For centuries, folklore and popular wisdom have linked poor eating habits and indigestion to nightmares and restless sleep. In A Christmas Carol, Ebenezer Scrooge at first dismisses the ghosts that torment him as mere dietary disturbances: “You may be an undigested bit of beef, a blot of mustard, a crumb of cheese, a fragment of an underdone potato,” he says to one spectral visitor. “There’s more of gravy than of grave about you, whatever you are!” Earlier, Benjamin Franklin lamented that “[I]ndolence, with full feeding, occasions nightmares and horrors inexpressible; we fall from precipices, are assaulted by wild beasts, murderers, and demons, and experience every variety of distress.” In the early 20th century, cartoonist Winsor McCay made his name with his “Dreams of the Rarebit Fiend” series, in which his protagonists suffer bizarre dreams and nightmares which they attributed to eating Welsh rarebit—a delicacy of spiced cheese on toast.

A modest body of contemporary research has sought to explore the link between food and nightmares more empirically. The latest is a new study published in the journal Frontiers in Psychology—finding that if you want to get your z’s, you’d best limit the cheese.

To conduct the current study, Tore Nielsen, a professor of psychiatry at the University of Montreal, and his colleagues surveyed 1,082 students at MacEwan University in Alberta. All of them completed a questionnaire about their diet, food sensitivities, sleep habits, dream recall, and more. The students reported how late in the evening they eat, whether they regularly snack without feeling hungry, and if they have any gastrointestinal symptoms, food allergies, or diet-related conditions such as lactose intolerance. They also reported how well they sleep and how often their sleep is disturbed by nightmares.

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About 25% of people said that eating certain foods before bed seemed to worsen their sleep, while just over 20% said that some foods improved their sleep. Of the people who reported having more nightmares after eating certain foods, 31% attributed the bad dreams to consumption of desserts and other sweets, 22% pointed to dairy, 16% cited meats, and 13% blamed spicy foods.

The most commonly cited medical condition linked to sleep quality was lactose intolerance—lending legitimacy to Scrooge’s “crumb of cheese” charge. Of the people who believed their diet was related to worse sleep overall, 30% were lactose intolerant.

“Nightmares are worse for lactose intolerant people who suffer severe gastrointestinal symptoms and whose sleep is disrupted,” said Nielsen in a statement that accompanied the release of the study. “This makes sense because we know that other bodily sensations can affect dreaming.” One 2024 meta-analysis, for example, found that all manner of sensory experiences—including sounds, smells, flashing lights, physical pressure, and pain—can be incorporated into dreams when people are sleeping and investigators provide the stimulus.

Food-related nightmares might also be linked to depression and anxiety, the researchers say; lactose-intolerance symptoms like bloating, cramping, and gas directly affect mood, which can carry over into sleep, powering bad dreams. The paper cites an earlier 2005 study by Nielsen showing that “dreaming is more emotionally intense and conflictual when abdominal cramping is at its worst,” including during menstruation.

Read More: What’s the Least Amount of Sleep You Need to Get?

When people eat can make a difference as well. Eating late in the evening or snacking up until bedtime is linked to an “eveningness chronotype”—essentially the state of being a night owl—which by itself has been associated with nightmares in earlier cited studies.

Nielsen and his colleagues concede that their current work does not establish causation, with at least the possibility existing that bad dreams and poor sleep may lead to equally poor dietary habits, rather than the other way around. “Direction of causality in many studies of food and sleep remains unclear,” the authors write.

Not all foods, of course, are linked to nightmares and sleep disruption, and some may even support better sleep. Close to 18% of people who regularly eat fruits reported better sleep, along with 12% of people who consume a lot of vegetables, and 13% of people who drink herbal tea.

Nielsen does not believe the current research remotely closes the book on the food and sleep and dreaming link, seeing a need for a lot of future work. “We need to study more people of different ages, from different walks of life,” he said in the statement. “Experimental studies are also needed to determine if people can truly detect the effects of specific foods on dreams. We would like to run a study in which we ask people to ingest cheese products versus some control food before sleep to see if this alters their sleep or dreams.” 

Medicaid, the health insurance program for low-income Americans that provides coverage for more than 70 million people, faces its biggest overhaul in decades under President Donald Trump’s “One, Big, Beautiful Bill,” a massive tax and spending package now being considered by the Senate that would slash its funding. 

Both the House and Senate versions of the bill, which is still undergoing changes as the upper chamber votes on amendments, would reduce funding for the program by hundreds of billions of dollars, according to the nonpartisan Congressional Budget Office (CBO). Nearly 12 million adults could lose health insurance because of the proposed cuts in the Senate’s revised bill over the next decade, the CBO estimated in a Saturday report. Much of the cuts are expected to come through imposing new administrative requirements on enrollees, or risk losing their coverage.

The White House has rejected the CBO’s findings, insisting that the cuts to the program will only reduce fraud and waste. “President Trump pledged to protect and preserve Medicaid, and that’s exactly what The One, Big, Beautiful accomplishes by kicking illegal immigrants off the program, implementing commonsense work requirements, and enforcing basic eligibility verification to combat fraud,” White House spokesman Kush Desai wrote to TIME.

The House narrowly passed the bill in May, and lawmakers are now working in an effort to pass the proposed legislation by a July 4 deadline imposed by Trump. The proposed Medicaid cuts have been contentious among Republicans, some of whom have been wary of their potential impact. Senator Thom Tillis, a Republican of North Carolina, has vowed to vote against the bill unless his concerns over the cuts are addressed.

Read more: Trump’s ‘Big, Beautiful Bill’ Faces Opposition From Musk and Some Republicans as the Senate Narrowly Votes to Advance It

Here’s what to know about Medicaid. 

What is Medicaid? 

Medicaid was created following the passage of the 1965 Social Security Amendments under President Lyndon B. Johnson, according to the National Archives. The law established both Medicare, which generally provides health insurance coverage for Americans aged 65 and older, and Medicaid, which serves low-income people. 

Medicaid is financed jointly by state and federal governments and accounts for about a sixth of health care spending in the U.S. It’s a hugely popular program among Americans: More than 80% have a positive view of Medicaid, according to a survey conducted earlier this month by nonpartisan research organization KFF. 

The Affordable Care Act enabled states to expand Medicaid eligibility to include non-elderly adults whose income was up to 138 percent of the federal poverty level—a national median of $44,367 for a family of four this year. Forty states and Washington, D.C., have so far adopted the expansion, 90% of which is funded by the federal government. 

During the COVID-19 pandemic, Congress allocated additional Medicaid funds so recipients could maintain “continuous coverage,” requiring states to keep most people enrolled in the program regardless of income in exchange for the enhanced federal funding. Continuous enrollment concluded at the end of March 2023, and an “unwinding” process began.

Some states have alternative names for Medicaid, such as DenaliCare in Alaska, KanCare in Kansas, and SoonerCare in Oklahoma. 

How many people are enrolled in Medicaid? 

Medicaid enrollment has stood at around 20% of the total U.S. population for the last several years, the Pew Research Center reports.

Some 71.3 million low-income people in the U.S. were enrolled in the program in March 2025, more than half of whom were adults, according to a report from the Centers for Medicare & Medicaid Services (CMS). The figure was notably higher in recent years: Roughly 100 million people were enrolled in Medicaid at some point in 2023, according to a December 2024 report by The Medicaid and CHIP Payment and Access Commission. The numbers have declined following the end of continuous enrollment, however, as states have resumed disenrolling people from the program.

Read more: Medicaid Expansions Saved Tens of Thousands of Lives, Study Finds

The proportion of people enrolled in the program varies significantly between states. More than 30% of residents in Louisiana and New Mexico are covered by Medicaid, according to KFF, compared to just 12% in Wyoming and North Dakota. 

Who is eligible for Medicaid? 

The federal government sets broad eligibility requirements for Medicaid. It requires states to cover some groups when they fall below certain income levels, including pregnant women, families with children, disabled people, and most children in foster care. 

But since the program is state-administered, Medicaid qualifications vary on a state-by-state basis. For instance, some immigrants may be eligible for coverage in states such as New Jersey or New York. One of the provisions in the Senate version of Trump’s tax and spending bill was intended to cut federal funding to states that use Medicaid to provide health care to undocumented immigrants. However, that part of the bill is in limbo after the Senate parliamentarian found that the measure did not comply with Senate rules.   

Are Medicaid recipients required to work? 

Current regulations in most states do not require Medicaid recipients to work. In Georgia, however, applicants are required to prove that they completed at least 80 hours of work or volunteer services to receive coverage.  Because of this verification system, a ProPublica report found that Georgia enrolled only a fraction of Medicaid-eligible people: some 7,500 of the estimated 250,000 eligible residents. 

Attempts to implement work requirements in Arkansas were struck down by a federal court in 2019. A federal judge blocked similar requirements in Kentucky from taking effect the previous year, and Governor Andy Beshear halted efforts to impose them in 2019 shortly after taking office.

Idaho, Kentucky, and Indiana have adopted legislation to impose work requirements this year, according to KFF. Other states are weighing imposing similar measures. And potential work requirements are being considered on a federal level in Trump’s “One, Big, Beautiful Bill.” The package would require Medicaid recipients from ages 19 to 64 to verify that they work at least 80 hours a month, or are training for a new job, studying, or volunteering. People’s work status would be checked twice a year.  

Most working-age adults on Medicaid are employed, or have a disability or caregiving responsibilities, according to KFF. 

TIME reporter Andrew Chow discussed the findings of a new study about how ChatGPT affects critical thinking with Nataliya Kosymyna. Kosymyna was part of a team of researchers at MIT’s Media Lab who set out to determine whether ChatGPT and large language models (LLMs) are eroding critical thinking, and the study returned some concerning results. The study divided 54 subjects into three groups, and asked them to write several essays using OpenAI’s ChatGPT, Google’s search engine, and nothing at all, respectively. Researchers used an EEG to record the writers’ brain activity. What they found was that of the three groups, the ChatGPT users had the lowest brain engagement and consistently underperformed at neural, linguistic and behavioral levels. Over the course of several months, the ChatGPT users got lazier with each subsequent essay, often resorting to copy and paste.

On this season of And Just Like That…, Harry Goldenblatt couldn’t help but wonder if his health had taken a turn. On the June 26 episode of the show, Charlotte’s affable husband goes from wetting his pants in a nightclub to joining a club he’d rather not be part of—even though, as he points out, it also includes Robert De Niro, Warren Buffett, and Nelson Mandela.

During an evening walk past the Guggenheim Museum, Harry tells Charlotte there’s a reason he asked her to go for a stroll. “To get away from the kids? Me too,” she quips. Not exactly: Because of a couple strange symptoms he’d been experiencing, Harry decided to go to the doctor for a check-up. “What do you know? I got prostate cancer,” he tells his wife, who immediately dissolves into panicky fear. “Everything is going to be fine,” he reassures her. “We caught it early.”

Charlotte might not be happy about Harry’s news, but some experts are pleased with the development. “I’m ecstatic about this plotline, because the awareness and discussion around prostate cancer is often hidden,” says Dr. Phillip Koo, chief medical officer at the Prostate Cancer Foundation. “Men don’t like talking about it—I think we often put up that tough shell on the outside, especially when it involves the sort of organs that men define their masculinity based on. I think it’s wonderful we’re raising awareness.”

Still, that doesn’t necessarily mean the show’s depiction is accurate. We asked experts how realistic Harry’s experience is—and what they want men to know about prostate cancer.

Creative liberties

Harry went to the doctor after experiencing two symptoms (played for cringey laughs from viewers). Earlier in the season, he hits the clubs with Charlotte, who’s trying to finagle an art sale for the gallery she manages. As the group plots their move to an after-party, Harry makes a pit-stop at the bathroom, where he finds, much to his horror, that he can’t undo his fancy jeans quickly enough. “Oh boy, oh boy,” he mutters. “These buttons! Why so many?” And just like that, Harry pees in his pants. “It’s a good thing these babies are so dark,” he says to Charlotte when he meets up with her again. “You can’t tell they’re soaked.”

Then, in the next episode, Harry has trouble performing in the bedroom with Charlotte. As he wonders in exasperation what is—or, he clarifies, isn’t—”going on down there,” he bemoans how out-of-character this is for him. “Is this it? The beginning of the end?” he spirals. “Knock knock, who’s there? Old age!”

Read More: Why Some Men Keep Their Prostate Cancer a Secret

Cut to the latest episode, and Harry has been diagnosed with prostate cancer based on those symptoms. “There’s definitely some creative liberties the show has taken,” says Dr. Julia Willingham, a urologist who treats prostate cancer patients at Texas Oncology. “It makes sense—it helps drive the plot forward—but most early-stage prostate cancer has no symptoms at all.” That’s why some people call the disease—which will affect more than 313,000 men in the U.S. in 2025—a silent killer. It’s almost always detected via a routine prostate-specific antigen (PSA) test, a screening blood test that most men undergo every couple of years or so starting around age 50 for those with average risk. (Exact screening frequency depends on a person’s age and risk factors.)

When a man’s PSA level is high, doctors typically do a biopsy and, potentially, tests like a CT scan or bone scan to confirm the diagnosis. “Sometimes men say, ‘Oh my gosh, I feel great,’” Willingham says. “‘There’s no way I can have prostate cancer. I have no symptoms.’ And then they do.”

A more likely path to diagnosis

Before the PSA test was approved as a diagnostic tool in 1994, men were more likely to figure out something was wrong because they were experiencing urinary retention, rather than Harry’s incontinence. That can mean difficulty starting to pee, a weak stream, trouble fully emptying the bladder, or sometimes, an inability to pee at all. “The prostate is in a very busy neighborhood,” says Dr. Mark Pomerantz, clinical director of the Lank Center for Genitourinary Oncology at Dana-Farber Cancer Institute. “It sits right under the bladder and the urethra—and if there’s a large prostate tumor, in theory it could press against that tube and cause urinary retention.”

Other times, men were diagnosed because their prostate cancer spread, leading to symptoms that affected other parts of the body. “Prostate cancer loves to go to bone,” Pomerantz says. “It was not uncommon, prior to PSA testing, for people to show up in the emergency room with terrible back pain.” There, they’d get an X-ray that ultimately led to a diagnosis of metastatic prostate cancer that had spread to the bones in their back. “We don’t see that nearly as much anymore now that we have a test that can catch the cancer early,” Pomerantz says. “When it does cause symptoms, typically the disease is pretty far along.”

That means, if Harry were a real-life patient, there’d be reason to believe his disease was advanced. “It could still be local”—which means it hasn’t yet spread beyond the prostate—“but it would take a tumor that’s pretty far along to get to the point where it would cause those symptoms.”

Read More: The Race to Explain Why More Young Adults Are Getting Cancer

Overall, Harry’s path to diagnosis is “possible, but certainly not typical,” Pomerantz says. That said, he understands why the show’s creators probably chose to highlight urinary incontinence and erectile dysfunction. “Those side effects are famously common consequences of prostate cancer treatment, but are rarely the symptoms that lead to diagnosis.”

Sometimes, doctors recommend active surveillance, or watchful waiting. But if a man’s cancer is aggressive, doctors typically take the prostate out, and that’s when side effects enter the picture. “The way the surgery works is the whole prostate has to come out, and when you remove the prostate, you must remove the part of the urethra that runs right through the middle of the prostate,” Pomerantz says. “The surgeon takes the remaining urethra that’s still in the body and drags it up and sews it into the bottom of the bladder to make a new connection. That connection can be a little fragile.” Urine might have an easier time getting through, for example, which can lead to leakage. Plus, there are critical nerves that run alongside the prostate and are in charge of the sphincter muscle, which closes the bladder and keeps urine contained. “If those nerves get damaged in surgery, then you can have the side effects that were depicted in the show,” he says.

A natural reaction

Throughout the episode, Charlotte—who promised Harry she wouldn’t tell their kids about his diagnosis—struggles to contain her emotions. During a pre-planned glamping trip, she repeatedly snaps at her kids about the importance of savoring every moment together, and appears on the verge of an emotional breakdown. That’s a natural reaction, experts say.

“Everyone always talks about the C word,” Koo says. “I think your mind automatically jumps to the worst scenario, and the impact it will have on your life expectancy.” Many men worry about how they’ll continue working—and the impact their disease will have on their family’s finances. “Someone like Harry, who has young kids, might wonder: ‘How am I going to support them?’’’ he says. “It’s devastating,” no matter how optimistic the prognosis.

A welcome spotlight

Experts hope Harry’s diagnosis encourages more men to get screened. “Men should not be afraid of prostate cancer screening,” says Dr. Jamin Brahmbhatt, a urologist at Orlando Health. “It’s a simple blood test, just like you’re getting your cholesterol checked.”

Prostate cancer is one of the most common diagnoses among men, he adds, and it’s also very treatable, especially when caught early. More men die with the disease than of it. “It’s not like some of those other rare cancers,” he says. “The more we get screened, the healthier we can get people.”

Read More: Why Are So Many Young People Getting Cancer? It’s Complicated

Willingham has seen an increasing number of men come in proactively for screening, and she believes knowledge is power. That’s why she applauds Harry’s new storyline. “If anything, we should take this as encouragement to get those annual checks in, to take care of ourselves, and to know what’s going on,” she says. “Cancer aside, if you’re having urinary or sexual symptoms, go talk to your doctor, because these are things that we can handle and take care of—you don’t have to suffer with these symptoms.”

The fraction of people who got an abortion in their second trimester more than doubled in states that enforced near-total abortion bans after the Supreme Court overturned Roe v. Wade, new research has found.

The study, published in the American Journal of Public Health on Thursday, found that the proportion of abortions that took place at or after 13 weeks of pregnancy jumped from 8% before a ban was enforced to 17% afterward. The average point in pregnancy when the people who participated in the study were able to obtain an abortion also rose, from 7.7 weeks gestation pre-ban to 8.8 weeks gestation post-ban.

The overwhelming majority of abortions take place during the first trimester: In 2022, nearly 93% of abortions occurred before or at 13 weeks of pregnancy, according to the Centers for Disease Control and Prevention. Diana Greene Foster, the senior author of the study published on Thursday and a professor at the University of California, San Francisco, says the increase her study found in second-trimester abortions likely wasn’t what lawmakers behind the bans had intended, but it was an “unintended effect” of the laws.

“When you increase the logistical burden to get an abortion, the delays snowball. If people are later in pregnancy, then they have to travel farther to a provider that can care for them,” Foster says. “Every pregnancy is risky, and [for] people who don’t want to be pregnant, forcing them to continue to be pregnant longer is a real burden. There’s an increased risk and burden on their well-being.”

Foster and her colleagues conducted a survey of about 855 residents in the 14 states that, at the time, had implemented near-total abortion bans: Alabama, Arkansas, Idaho, Indiana, Kentucky, Louisiana, Mississippi, Missouri, Oklahoma, South Dakota, Tennessee, Texas, West Virginia, and Wisconsin. Researchers asked clinics in those states to invite patients who received an abortion during the two weeks before a ban was enforced, as well as those whose appointment was canceled or who were unable to make an appointment because of the new law, to participate in the survey. Researchers also asked call centers that help connect people to abortion services to invite callers living in those 14 states to participate in the study. Of the 855 people who participated in the study, 196 obtained an abortion before a ban was enforced and 659 had their appointments canceled or contacted clinics or call centers after a ban took effect.

The survey asked participants to recount their experiences seeking care and their pregnancy outcomes, among other questions, every few months starting in June 2022 through June 2024. The burden of traveling to access abortion care skyrocketed after states passed near-total bans, researchers found. The mean time it took for people to travel to obtain an abortion increased from 2.8 hours before a ban was implemented to 11.3 hours after a ban was enforced. Similarly, the mean costs associated with traveling to access care rose from $179 pre-ban to $372 post-ban. And the proportion of survey participants who had to spend the night after traveling to seek abortion care jumped from 5% pre-ban to 58% post-ban.

Read More: ‘An Exodus of OB-GYNs’: How the Dobbs Decision Has Shaken the Reproductive Health Landscape

Despite these challenges, the study found that most people seeking an abortion were able to get one. About 81% of survey respondents who contacted a clinic or call center after a ban took effect in their state said they traveled to another state to get an abortion; only roughly 3-11% of people who contacted a clinic or call center continued their pregnancy to birth, the study found.

“The fact that so many people get their abortions shows that, even when it’s hard, folks understand the consequences of not being able to get care, and they do the best they can to try and get care,” Foster says. “Some people still fall through the cracks and aren’t able to get care. But people are willing to go to great lengths—literally—to get an abortion when they think they need one.”

Previously released data have shown that the number of abortions provided in most of the country has increased in recent years, even after the Dobbs v. Jackson Women’s Health Organization decision that enabled many states to implement restrictions. Research suggests that part of that increase has likely been driven by patients receiving abortion pills in the mail via telehealth. Studies have also indicated that tens of thousands of people are traveling across state lines each year to get abortions; according to data released by the Guttmacher Institute in April, about 155,100 people traveled out of state for an abortion in 2024.

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Foster says her research shows that the effect of abortion bans has been “to make the burden of getting an abortion much greater—to make people travel and spend the night away from their kids or miss work and just be pregnant for longer than they want to be.”

“Even when abortion is made illegal, [given] the circumstances that people find themselves in when they’re pregnant and can’t support another child, they will not feel bound by state law [and] they will do everything they can to get a safe—preferably legal—abortion somewhere else,” Foster says. “Their needs are too great to let a state policymaker decide for them.”

While working on this research, Foster and her colleagues received a grant from the National Institutes of Health (NIH). The grant, which started in September, was meant to last for five years. But a few months ago, Foster and her colleagues received a notice informing them that the NIH grant had been canceled and they should stop their research immediately.

“Their reason was that the study didn’t fit priorities, and specifically that research on gender identity isn’t scientifically useful, which is so bizarre because—never mind that gender identity research really should be done—this grant doesn’t have anything to do with it,” Foster says.

On his first day in office, President Donald Trump signed a number of Executive Orders, including one aimed at dismantling diversity, equity, and inclusion (DEI) programs. Trump also signed an Executive Order declaring that the federal government would only recognize “two sexes, male and female.” Weeks later, the NIH announced massive cuts in the funding it provides to research grants.

Foster had planned on using funding from the NIH grant to continue studying the impact that abortion restrictions are having on people’s access to care; she had already begun work on a project to collect data on how pregnant people are being treated in emergency departments. There have been many reports of people experiencing pregnancy complications being turned away from emergency rooms in states that have banned abortion.

Foster and her colleagues have appealed the decision in the hopes of getting the NIH grant restored, but haven’t heard back. For now, Foster says she has some private funding that she can use to keep moving forward with her research. But to have the NIH grant taken away “is deeply painful,” she says.

“It’s extremely frustrating because this work is important,” Foster says. “It’s important for the inevitable debates and judicial questions that will come [up] about these abortion bans. We have to have actual data to make decisions. We can’t just put people’s health in jeopardy for ideology; we need to understand what the impact will be and mitigate those harms, if there are harms.”

“But I never felt like I was going to stop doing the work,” she says. “I just knew we’d have to be resourceful and find other sources because it’s too important not to do it.”

You’re feeling on edge, your sleep is off, and your thoughts are racing. Is it just a stressful week, or something deeper?

Stress and anxiety share many symptoms, but they’re not the same thing—and coping with anxiety requires a slightly different approach than dealing with stress. Here’s what to know. 

The differences

“Many people use the words ‘stress’ and ‘anxiety’ interchangeably,” says Judith S. Beck, president of Beck Institute for Cognitive Behavior Therapy. “While their symptoms overlap, there are some distinctions between them.”

Stress arises when a person faces demands greater than what they believe they can cope with. It often triggers negative emotions like irritation, anger, or sadness, along with physical symptoms like a fast heart rate, an upset stomach, and tense muscles.

Stress often has a clear external cause and is situation-dependent. Once the event passes, “the intensity of a stress response usually decreases,” Beck says.

Read More: Are You Just Tired or Truly Burned Out?

Anxiety, on the other hand, can show up even when there’s no clear trigger, and it tends to linger. It’s also typically disproportionate to any stressful situation in a person’s life.

Stress can escalate into anxiety. “Stress and anxiety may be on a continuum,” Beck says. “If stress continues, and efforts to overcome it do not work, individuals may develop an anxiety disorder.”

What happens in your body when you’re stressed vs. anxious

When you’re stressed, your body kicks into fight-or-flight mode. You pump out cortisol and adrenaline, your heart rate increases, you may get short of breath, and your body becomes more activated. It’s your body saying, “Let’s handle this.”

This response is helpful when there is a short-term challenge, but can be deleterious if chronically activated. Stress responses resolve when the threat or demand subsides.

Read More: How to Deal With a Narcissist

Anxiety disorders, however, involve a more sustained state of heightened arousal and vigilance. “With anxiety, that same system might stay activated, even when there’s no real danger. Your brain is stuck in a loop of anticipating problems, so your body keeps reacting as if there’s something to fix, even when there isn’t,” says Nina Westbrook, a marriage and family therapist and founder of the digital wellness community Bene. “It’s exhausting, because your nervous system isn’t getting a break.”

How to cope

Accurately labeling your emotional experiences like stress or anxiety can be a first step in selecting the best coping strategy or treatment.

“Naming what you’re feeling is more powerful than you might think,” says Westbrook. “It gives you a starting point. If you can say, ‘This is stress,’ you can start to connect the feeling to the source.”

Stress might be addressed in many different ways, depending on the trigger. If you’re sweating an upcoming presentation, for instance, better time-management might calm your nerves. In other situations, you might need to set more boundaries or ask for support, Westbrook suggests. Other stress-reduction strategies include dividing overwhelming tasks into smaller, doable steps; taking a short walk; sharing your experiences with a trusted friend; and giving yourself permission to say “not right now,” says Beck.

Read More: 7 Questions That Can Instantly Boost Your Work Relationships

Handling anxiety doesn’t rely as much on addressing any single trigger, since the emotion tends to persist throughout different situations.  “You might shift focus to calming your nervous system and working on grounding practices or techniques that you know work for you,” Westbrook says. Anxiety might also require more intensive cognitive-behavioral interventions aimed at changing negative thought patterns. 

Deep breathing, mindfulness practices, and regular physical activity can all help reduce anxiety symptoms in the moment and over time. Westbrook recommends routinely limiting stimulation, cutting back on caffeine and social media, setting up and sticking to a routine, and practicing positive self-talk to deal with anxiety

“Therapy can be a game-changer too,” says Westbrook. “It gives you tools, but more importantly, a safe space to process.”

Tempers often soar sky-high on airplanes—and that’s not just because of the cramped quarters, lack of an escape route, and frequent delays. In the same way that travelers are geographically and culturally diverse, they come from a hodgepodge of etiquette backgrounds, too. “The rules in Manhattan, Kansas, are different than in Manhattan, New York,” says Nick Leighton, who co-hosts the etiquette podcast Were You Raised By Wolves? “We’re all operating from slightly different etiquette playbooks, and we all have slightly different ideas about personal space, volume, and what’s acceptable and not acceptable. Combine that with people being sleep-deprived, hungry, cranky, and stressed out, and it’s a recipe for disaster.”

How should you handle an inconsiderate or even unruly fellow passenger? We asked experts to share the best words to use.

“Excuse me, I’m sorry to bother you….” 

No matter what your fellow traveler is doing to annoy you—maybe reclining their seat back so far, you can’t feel your legs—you can use a variety of diplomatic opening lines. One of Leighton’s favorites is apologizing for bothering them, and then segueing into your issue. “With a lot of these things that are happening on an airplane, people are not being malicious,” he says. “They’re not intending to make things unpleasant for you. It helps to come at it with that understanding.”

“I hope you don’t mind me asking, but could you put your shoes back on?”

This is another polite way to call out someone’s inappropriate behavior. It’s not an attack and shouldn’t make them feel defensive. You could also word it like this, Leighton suggests: “I hope you don’t mind me mentioning this, but I can see an inappropriate video on your phone, and I’m with my child. Would it be possible to watch something else?”

“Could I ask a small favor?”

It’s hard to ask a perfect stranger to do something that will benefit you while potentially disrupting them. That’s why Leighton likes this phrasing or a similar approach: “I understand this is inconvenient, but would it be possible for you to close the window shade?”

Read More: 8 Ways to Respond to an Apology Besides ‘It’s OK’

When you make a request in such a friendly way, it’s more likely “to be received in the spirit in which it’s intended,” Leighton says. He advises using a non-judgmental, neutral tone, and not pushing the issue. “That’s the best way to prevent things from escalating,” he says. “Because in an airplane, we just don’t want things to escalate.”

“Hoo boy! That sandwich really smells pungent.”

If your neighbor’s tuna sandwich is really bothering you—are those extra onions?—open your air vent and then try handling the situation with humor. “Maybe the person will get the hint, though that doesn’t mean they’re going to stop eating,” says Jacqueline Whitmore, a former flight attendant who’s now an etiquette expert and founder of the Protocol School of Palm Beach, a coaching and training company.

If you’re seriously struggling with the noxious odor, it might be best to enlist a crew member’s help, she adds, especially if you’ll be in the air for a while. “I’d get up and discreetly speak to a flight attendant and say, ‘Do you have another seat available?’” she suggests. “‘I’m really having a hard time with the smelly sandwich.’”

“Thanks for the conversation. I’m going to get some work done now.”

Maybe you’re fortunate enough to be sitting next to a friendly passenger. (It could always be much, much worse.) That doesn’t mean you want to spend the duration of the flight making small talk. After some brief banter, tell them it was nice chatting with them, and that you’re going to shift your attention elsewhere—which could mean opening your laptop, taking a nap, or simply zoning out. Ending the conversation is preferable to simply ignoring the other person, Whitmore says. To help ensure she has an easy time pivoting from unwanted conversations, “I always travel with earbuds,” she adds.

“I’m going to push your bag over just a bit to give myself some more leg room.”

One of the most common complaints on flights is that another traveler’s legs or bags are spilling into their neighbor’s personal space. “It happens all the time,” Whitmore says. If someone has stuffed their duffel bag in front of them—rather than in the overhead bin, where it should be stowed—she reaches down and says, “Sorry, I’m just going to push your bag over a bit so I have more leg room.” Most people are understanding, she’s found.

“Do you mind turning the volume down? I can’t hear my movie.”

When you request something from a stranger on a plane, it’s best to offer a reason, says Rich Henderson, a flight attendant who hosts the podcast Two Guys on a Plane with his husband. That includes not being able to hear the sound of your own podcast or movie over the volume of theirs. “I always feel like giving a reason just really helps people process, like, I’m not just doing this to just shut you down,” he says. “I’m doing this because I’m legitimately having an issue here.” Most people are receptive to that, he adds.

“Sorry—I’m not able to help.”

Airplane disputes often occur when one traveler asks another to switch seats in order to be closer to a friend or family member. Often, one of them splurged for an assigned seat, while the other didn’t, and these requests usually don’t land well. “I don’t have a lot of empathy for that, because these people paid for their seats,” Henderson says. “We can ask, but there’s no forcing anybody here.”

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If you’re on the receiving end of such a request, and you don’t want to move, he suggests handling the situation in a succinct, straightforward way: by telling them you’re not able to help. No further explanation is necessary.

“Hey, sorry to wake you up.”

Sure, there are perks to a window seat. But if you’re in the aisle? No one cares how many times you pop up to head to the restroom. Otherwise, you run the risk of having to wake up the stranger(s) next to you when nature calls. In those situations, Henderson suggests starting verbally: In a louder-than-usual voice, let your seatmate know you need to get up. “Nobody likes to be touched in a surprising way,” he says. If that doesn’t work, however, it’s OK to say “excuse me” loudly and lightly tap the other person’s shoulder. “That usually does the trick,” he says.

“Could you repeat that?”

When a passenger is clearly starting to get agitated, Henderson likes to ask them to repeat what they just said. People often speak without thinking, he’s found, and when pressed to say their rude remark again while looking someone in the eyes, they usually won’t repeat it. “They’ll either rephrase it or they’ll be like, ‘You know what, it’s not that big of a deal,’ because they realize maybe they went too far,” he says.

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One of the best things about this line is its versatility: It will work in many situations involving ill-mannered airplane passengers. “If you’re in one of those situations, whether it’s over a seat recliner or an armrest or whatever the case may be, just be like, ‘Hey, say that again—I didn’t hear you,'” he advises. “It works really well to get people to not flip out.”

Wondering what to say in a tricky social situation? Email timetotalk@time.com

A coalition of health insurance companies is vowing to make changes to the prior authorization process, after years of patients and providers’ complaints over a system they say delays care and endangers people’s health.

On Monday, federal health officials met with representatives from some of the country’s major insurance companies, including Aetna, Blue Cross Blue Shield Association, Cigna, Kaiser Permanente, and UnitedHealthcare. The coalition of insurers voluntarily pledged to streamline the widely criticized process.

The insurance companies, as well as Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Dr. Mehmet Oz, touted the commitment as a step toward improving the country’s health care system. 

But this isn’t the first time insurers have pledged to reform the process in recent years, as it has drawn fierce criticism.

Here’s what to know about prior authorization, and what insurers have vowed to do.

What is prior authorization?

Prior authorization refers to when medical providers have to get approval from insurers before performing a service.

Why is it so contentious?

Patients and providers have criticized insurance companies for denying prior authorization requests, saying that them doing so prevents or delays patients from accessing care that is recommended by their doctors.

Almost one in three physicians report that prior authorization requests are frequently or always denied, and about 75% said the number of denials has increased somewhat or significantly over the last five years, according to a 2024 survey conducted by the American Medical Association. About 93% of physicians reported that prior authorization delayed access to necessary care, and 82% said that the process can, at least sometimes, lead to patients abandoning treatment altogether, the survey found. More than one in four physicians who responded to the survey reported that the process has led to a serious adverse event for a patient they were treating.

Read more: What to Do When Health Insurance Denies Care You Really Need

The fatal shooting in December of UnitedHealthcare CEO Brian Thompson, who had been on his way to an investor meeting in New York at the time of the attack, made national headlines and drew renewed attention to the controversies surrounding prior authorization.

Oz said during a press conference that there has been “violence in the streets over these issues,” in an apparent reference to the shooting. 

“This is not something that is a passively accepted reality anymore—Americans are upset about it,” Oz said.

Insurers have promised to reform the process before

Health insurance companies have made similar promises to revamp prior authorization in the past—in both 2018 and 2023, some insurers pledged to improve the process. But experts criticized the companies for failing to make substantial changes. 

UnitedHealthcare has said that, this year, it will aim to reduce the total number of services requiring prior authorization by nearly 10%. 

In February, Cigna committed to making a number of changes to the process, such as announcing plans to invest in resources that would help more patients resolve issues with prior authorization faster, as well as streamline the process for physicians to submit requests.

What are they committing to do now?

According to a press release from the Department of Health and Human Services (HHS), the coalition of health insurers on Monday committed to six reforms:

1. Standardize electronic prior authorization submissions
2. Reduce the number of medical services that require prior authorization by Jan. 1, 2026
3. Honor existing authorizations while patients are switching to another insurance plan to ensure that ongoing care is uninterrupted
4. Improve transparency and communication regarding authorization decisions and appeals
5. Decrease delays by expanding real-time approvals for most requests by 2027
6. Ensure that medical professionals review all denials for clinical care and services

What do RFK Jr. and Dr. Oz say?

Kennedy thanked the insurers who pledged to make reforms.

“Americans shouldn’t have to negotiate with their insurer to get the care they need,” he said in the press release. “Pitting patients and their doctors against massive companies was not good for anyone. We are actively working with industry to make it easier to get prior authorization for common services such as diagnostic imaging, physical therapy, and outpatient surgery.”

Noting Americans’ mounting negative feelings toward the process, Oz said in a press release from HHS that the commitment from insurance companies was “a step in the right direction toward restoring trust, easing burdens on providers, and helping patients receive timely, evidence-based care.”

If you want to protect yourself from mosquitoes and ticks—which seem to be everywhere this year—you might need to enlist a heavy-hitter. Insect experts reach for one thing: permethrin.

Here’s what to know about the synthetic insecticide, plus how and when to use it.

How permethrin works

Permethrin, which is derived from the chrysanthemum flower, has been used in some form since around 400 B.C. During the wars of the early 1800s, Napoleon dusted his soldiers with a permethrin-like powder to control fleas and body lice, which protected them from anemia and gave them a physical edge over their enemies.

Permethrin is a neurotoxin that targets an insect’s nervous system, triggering muscle spasms, paralysis, and eventually death. It functions as a contact insecticide, which means it kills via direct contact when a bug lands on a treated surface. That distinguishes it from DEET-based repellents, which work in a different way. DEET “blocks the sensors for an insect to find you, so you end up with a cloak of invisibility,” says Lee Haines, a medical entomologist at the University of Notre Dame who studies how insects spread diseases. “They’re attracted to your heat, but they can’t find you.”

To visualize how permethrin works, consider what would happen if you ate nothing but cotton candy for a week. “Can you imagine how hyperactive you would be?” Haines asks. The same thing happens to bugs: “If you see a mosquito that touches permethrin, it’s shaking uncontrollably, it’s flying uncontrollably, like it just had a lot of sugar. It’s buzzing around, and that’s because all of its nerves are firing at once.” That causes muscle spasms; once the insect’s muscles are exhausted, it becomes paralyzed and then dies.

If that sounds unpleasant, it is. “It’s not a nice way to die,” Haines says.

Read More: 7 Surprising Symptoms of Lyme Disease

Permethrin is odorless and colorless, and insects can’t detect its presence, she adds. That helps make it effective. In one study of Iranian military members, for example, the average number of mosquito bites in those wearing untreated uniforms was 108 per hour, compared to 10 per hour in soldiers wearing permethrin-treated uniforms.

Meanwhile, research has found that people who wore permethrin-treated socks and sneakers were 74 times less likely to get a tick bite than those wearing untreated footwear. Study participants who wore permethrin-treated shorts and T-shirts were about 5 and 2 times less likely, respectively, to get tick bites than those who were permethrin-free. The results highlight “the potential of permethrin-treated summer clothing for significantly reducing tick bites and tick-borne pathogen transmission,” the researchers wrote.

DIY vs. pre-treated clothes

How you apply permethrin matters. If you want to go the DIY route, opt for a product with a concentration of 0.5% permethrin. You can either buy a pre-diluted spray bottle, or dilute a concentrated jug yourself.

You can spray permethrin on your clothing, accessories, and gear—just not your skin. People often spray their pants, shirts, socks, shoes, hats, jacket, backpack, and tent, for example. (It doesn’t harm clothing.) You typically need to apply it 24 to 48 hours before going out; that way, it has time to dry and bond to the material you sprayed it on. Spray your clothing outside and while it’s off your body; hang it up on a clothesline, for example, and spray it evenly so that it becomes damp but not dripping wet.

Bobbi Pritt, a professor of laboratory medicine and pathology and the chair of the division of clinical microbiology at Mayo Clinic, always sprays permethrin on her gear outside on her screen porch, which is well-ventilated. Keep in mind that the liquid form can be toxic to cats, though it’s safe once it dries. At that point, “You don’t need to worry about having a cat in your lap,” says Pritt, who runs the blog Creepy Dreadful Wonderful Parasites.

Read More: Long Dismissed, Chronic Lyme Disease Is Finally Getting Its Moment

If you choose to spray permethrin on your clothing and gear, you’ll need to keep track of when you do it. Most products last up to six weeks or six washes—whichever comes first—and then need to be reapplied. That’s one reason why some people prefer longer-lasting pre-treated clothing, which is sold at outdoor-gear stores and can generally last up to 70 washes. It’s the only insect repellant used for factory treatment of clothing, according to the U.S. Environmental Protection Agency, and the EPA’s risk-assessment procedures “showed that permethrin factory-treated clothing is unlikely to pose any significant immediate or long-term hazard to people wearing the clothing,” according to their website.

Haines recommends opting for pre-treated garments rather than applying permethrin yourself. “It’s way better to get factory clothes,” she says. “It’s longer-lasting, and they’ve had to test it to make sure it works.” Plus, it’s more consistently applied and eliminates the possibility of human error from an imperfect spraying technique. It also removes the need for advanced preparation: People sometimes forget to apply permethrin to their clothing ahead of needing it, but with pre-treated clothes, you can grab and go.

What about natural bug sprays?

Permethrin is considered safe when used as directed. Research suggests that less than 2% of the insecticide is absorbed through the skin when it’s applied to clothing, and the EPA notes that there are no known risks of permethrin to women who are pregnant or nursing. It’s also safe for kids who are over 2 months old. “From all the studies and data that we have, it’s considered pretty safe as long as you use it according to the instructions on the container of the specific brand that you have,” Pritt says. 

Still, some people prefer natural options. There are a couple of candidates: Oil of lemon eucalyptus can be applied to exposed skin as well as clothing and works well to repel mosquitoes and ticks, Haines says; make sure to get one with a 30% to 40% concentration, and dilute it with water before use. “It has a very strong smell, and you have to reapply it every two to three hours, but it works,” she says. Tea tree oil, which also needs to be diluted, is another popular natural insect repellent. It “reeks,” according to Haines, which keeps bugs away, but you have to reapply it as frequently as oil of lemon eucalyptus.

“What I try to tell people is that, yes, there are alternatives, but you have to use them responsibly if you want to protect yourself,” she says. “The natural answer is never as good as one that has been tweaked by a chemist to be higher efficacy.”

Making permethrin part of your routine

Pritt thinks of permethrin as “one piece of the puzzle—one tool in your toolbox of protecting yourself against ticks and mosquitoes.” When she goes out in the field to do research, she tucks her pants into her socks and wears tall boots. She sprays her entire outfit with permethrin the night before so it’s ready the next morning. She also sprays insect repellent on any exposed skin—often opting for oil of lemon eucalyptus, which she’s found works well for her.

Read More: The Best and Worst Way to Remove a Tick

Haines takes a similar approach, but sprays a repellant with 20% picaridin on her exposed skin. “It’s really deadly on ticks,” she says. “It works on midges and mosquitos—it works on everything.” Plus, it typically lasts for eight to 12 hours. It doesn’t have a strong smell, she adds, and isn’t greasy. Pair it with your permethrin-treated clothing, and you’ll be much more protected from the blood-thirsty pests of summer.

Run-of-the-mill fatigue can be hard to distinguish from true burnout. But while both can leave you drained and unfocused, burnout runs deeper. Here’s how to know whether you simply need to catch up on rest—or a more serious reset.

What’s the difference, really?

Being tired is a normal part of life, especially when you’ve had a late night or a busy week. Fatigue is usually temporary and goes away with rest, sleep, or a short break. Once you take a step back, your energy typically returns.

“Burnout is completely different,” says Dr. Marjorie Jenkins, chief clinical officer at Incora Health, a women’s health tech company. “It causes us to question our purpose, lose our motivation, and destroy our emotional wellness. In essence, we lose our sense of self.”

Burnout is often rooted in chronic stress, emotional exhaustion, and a sense of detachment from work or life responsibilities. It’s not just a psychological state: burnout can lead to measurable changes in the brain’s structure and function.

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A 2014 study published in PLOS ONE used brain imaging to show that people with job-related burnout had less gray matter in areas tied to emotional regulation and cognitive control, particularly the anterior cingulate cortex and dorsolateral prefrontal cortex. These areas help manage stress, decision-making, and emotional response—functions that can be impaired in burnout.

Another study in Neuropsychopharmacology found that the amygdala—the brain’s fear and stress response center—can become hyperactive in burnout, leading to heightened emotional reactivity and difficulty calming down even after the stressor is removed.

What causes burnout? 

Burnout happens when chronic stress fundamentally alters how your brain operates, explains Kevin J.P. Woods, director of science at Brain.fm, a company that engineers music to improve focus.

“From a neurological standpoint, it represents a breakdown in the brain’s ability to manage stress,” he says. “The brain has sophisticated systems for handling short-term stress. They helped our ancestors survive threats. But these same systems weren’t designed for the constant, unrelenting stress of modern life. When activated continuously, they begin to malfunction.”

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Some common causes of burnout include having an excessive workload where you lack control over tasks and recognition for your efforts, a poor work-life balance, strained relationships, a mismatch between your values and environment, a toxic work culture or leadership, and mounting responsibilities outside of work (like kids, ailing parents, health problems). Constantly using technology without disconnecting is another risk factor.

Who’s most at risk?

Burnout can affect anyone, but certain people and professions are especially vulnerable. Research shows that a combination of personality traits, job demands, and life roles can significantly raise the risk.

“Many people address burnout when it is too late,” says Thea Gallagher, a clinical psychologist at NYU Langone Health. “It’s easy for people to become burned out in careers they love, but we all need boundaries and work-life balance, even if we love our work.”

These are some of the careers and roles that can lead to a higher risk of burnout.

High-stress professions

People in health care, education, social work, and emergency services often face long hours, emotional labor, and limited control over their workload—all classic drivers of burnout. A 2022 report from the World Health Organization named these sectors as particularly high risk, especially since the COVID-19 pandemic.

Perfectionists and overachievers

Those with high internal pressure or people-pleasing tendencies may push themselves past healthy limits. These traits, while often praised professionally, can make it harder to recognize when rest is needed—or to ask for help, Gallagher says.

Remote and gig workers

Those who work from home or lack clear work-life boundaries may feel like they’re always “on.” Without physical separation from their job, it becomes harder to unplug, recover, and recharge.

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Caregivers

Whether you’re a parent, taking care of aging parents, or both, caregiving can be emotionally draining, physically exhausting, and under-appreciated, making burnout common.

Women and marginalized groups

Women, especially women of color, often face invisible labor, inequities, and microaggressions that add chronic stress to their work and home lives. Studies show women are more likely to report burnout than men, and more likely to suffer in silence.

People without strong support systems

Those lacking emotional or social support at work or at home have a harder time buffering stress, making them more vulnerable to burnout’s long-term effects.

How to recover from burnout and prevent it in the future

Stress is a part of life, and knowing how to manage and respond to it is key to success professionally and personally.

“Recovering from burnout takes time,” says Woods. “The brain changes that occur with chronic stress don’t reverse overnight. Most patients need at least three to six months of consistent lifestyle changes to see significant improvement.”

He says taking breaks from work-related thinking throughout the workday—every 90 minutes or so—can help “prevent cognitive overload.” Make time for face-to-face interactions, ideally with friends or loved ones; these can help counteract stress. Exercise, too, helps restore energy. “Even 20-30 minutes of walking makes a measurable difference,” he says. So does getting adequate sleep.

“Ultimately, our bodies need rest” to prevent burnout, says Jenkins—and that’s true “no matter how strong, resilient, brilliant, and successful we are. Once rested, we feel better, energized, and can get back to our lives with renewed energy.”