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How to get all-day-energy

No one is immune to the occasional bout of low energy and weariness. But timed right, small changes in your routine can give you a lift during the day and improve sleep, says Consumer Reports.

See your doctor if you have other symptoms -- such as unexplained weight gain or loss, fever, shortness of breath, morning headaches or difficulty concentrating -- or recently started a new medication. Otherwise, Consumer Reports suggests giving these seven strategies a try for a month to see whether your energy levels reboot.

Morning

-- Let the sunshine in. The brain makes melatonin, the hormone that causes sleepiness, when it's dark. Morning light helps stop the production of melatonin, says Shelby F. Harris, Psy.D., director of the Behavioral Sleep Medicine Program at Montefiore Medical Center in New York City. Upon awakening, open the curtains or shades, sit by a window while you eat breakfast or take a morning walk. Continue to expose yourself to light during the day to keep your body's sleep-wake cycle synchronized.

-- Take a drink break. Even mild dehydration can zap energy, memory and attention, according to a 2016 study published in the American Journal of Clinical Nutrition. Older adults can have a tougher time staying hydrated, in part because the mechanism that triggers thirst may become less efficient with age. To compensate, make it a point to drink at regular intervals throughout the day, beginning in the morning. Coffee and tea count (they have only a mild diuretic effect, if any), as do foods with a high water content, such as soup and most fruits and vegetables.

Afternoon

-- Get moving. It seems counterintuitive, but physical activity is a powerful antidote for fatigue. And it doesn't have to be strenuous: In a small University of Georgia study, couch potatoes who engaged in a 20-minute, low-intensity aerobic exercise routine three times per week for six weeks reduced their fatigue by 65 percent; those who engaged in moderate-intensity exercise lowered it by 49 percent.

-- Stop sipping coffee and tea. Thanks to their caffeine, both are great pick-me-ups, but it's a good idea to limit the stimulant to 400 mg per day (roughly two to four 8-ounce cups of coffee) and taper off by late afternoon. Consumer Reports notes that caffeine can disrupt sleep when it's consumed even six hours before bedtime.

Evening

-- Power down. Dim the lights, switch off the TV and put away smartphones, tablets and computers at least an hour before bedtime. This will trigger your brain to start producing melatonin.

-- Make over your bedtime habits. To get the seven to nine hours of slumber you need to restore body and mind, improve your sleep hygiene. Keep your bedroom dark, use your bed only for sex and sleep (no pets allowed), and stick with a regular sleep schedule.

-- Address your stress. Sometimes it's difficult to separate physical fatigue from the mental drain caused by life's demands and worries. Harris recommends listening to a meditation or relaxation app before bed.

To learn more, visit ConsumerReports.org

How to beat a surprise medical bill

There are two ways to combat surprise medical bills, whether they come from an air ambulance, a ground ambulance or a health-care professional: Prevent them in the first place or fight them later.

Prevent the Bills.

Most bills are the result of being treated by someone outside your insurance company's network of providers. So avoid those out-of-network providers whenever you can.

That's easier in non-emergencies, such as when planning a knee replacement or having a baby. In those cases, ask the person who handles billing in your doctor's office for a list of the anesthesiologist, radiologist and anyone else who could conceivably be part of your care, including while you're in the hospital.

Then call your insurer to make sure that those people are in your network. (Don't rely on online directories, Consumer Reports advises; they can be out of date.) If anyone isn't, tell the physician that you only want in-network providers. It's harder to find them during an emergency, because you might not have the time.

Still, it's wise -- before you need to go to an ER -- to find out which nearby hospitals are in your network and use in-network ER physicians. Then, in an emergency, try to go to one of those if you can.

If you need an ambulance, you can ask to be taken to an in-network hospital, though the first-responder onboard will make the final decision. So reserve ERs for true emergencies, and if it's safe, go in a car.

Fight the Bills.

If you're stuck with a surprise medical bill, call the provider and your insurer. Explain that you didn't realize the care, which was essential, would involve out-of-network providers.

Some physicians may accept the insurance payment and forgive the balance. Or the insurer and the non-network physician may agree to lower the bill, making it easier for you to afford.

If you're billed for emergency care or ambulance transport, also ask the first responders or ER doctors to provide documents confirming that you had no choice in how you were transported and that it was medically necessary.

If all else fails, Consumer Reports recommends complaining to your state's health insurance agency, says Caitlin Donovan of the National Patient Advocate Foundation.

Those agencies can't always help -- for example, states have little power over air ambulances -- but lodging a complaint could strengthen your bargaining power.

To contact your state's insurance department, use Consumer Reports' surprise medical bill tool, at ConsumersUnion.org/insurance-complaint-tool.

The Patient Advocate Foundation has counselors who can help. Contact them at patientadvocate.org or 800-532-5274.

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To learn more, visit ConsumerReports.org

Who really needs cholesterol and blood pressure drugs

Experts agree that high blood pressure and high cholesterol increase the risk of having a heart attack. So you might think they also agree on when you should take drugs to control them.

They don't, says Consumer Reports.

Earlier this year, the American College of Physicians issued more lenient guidelines for blood pressure in people 60 and older: They don't need drugs until their systolic, or upper, blood pressure number goes above 150, the ACP now says. But the American Heart Association sticks with the traditional cutoff of 140. And last year, the U.S. Preventive Services Task Force suggested that people who don't have particularly high cholesterol levels can still benefit from cholesterol-lowering statin drugs.

Here's Consumer Reports' guide through the maze.

-- Focus on your overall risk. Though blood pressure and cholesterol levels are important, other factors play a role, too -- including your age, gender, race, and whether you smoke or have diabetes.

"Everyone 40 and over should know their overall risk of having a heart attack or stroke," says Marvin M. Lipman, M.D., Consumer Reports' chief medical adviser. So he and other experts recommend estimating your 10-year risk by using a calculator developed by the American College of Cardiology and the American Heart Association, at tools.acc.org/ASCVD-Risk-Estimator. The ideal is a 10-year risk that's less than 7.5 percent.

-- Don't rush to drugs. If your 10-year risk is greater than 10 percent, or if your LDL (bad) cholesterol level is over 190, you should start a statin. But if your risk is between 7.5 and 10, it can be worth trying lifestyle changes first, Consumer Reports' consultants say.

That means stopping smoking, losing excess weight, being active, consuming a heart-healthy diet, drinking alcohol in moderation only and getting blood sugar levels under control. If that doesn't lower your risk enough after three to six months, consider a statin, even if your LDL cholesterol isn't elevated.

The same basic strategy applies to blood pressure. If it's moderately elevated (150 to 160 for people 60 and older; 140 to 150 for others), consider drugs only if several months of diet and lifestyle changes weren't enough.

-- Get the right medication. People with a history of heart attack or stroke, or at very high risk of one (greater than 20 percent), should start with higher doses of a potent statin: 40 to 80 mg of atorvastatin (Lipitor and generic) or 20 to 40 mg of rosuvastatin (Crestor and generic).

Doctors use several different kinds of drugs to lower blood pressure, and for people with levels above 150 it can take a combination to control the problem. Still, it usually makes sense to start with the oldest, safest and least expensive drug: diuretics, or water pills, such as chlorthalidone or hydrochlorothiazide. If that doesn't work, you may need to switch to or add an ACE inhibitor, calcium channel blocker, or other kind of drug.

To learn more, visit ConsumerReports.org

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