. “Idiopathic” means the cause is not known.

Insomnia. Insomnia can be due to many conditions, including medical, psychiatric, or psychological. Insomnia has been linked to anxiety and/or depression, and there is growing proof that insomnia may cause psychiatric problems. Because insomnia has such an effect on mood and performance, it’s important to get treatment.

One of the most common causes of insomnia is “restless legs syndrome” (RLS). People with RLS experience an uncomfortable sensation and an irresistible urge to move their legs as they begin to fall asleep. RLS is a neurological movement disorder. Because it may cause insomnia, it is sometimes mistaken for a sleep disorder.

RLS is common in both men and women, and affects 5 to 10 percent of the population. It may begin in childhood, but is more common in adults. It sometimes runs in families. Hormones appear to be a factor for women, as RLS sometimes occurs more often during menstruation, pregnancy, or menopause. Up to 27 percent of pregnant women may experience RLS.

RLS has been linked to iron deficiency anemia and other neurological disorders. It affects 20 to 40 percent of patients on dialysis due to chronic kidney failure. There is no evidence that RLS is related to any mental problems.

Circadian Rhythm Disturbances. The sleep/wake schedule disorders fall into two categories:

• Primary: “malfunction” of your biologic clock (needing to go to sleep earlier than you usually do, sleeping longer than you usually do, or having to take naps when you normally do not need to take naps)

• Secondary: due to external changes imposed on your biologic clock (shift work and jet lag)

What are the symptoms? Symptoms vary by sleep disorder. Most sleep disorders include one or more of the following symptoms:

• Inability to fall asleep at night

• Inability to stay asleep at night

• Excessive daytime sleepiness

• Fatigue

• Loud snoring or gasping sounds when you sleep (sleep apnea)

• “Sleep attacks,” loss of muscle control or inability to move (narcolepsy)

Unusual behaviors arising from sleep (Parasomnias). Parasomnias are unpleasant or undesirable behaviors or experiences that happen mostly or only during sleep. Most are not signs of mental health disorders. Although there are many different parasomnias, two are most common:

Disorders of arousal. Disorders of arousal occur when one appears to be partially asleep and partially awake. Sleepwalking and sleep terrors are two disorders of arousal that are common in children.

But they are common in adults as well. Sometimes they are mistaken for mental health disorders. If the behaviors are violent or harmful, treatment with drugs or hypnotherapy (practicing self-hypnosis before sleep) often helps.

REM sleep behavior disorder (RBD). People with RBD appear to be acting out their dreams. RBD occurs mainly in older males who do not experience the normal relaxation of muscles during REM sleep. Instead, they move about in bed, mirroring the movement in their life-like dreams. Because people with RBD can accidentally hurt themselves or their bed partners, medical help is often needed to manage the disorder.

RBD is diagnosed through an overnight sleep study. It is easily managed with the drug, clonazepam, which is taken before bedtime.

How is it diagnosed? Sleep medicine is a well-recognized field. Sleep specialists can diagnose and help you manage your sleep disorder. Evaluation starts with a visit to the sleep doctor’s clinic. It takes about an hour. The staff will ask you about your sleep problems and do a physical exam.

Other tests may be necessary to understand your sleep problem. This may include blood tests or an overnight sleep study. Sometimes a test for daytime sleepiness is done.

If you need to visit a sleep center, you can expect a physical exam and some diagnostic tests. You will be asked for a detailed history of your sleep/wake function. The doctor may also ask for information from your bed partner, other family members, co-workers, or caregivers. This will help understand your sleep behaviors. You or an observer may fill out a sleep/wake diary to record sleep/wake patterns not seen during the exam.

What is an overnight sleep study? An overnight sleep study evaluates the quality of your sleep by observing body functions as you sleep. These include heart rate, electrocardiogram, breathing, snoring, brain activity, eye movements, body movements, and oxygen level. Tests may involve applying sensors to your body that are easily removed the next morning. You may also be video taped so your doctor can see your sleep problem firsthand.

Overnight sleep tests can include:

Polysomnography (PSG). In PSG, simple electrodes are placed on your body to record brain activity, breathing, heart activity, muscle activity, eye movements, and body movements. An audio-video recording of the sleep is also done. PSG will determine if there are:

• Disruptions of normal brain wave activity during sleep

• Heart or breathing abnormalities

• Sleep-related movements

• Other sleep-related disorders

Multiple Sleep Latency Test (MSLT). The MSLT measures daytime sleepiness. It helps to understand different complaints of “sleepiness,” “tiredness,” and “fatigue.” It is designed to:

• Measure how quickly you fall asleep when you nap during the day

• Identify unusual REM sleep during a nap

This test is usually done the day after you have a PSG. The test measures the same factors as the PSG and compares daytime and night time results. Sleep is observed during four or five 20-minute naps over a two hour period.

Actigraphy. Some people have a hard time keeping an accurate sleep diary. In such cases, actigraphy may provide more reliable information on activity while you are awake and asleep.

An actigraph is a small device worn on the wrist. It records body activity and the time of day. It is usually worn for a week or two. Then the information is transferred to a computer. Many cases of severe insomnia require an actigraph for diagnosis and treatment.

Hypersomnia. Hypersomnia is diagnosed by taking a complete history. Voluntary sleep deprivation is the most common cause of hypersomnia. If the cause is not clear, then additional tests may be performed. This could include all-night sleep monitoring, a series of nap studies the next day, or blood tests.

Obstructive Sleep Apnea. Obstructive disorders are usually diagnosed through a sleep study.

Narcolepsy. Narcolepsy is diagnosed during an all-night sleep study followed by nap studies the next day. In the future, tests of fluid in the brain and spinal cord may be useful.

Idiopathic Central Nervous System Hypersomnia. Idiopathic Central Nervous System Hypersomnia is diagnosed with a sleep study.

Insomnia. Most cases of insomnia can be easily diagnosed and managed by your primary care doctor.

RLS. RLS is diagnosed in a sleep specialist’s office. Formal sleep studies are rarely needed. Blood tests may be done to look for mild degrees of anemia.

Circadian Rhythm Disturbances. The primary circadian rhythm disorders may be more difficult to diagnose because they are often similar to other disorders such as hypersomnia, insomnia, drug abuse, or mental health conditions. For example, the delayed sleep phase syndrome (people who go to sleep later than usual) is often similar to sleep onset insomnia or difficulty falling asleep. You try to go to sleep before your biological clock permits, and you lie in bed unable to sleep until your body clock says sleep.

Secondary disorders, arising from problems such as jet lag and shift work, are usually diagnosed from information about your work and travel routines.

What are the treatments? Once the tests are done, your sleep doctor will discuss these results with you and make a treatment plan. Most sleep problems are treatable. Select a specific disorder from the list below to find a treatment option.

Hypersomnia. Treatment depends on the cause. If you are sleep deprived, getting enough sleep is vital. So good sleep habits are important. Stimulant or wake-promoting medications such as mazindol, methylphenidate, methamphetamine, exedrine, or modafinil are treatments.

Obstructive Sleep Apnea. If you have sleep apnea, you have several medical and surgical treatment options. The preferred treatment is nasal continuous positive airway pressure. A small, toaster-size machine sits next to your bed. It delivers air under pressure through a mask. Wearing this mask over your nose keeps your airway open during sleep.

Several types of surgery are available, including:

• Tracheostomy: an opening is cut in the trachea and a tube is place in the opening. The patient breathes through the tube. This is an effective but extreme option

• Uvulopalatopharyngoplasty: a surgical procedure that removes the uvula and part of the palate to make the airway bigger

Another option is the use of oral/dental devices. They are similar to a small mouth guard athletes use while playing. They may work in mild cases.

Weight loss may help. However, the long-term success of weight reduction programs for any condition is very poor. And weight is only one factor in patients with sleep apnea.

Narcolepsy. There are many treatment choices. The hypersomnia in people with narcolepsy responds well to stimulant drugs. These include modafinil, methylphenidate, dextroamphetamine, or methamphetamine.

The symptoms of cataplexy, sleep paralysis, and hypnologic hallucinations respond to a group of medicines called tricyclic antidepressants or serotonin-specific reuptake inhibitors (fluoxetine or venlafaxine). Scheduled short naps can also be helpful for many people.

Idiopathic Central Nervous System Hypersomnia. This disorder is treated with stimulant drugs.

Insomnia. First, it’s necessary to identify and treat any medical or mental health conditions. Then, a combination of behavior changes and drug therapy is often successful. Sleep medication and hypnosis can relieve short-term insomnia. They may also prevent constant insomnia.

Effective medications include the benzodiazepines, as well as zolpidem and zaleplon. Beware that many drugs commonly given for insomnia (diphenhydramine, tricyclic antidepressants, or trazodone) are much less effective. The risk of drug tolerance, dependence, and abuse with these medications appears to have been greatly exaggerated.

Recently, melatonin has been touted as a “cure-all” for insomnia (as well as jet lag and shift work). More studies are needed.

RLS. Three classes of medications are used to treat RLS:

• Drugs that act on the brain neurotransmitter called dopamine, such as levodopa/carbidopa, bromocriptine, pergolide, pramipexole, and ropinirole

• Benzodiazepines such as clonazepam

• A wide variety of opiates including codeine, propoxyphene, oxycodone, and methadone

Circadian Rhythm Disturbances. Successful treatments are available for these disorders. They include:

• Chronotherapy (resetting the biological clock)

• Sedative/hypnotic drugs

• Phototherapy (bright light exposure at particular times of the day)

• Melatonin

Living with sleep disorders. Most sleep disorders are either treatable or preventable. There is no need to suffer and lose even more sleep over these disorders.

Prevention. Many sleep disorders cannot be prevented but may be linked to other preventable health conditions.

Overall good sleep practices. Good sleep practices may help you improve your sleep in general. They may also help with some sleep disorders. Try to:

• Sleep only when drowsy.

• Sleep only in the bedroom. Use the bedroom for sleeping only.

• Avoid napping.

• Avoid caffeine, drinking, and smoking.

• Avoid a large meal before bed.

• Exercise on a regular basis, but avoid strenuous exercise within six hours of bedtime.

• Make your bedroom comfortable with low light and noise levels.

• Consider relaxation techniques to reduce stress levels.

TEXT 19. SPEECH DISORDERS

Read the text and answer the question: Can speech problems be treated?

More than 3 million Americans have the speech disorder known as stuttering (or stammering, as it’s known in the United Kingdom). It’s one of several conditions affecting a person’s ability to speak clearly.

Some common speech disorders:

Stuttering is a problem that interferes with fluent speech. A person who stutters may repeat the first part of a word (as in sssssing) or hold a single sound for a long time (as in caaaaaaake). Some people who stutter have trouble getting sounds out altogether. Stuttering is complex, and it can affect speech in many different ways.

Cluttering is another problem that makes a person’s speech difficult to understand. Like stuttering, cluttering affects the fluency, or flow, of a person’s speech. Someone who clutters may speak in bursts or pause in unexpected places. The rhythm of cluttered speech may sound jerky, rather than smooth, and the speaker often seems unaware of the problem.

Articulation disorders encompass a wide range of errors people can make when talking. Substituting a "w" for an "r" ("wabbit" for "rabbit"), omitting sounds ("cool" for "school"), or adding sounds to words ("pinanio" for "piano") are examples of articulation errors. Lisping refers to specific substitution involving the letters "s" and "z." A person who lisps replaces those sounds with "th."

Apraxia (dyspraxia), also known as oral-motor speech disorder, is a problem with motor coordination or motor planning. A person with this speech problem has difficulty moving the muscles and structures necessary to form speech sounds into words.

What causes speech problems? It’s easy to take the ability to speak for granted, but producing fluent speech without errors (speech that flows smoothly and is easily understood) is actually a highly complicated process. When we speak, we must coordinate many muscles from various body parts and systems, including the larynx, which contains the vocal cords; the teeth, lips, tongue, and mouth; and the respiratory system. Normal speech may seem effortless, but it requires precise timing, nerve, and muscle control. The ability to understand language and produce speech is coordinated by the brain. So a person with brain damage from an accident, stroke, or birth defect may have speech and language problems. Apraxia is thought to be due to a brain impairment that may or may not show up on brain magnetic resonance imaging (MRI) tests.

Some people with speech problems, particularly articulation disorders, may have hearing problems. Even mild hearing loss may have an impact on how a person reproduces the sounds they hear. Certain birth defects, such as a cleft palate, can interfere with a person’s ability to produce speech. When a person has a cleft palate there is a hole in the roof of the mouth, which affects the movement of air through the oral and nasal passages. There also may be problems with other structures needed for speech, including the lips, teeth, and jaw.

Genetics may also play a role in some speech problems. For example, stuttering seems to run in some families. But in most cases, no one knows the exact cause of a person’s speech problems.

How are speech problems treated? The good news is that treatments such as speech therapy can help people of any age overcome some speech problems.

If you are concerned about your speech, it’s important to let your doctor know. If hearing tests and physical exams don’t reveal any problems, some doctors arrange a consultation with a speech-language pathologist.

A speech-language pathologist is trained to observe people as they speak and to identify their speech problems. Speech-language pathologists look for the type of problem (such as a lack of fluency, articulation, or motor skills) a person has. For example, if you stutter, the pathologist will examine how and when you do so. Speech-language pathologists may evaluate their clients’ speech either by recording them on audio or videotape or by listening during conversation. A few clinics that specialize in fluency disorders may use computerized analysis. By gathering as much information as possible about the way a person speaks, the pathologist can develop a treatment plan that meets each individual’s needs. The plan will depend on things like age and the type of speech disorder a person has.

If you’re being treated for a speech disorder, part of your treatment plan may include seeing a speech therapist, a person who is trained to treat speech disorders. How often you have to see the speech therapist will vary - you’ll probably start out seeing him or her more frequently at first, then your visits may decrease over time. Most treatment plans include breathing techniques, relaxation strategies that are designed to help you relax your muscles when you speak, posture control, and a type of voice exercise called oral-motor exercises. You’ll probably have to do these exercises each day on your own to help make your treatment plan as successful as possible.

Dealing with speech problems. Only people with speech problems know how frustrating it can be. People who stutter, for example, often complain that others try to finish their sentences or fill in words for them. Some feel like people treat them as if they’re stupid, especially when a listener says things like "slow down" or "take it easy." (Most people who stutter are just as intelligent as people who don’t.) People who stutter report, that listeners often avoid eye contact and refuse to wait patiently for them to finish speaking. If you have a speech problem, let others know how you like to be treated when speaking.

Some people look to their speech therapists for advice and resources on issues of stuttering. Speech therapists can often connect you with others in similar situations, such as support groups in your area for teens who stutter.

If you’re a teen with a speech problem, achieving and maintaining control of your speech may be a lifelong process. Although speech therapy can help, you are sure to have ups and downs in your efforts to communicate. But the truth is that the way you speak is only one part of who you are. Don’t be embarrassed to make yourself heard!

TEXT 20. STRESS

Make up your own summary of the text.

Everyone experiences stress at times – adults, teens, and even kids. But there are things you can do to minimize stress and manage the stress that’s unavoidable.

What is stress? Stress is a feeling that’s created when we react to particular events. It’s the body’s way of rising to a challenge and preparing to meet a tough situation with focus, strength, stamina, and heightened alertness.

The events that provoke stress are called stressors, and they cover a whole range of situations – everything from outright physical danger to making a class presentation or taking a semester’s worth of your toughest subject.

The human body responds to stressors by activating the nervous system and specific hormones. The hypothalamus signals the adrenal glands to produce more of the hormones adrenaline and cortisol and release them into the bloodstream. These hormones speed up heart rate, breathing rate, blood pressure, and metabolism. Blood vessels open wider to let more blood flow to large muscle groups, putting our muscles on alert. Pupils dilate to improve vision. The liver releases some of its stored glucose to increase the body’s energy. And sweat is produced to cool the body. All of these physical changes prepare a person to react quickly and effectively to handle the pressure of the moment.

This natural reaction is known as the stress response. Working properly, the body’s stress response enhances a person’s ability to perform well under pressure. But the stress response can also cause problems when it overreacts or fails to turn off and reset itself properly.

Good stress and bad stress. The stress response (also called the fight or flight response) is critical during emergency situations, such as when a driver has to slam on the brakes to avoid an accident. It can also be activated in a milder form at a time when the pressure’s on but there’s no actual danger – like stepping up to take the foul shot that could win the game, getting ready to go to a big dance, or sitting down for a final exam. A little of this stress can help keep you on your toes, ready to rise to a challenge. And the nervous system quickly returns to its normal state, standing by to respond again when needed.

But stress doesn’t always happen in response to things that are immediate or that are over quickly. Ongoing or long-term events, like coping with a divorce or moving to a new neighborhood or school, can cause stress, too. Long-term stressful situations can produce a lasting, low-level stress that’s hard on people. The nervous system senses continued pressure and may remain slightly activated and continue to pump out extra stress hormones over an extended period. This can wear out the body’s reserves, leave a person feeling depleted or overwhelmed, weaken the body’s immune system, and cause other problems.

What сauses stress? Although just enough stress can be a good thing, stress overload is a different story – too much stress isn’t good for anyone. For example, feeling a little stress about a test that’s coming up can motivate you to study hard. But stressing out too much over the test can make it hard to concentrate on the material you need to learn.

Pressures that are too intense or last too long, or troubles that are shouldered alone, can cause people to feel stress overload. Here are some of the things that can overwhelm the body’s ability to cope if they continue for a long time:

• being bullied or exposed to violence or injury

• relationship stress, family conflicts, or the heavy emotions that can accompany a broken heart or the death of a loved one

• ongoing problems with schoolwork related to a learning disability or other problems, such as ADHD (usually once the problem is recognized and the person is given the right learning support the stress disappears)

• crammed schedules, not having enough time to rest and relax, and always being on the go

Some stressful situations can be extreme and may require special attention and care. Posttraumatic stress disorder is a very strong stress reaction that can develop in people who have lived through an extremely traumatic event, such as a serious car accident, a natural disaster like an earthquake, or an assault like rape.

Some people have anxiety problems that can cause them to overreact to stress, making even small difficulties seem like crises. If a person frequently feels tense, upset, worried, or stressed, it may be a sign of anxiety. Anxiety problems usually need attention, and many people turn to professional counselors for help in overcoming them.

Signs of stress. People who are experiencing stress may notice some of the following signs:

• anxiety or panic attacks

• a feeling of being constantly pressured

• irritability and moodiness

• physical symptoms, such as stomach problems, headaches, or even chest pain

• allergic reactions, such as eczema or asthma

• problems sleeping

• drinking too much, smoking, overeating, or doing drugs

• sadness or depression

Everyone experiences stress a little differently. Some people become angry and act out their stress or take it out on others. Some people internalize it and develop eating disorders or substance abuse problems. And some people who have a chronic illness may find that the symptoms of their illness flare up under an overload of stress.

Keep stress under control. What can you do to deal with stress or to avoid? The most helpful method of dealing with stress is learning how to manage the stress that comes along with any new challenge, good or bad. Stress-management skills work best when they’re used regularly, not just when the pressure’s on. Knowing how to "de-stress" and doing it when things are relatively calm can help you get through challenging circumstances that may arise. Here are some things that can help keep stress under control:

• Take a stand against overscheduling. If you’re feeling stretched, consider cutting out an activity or two, opting for just the ones that are most important to you.

• Be realistic. Don’t try to be perfect. If you need help on something, like schoolwork, ask for it.

• Get a good night’s sleep. Getting enough sleep helps keep your body and mind in top shape, making you better equipped to deal with any negative stressors. Because the biological "sleep clock" shifts during adolescence, many teens prefer staying up a little later at night and sleeping a little later in the morning. But if you stay up late and still need to get up early for school, you may not get all the hours of sleep you need.

• Learn to relax. The body`s natural antidote to stress is called the relaxation response. It`s your body`s opposite of stress, and it creates a sense of well-being and calm. The chemical benefits of the relaxation response can be activated simply by relaxing. You can help trigger the relaxation response by learning simple breathing exercises and then using them when you’re caught up in stressful situations. And ensure you stay relaxed by building time into your schedule for activities that are calming and pleasurable: reading a good book or making time for a hobby, spending time with your pet, or just taking a relaxing bath.

• Treat your body well. Experts agree that getting regular exercise helps people manage stress. (Excessive or compulsive exercise can contribute to stress, so use moderation.) And eat well to help your body get the right fuel to function at its best. It’s easy when you’re stressed out to eat on the run or eat junk food or fast food. But under stressful conditions, the body needs its vitamins and minerals more than ever. Some people may turn to substance abuse as a way to ease tension. Although alcohol or drugs may seem to lift the stress temporarily, relying on them to cope with stress actually promotes more stress because it wears down the body’s ability to bounce back.

• Watch what you’re thinking. Your outlook, attitude, and thoughts influence the way you see things. Is your cup half full or half empty? A healthy dose of optimism can help you make the best of stressful circumstances. Even if you’re out of practice, or tend to be a bit of a pessimist, everyone can learn to think more optimistically and reap the benefits.

• Solve the little problems. Learning to solve everyday problems can give you a sense of control. But avoiding them can leave you feeling like you have little control and that just adds to stress. Develop skills to calmly look at a problem, figure out options, and take some action toward a solution. Feeling capable of solving little problems builds the inner confidence to move on to life’s bigger ones – and it and can serve you well in times of stress.

• Build your resilience. Certain people seem to adapt quickly to stressful circumstances and they’re able to handle problems as they come up. Researchers have identified the qualities that make some people resilient even when faced with high levels of stress.

• Think of change as a challenging and normal part of life.

• See setbacks and problems as temporary and solvable.

• Believe that you will succeed if you keep working toward your goals.

• Take action to solve problems that crop up.

• Build strong relationships and keep commitments to family and friends.

• Have a support system and ask for help.

• Participate regularly in activities for relaxation and fun.

Learn to think of challenges as opportunities and stressors as temporary problems, not disasters. Practice solving problems and asking others for help and guidance rather than complaining and letting stress build. Make goals and keep track of your progress. Make time for relaxation. Be optimistic. Believe in yourself. Be sure to breathe. And let a little stress motivate you into positive action to reach your goals.