Sleep is regulated by processes in the brain in response to how long we are awake in addition to the light/dark cycle controlled by the circadian rhythm. With Drs. Oum Hassani and Maan Gee Lee, Dr. Barbara Jones at the MNI were studying a structure in the brain called the lateral hypothalamus (LH) known to be critical for maintaining wakefulness. MCH neurons, co-distributed with Orx neurons, constitute less than 10% of the LH. Previous studies have shown that Orx neurons are essential for maintenance of the awake state. These neurons are active in the waking state and turn off during sleep and in their absence, animals and humans experience narcolepsy with cataplexy or sudden loss of mucle tone. However, the role of MCH neurons was until now, unclear. Evidence from earlier knockout studies suggested that MCH neurons might play a different role than Orx neurons in regulating activity and sleep-wake states. Therefore the team at the MNI set up experiments to study the function of MCH neurons during the sleep-wake states.

“Remarkably, what we found is that MCH neurons are actually silent during waking, which is a surprising finding especially in this wake-promoting region of the brain. The neurons fire during sleep, and are most active during REM sleep,” says Dr. Barbara Jones, neuroscientist at the MNI and principal investigator in the study. “Our study markedly demonstrates that MCH neurons discharge in a reciprocal manner to the Orx neurons across the sleep-wake cycle.” Dr. Jones and colleagues used their expertise to apply and develop a difficult technique which allowed them to selectively record, label and thus identify a nerve cell containing a particular chemical. This allowed them to isolate the functions of the MCH and Orx cells even though they comprise less than 10% of the nerve cells in the LH.

The reciprocal profiles and roles of the Orx and MCH neurons could be significant in the manifestation of sleep disorders. It is possible that narcolepsy, which occurs with the loss of Orx neurons, is provoked in part by the MCH neurons that remain intact in the narcoleptic patients. A growing body of research shows that regular and normal sleep is necessary for overall health; regulating hormone levels, blood pressure, metabolism, alertness, mood, and consolidating memory. This study presents potential therapeutic avenues and targets for the treatment of various sleep disorders including the development of drugs that will act on receptors for Orx and MCH, to stimulate or block these receptors accordingly.

The study shows that those patients who complained of nightmares during the week following the suicide attempt were three times more likely to attempt to take their own life again, regardless of gender or psychiatric diagnosis, such as depression or post-traumatic stress syndrome.

“Those who were still suffering from nightmares after two months faced an even greater risk. These people were five times more likely to attempt suicide a second time,” says author of the thesis, Registered Nurse Nils Sjöström.

Other sleeping difficulties do not increase risk of repeat suicide attempts

It is normal for patients that have attempted suicide to suffer from sleeping difficulties. Some 89 percent of the patients examined reported some kind of sleep disturbance. The most common problems were difficulty initiating sleep, followed by difficulty maintaining sleep, nightmares and early morning awakening. Nils Sjöström has also examined the possibility of there being an increased risk of repeat suicide attempts if the patient has difficulty falling asleep, difficulty sleeping during the night, or wakes up early in the morning. However, the result did not indicate any increased risk.

“The results show how important it is for healthcare staff to highlight the significance of nightmares in the clinical suicide risk assessment,” says Nils Sjöström.

“They said that I had 35 interruptions of my sleep per hour. So that meant that I was never getting fully asleep,” says Lou.

Because he was deprived of oxygen at night, Lou’s heart was being damaged, which is why he started using a continuous positive airway pressure mask, or a C-PAP mask. Doctors have known for sometime that it helps patients breathe better.

“What we haven’t known as well, is, whether or not C-PAP benefits the heart,” says Doctor Subha Raman, MD at the Ohio State University Medical Center.

So doctors at the Ohio State University Medical Center decided to find out. They took MRI’s of patients to get a good idea of the size and shape of their hearts when they were first diagnosed. Then patients were given C-PAP masks to sleep in. After several weeks they came back for another MRI, and doctors were surprised by what they saw.

“We saw that before treatment, the heart was enlarged. But after three months of careful use of their CPAP, we saw a reduction in the enlargement of the heart,” says Dr. Raman.

In all, experts say of the 13 patients who tried it, there were “significant” changes in the right ventricle of the heart.* Which means this mask not only helps with sleep disorders, but may be helping doctors get to the heart of a much more serious problem, as well.

Doctors say if left untreated, sleep apnea can lead to high blood pressure, and increase your risk of diabetes or having a stroke. If someone complains that you snore loudly and often you may want to get checked out by your doctor.

“The Sleep and Human Health Institute has a history of groundbreaking work, and this study will be an important advancement in understanding the relationship between Insomnia and Sleep Apnea,” said David P. White, M.D., Chief Medical Officer, Philips Respironics. “We know there are many skeptics who insist Chronic Insomnia is largely a psychological problem, but recent studies on certain patients have already shown that continuous positive airway pressure (CPAP) therapy or upper airway surgery significantly decreases insomnia.”

Unlike other studies that investigated patients at sleep centers, the new research will examine randomly selected patients seeking care at their primary care clinics. This approach provides data much closer to what goes on in the general population compared to sleep center cohorts.

“This opportunity will clarify whether Sleep Apnea is a common problem often overlooked in Chronic Insomnia patients,” declared Dr. Barry Krakow, principal investigator and medical director of the Sleep & Human Health Institute. “We’ll be using the latest respiratory technology to more accurately measure breathing, and we hypothesize that more than half of these Chronic Insomnia patients will suffer from previously undiagnosed Sleep Apnea.” Dr. Krakow is also medical director of Maimonides Sleep Arts and Sciences, a co-sponsor of the research.

The authors wrote in their background information that there was very little research on any potential link between coffee consumption and stroke risk.

For this study, Lopez-Garcia and colleagues analyzed data from the Nurses’ Health Study. The data covered 83,076 women who were followed for 24 years, starting with the first assessment of coffee consumption in 1980. This assessment was repeated every 2 to 4 years until 2004.

None of the women had a history of stroke, coronary heart disease, diabetes, or cancer at the start of the study.

The main outcome measure was the number and type of strokes that occurred among the women during the follow up.

Using statistical tools like Cox regression models, the researchers analyzed the relative risks (RR) between the stroke events and coffee consumption, while ruling out potential confounders such as age, smoking status, body mass index (BMI), exercise/physical activity, use of alcohol, menopausal status, use of hormone therapy, use of aspirin, and other dietary factors.

The results showed that:

* Over the follow up period, there were 2,280 strokes: 426 of which were hemorrhagic (burst blood vessel in the brain), 1,224 ischemic (loss of blood supply to the brain), and 630 undetermined.

* The relative risk of stroke went down as coffee consumption went up.

* For women who drank between 1 cup of coffee a month and 4 cups per week, the relative risk of stroke was 0.98 compared to women who drank less than one cup a month.

* For women who drank 5 to 7 cups of coffee a week, the relative risk of stroke was 0.88.

* For 2 to 3 cups a day the relative risk was 0.81, and for more than 4 per day it was 0.80.

* After adjusting the figures again to take into account high blood pressure, high blood cholesterol and type 2 diabetes, the relative risk of stroke still showed the same inverse association with coffee consumption: it went down as coffee consumption went up.

* The association was stronger among women who had either never smoked or had given up than among current smokers .

* Stroke risk was not linked to consumption of other drinks containing caffeine such as tea and caffeinated soft drinks.

* After taking out the effect of caffeinated coffee drinking, increasing decaffeinated coffee consumption was also found to be linked to lower stroke risk (relative risk of 2 or more cups a day compared to less than 1 a month was 0.89).

The authors concluded that:

“Long-term coffee consumption was not associated with an increased risk of stroke in women. In contrast, our data suggest that coffee consumption may modestly reduce risk of stroke.”

It would appear from these results that the beneficial link is not due to caffeine. WebMD reported that Lopez-Garcia suggested it was other ingredients in coffee that may be responsible for the lower risk of stroke as consumption rises:

“Antioxidants in coffee lower inflammation and improve blood vessel function,” she said in a press statement.

However, Lopez-Garcia cautioned that the beneficial effect of coffee drinking only applies to healthy people. Increasing coffee consumption will not make existing stroke risk from other causes go away.

And anyone with health problems should talk to their doctor about their own specific risk, she said. For instance people suffering with blood pressure, heart problems, anxiety or insomnia may not benefit from drinking coffee.

According to the principal investigator Giora Pillar, M.D, Ph.D, with the Sleep Laboratory at Rambam Medical Center in Haifa, Israel, it is very difficult to objectively assess and quantify the capability of an individual to remain vigilant. Many of the study’s participants may have been highly motivated to overcome their sleepiness during the test in order to prevent their license from being revoked.

“It could be expected that the MWT40 will be superior to MWT20, but it is somewhat surprising that despite a strong drive to sleep, as in cases of severe apnea, people could pass the test by remaining awake in all trials,” said Pillar. “It emphasizes the strong effect of motivation.”

The study included 164 consecutive subjects with an average age of 50, who were referred to the Technion Sleep Lab between June 2006 and January 2007 by the Medical Institute for Driving Safety of the Ministry of Transportation. Participants who were suspected of suffering from EDS were referred for evaluation for their ability to maintain wakefulness for the purpose of renewal of their license to drive. Seventeen of the participants were professional drivers and one participant was an aviation pilot.

All subjects underwent a full-night polysomnograph followed by an MWT40, (four 40 minute long trials). During the MWT, participants were told to sit on a bed in a reclining position in a private, dimly lit room. Subjects were not allowed to perform any unusual action to maintain wakefulness, such as reading, talking, consuming caffeine or making repetitive movements. Trials were stopped if the subject fell asleep or if 40 minutes had passed.

According to Pillar, none of the participants who were receiving continuous positive airway pressure (CPAP) treatment failed the MWT 40; this information emphasizes the importance of treating OSA in preventing auto accidents caused by EDS. Pillar noted that findings of this study indicate that further research is necessary in order to determine a more efficient way to objectively assess an individual’s ability to remain vigilant while driving.

According to the American Academy of Sleep Medicine (AASM), OSA is a sleep-related breathing disorder that involves a decrease or complete halt in airflow despite an ongoing effort to breathe. It occurs when the muscles relax during sleep, causing soft tissue in the back of the throat to collapse and block the upper airway. This leads to partial reductions (hypopneas) and complete pauses (apneas) in breathing that can produce abrupt reductions in blood oxygen saturation. Brief arousals from sleep restore normal breathing but can cause a fragmented quality of sleep. Most people with sleep apnea snore loudly and frequently, and they often experience excessive daytime sleepiness.

AASM practice parameters for the MWT recommend the 40-minute protocol and advise that the MWT be used when sleep clinicians require objective data to assess an individual’s ability to remain awake. The MWT should be used in association with the clinical history to assess the ability to maintain wakefulness.

Experts say that poor air quality and ventilation is partly due to economies made by airlines to reduce fuel costs and extend the working life of aircraft.

In the study, a team of Belfast researchers measured oxygen saturation levels – the amount of oxygen carried in the blood.

Before take-off, levels averaged 97 per cent but these fell to 93 per cent at altitude.

For 54 per cent of travellers, the fall in oxygen levels was at least 6 per cent – a level at which many hospital doctors would prescribe extra oxygen.

The results were similar for both short-haul and long-haul fliers, according to the research published in Anaesthesia, the official journal of the Association of Anaesthetists of Great Britain and Ireland.

The 84 passengers who took part in the tests were aged between one and 78. None had severe cardio-respiratory problems and no one required permission from their doctor to fly.

Dr Susan Humphreys, anaesthetic specialist registrar, said research showed that a drop in oxygen levels in the blood can lead to an increase in blood clotting, which raises the risk of a deep vein thrombosis even in healthy people.

Illness Link

“We believe that these falling oxygen levels, together with factors such as dehydration, immobility and low humidity, could contribute to illness during and after flights,” she said.

“This has become a greater problem in recent years as modern aeroplanes are able to cruise at much higher altitudes.”

Dr Humphreys said oxygen deficiency can result in impaired mental performance and shortness of breath.

It can also worsen conditions such as angina and breathing problems.

Experts believe that a significant number of passengers travel with medical conditions that could put them at risk.

Farrol Kahn, of the Aviation Health Institute, a medical research charity promoting better health for passengers, said surveys show that around 10 per cent of travellers are unfit to fly.

“Oxygen reduction particularly affects people with pre-existing conditions, the old and very young, as infants can get into difficulty if they have insufficiently developed lungs,” he said.

“Economies play a role because if the altitude pressure is routinely changed on existing aircraft it cuts their working life.

“But passengers can ask for extra oxygen to be supplied to a section of the cabin and cylinders are available for giving individuals supplementary oxygen.”

Mr Kahn said travellers with cardiovascular disease or respiratory diseases such as bronchitis and asthma should have preflight checks, along with the over-50s, to ensure they were fit to fly.

“The conditions on board, especially long-haul flights, put special stress on essential organs such as heart and brain,” he added.

“At the Institute we provide medical advice to GPs who are concerned about whether a patient can fly after a stroke, for example.”

Mr Kahn said ventilation was cut on some flights to save fuel and, by making passengers sleepy, cut down on extra services needed on board.

A report on the risks of flying from the House of Lords select committee on science and technology said there should be display cards at every ticket sale point and in every doctor’s surgery asking intending passengers: “Are you fit to fly?

Welcome to the happiness frenzy, now peaking at a Barnes & Noble near you: Last year 4,000 books were published on happiness, while a mere 50 books on the topic were released in 2000. The most popular class at Harvard University is about positive psychology, and at least 100 other universities offer similar courses. Happiness workshops for the post-collegiate set abound, and each day “life coaches” promising bliss to potential clients hang out their shingles.

In the late 1990s, psychologist Martin Seligman of the University of Pennsylvania exhorted colleagues to scrutinize optimal moods with the same intensity with which they had for so long studied pathologies: We’d never learn about full human functioning unless we knew as much about mental wellness as we do about mental illness. A new generation of psychologists built up a respectable body of research on positive character traits and happiness-boosting practices. At the same time, developments in neuroscience provided new clues to what makes us happy and what that looks like in the brain. Not to be outdone, behavioral economists piled on research subverting the classical premise that people always make rational choices that increase their well-being. We’re lousy at predicting what makes us happy, they found.

It wasn’t enough that an array of academic strands came together, sparking a slew of insights into the sunny side of life. Self-appointed experts jumped on the happiness bandwagon. A shallow sea of yellow smiley faces, self-help gurus, and purveyors of kitchen-table wisdom have strip-mined the science, extracted a lot of fool’s gold, and stormed the marketplace with guarantees to annihilate your worry, stress, anguish, dejection, and even ennui. Once and for all! All it takes is a little gratitude. Or maybe a lot.

But all is not necessarily well. According to some measures, as a nation we’ve grown sadder and more anxious during the same years that the happiness movement has flourished; perhaps that’s why we’ve eagerly bought up its offerings. It may be that college students sign up for positive psychology lessons in droves because a full 15 percent of them report being clinically depressed.

There are those who see in the happiness brigade a glib and even dispiriting Pollyanna gloss. So it’s not surprising that the happiness movement has unleashed a counterforce, led by a troika of academics. Jerome Wakefield of New York University and Allan Horwitz of Rutgers have penned The Loss of Sadness: How Psychiatry Transformed Normal Sorrow into Depressive Disorder, and Wake Forest University’s Eric Wilson has written a defense of melancholy in Against Happiness. They observe that our preoccupation with happiness has come at the cost of sadness, an important feeling that we’ve tried to banish from our emotional repertoire.

Horwitz laments that young people who are naturally weepy after breakups are often urged to medicate themselves instead of working through their sadness. Wilson fumes that our obsession with happiness amounts to a “craven disregard” for the melancholic perspective that has given rise to our greatest works of art. “The happy man,” he writes, “is a hollow man.”

Both the happiness and anti-happiness forces actually agree on something important—that we Americans tend to grab superficial quick fixes such as extravagant purchases and fatty foods to subdue any negative feelings that overcome us. Such measures seem to hinge on a belief that constant happiness is somehow our birthright. Indeed, a body of research shows instant indulgences do calm us down—for a few moments. But they leave us poorer, physically unhealthy, and generally more miserable in the long run—and lacking in the real skills to get us out of our rut.

Happiness is not about smiling all of the time. It’s not about eliminating bad moods, or trading your Tolstoy-inspired nuance and ambivalence toward people and situations for cheery pronouncements devoid of critical judgment. While the veritable experts lie in different camps and sometimes challenge one another, over the past decade they’ve together assembled big chunks of the happiness puzzle.

What is happiness? The most useful definition—and it’s one agreed upon by neuroscientists, psychiatrists, behavioral economists, positive psychologists, and Buddhist monks—is more like satisfied or content than “happy” in its strict bursting-with-glee sense. It has depth and deliberation to it. It encompasses living a meaningful life, utilizing your gifts and your time, living with thought and purpose.

It’s maximized when you also feel part of a community. And when you confront annoyances and crises with grace. It involves a willingness to learn and stretch and grow, which sometimes involves discomfort. It requires acting on life, not merely taking it in. It’s not joy, a temporary exhilaration, or even pleasure, that sensual rush—though a steady supply of those feelings course through those who seize each day.

There has been real progress in understanding happiness and how to get it. Here are the greatest hits, as it were, that jump out from the research.

Some People Are Born Happy
Some lucky souls really are born with brighter outlooks than others; they simply see beauty and opportunity where others hone in on flaws and dangers. But those with a more ominous orientation can alter their outlook, at least to a point. They can learn to internally challenge their fearful thoughts and negative assumptions—”she thinks I’m an idiot,” “I’m going to get fired,” “I’ll never be a good mom”—if not eliminate them altogether. Engaging in positive internal dialogue is actually a mark of the mentally healthy.

Getting What You Want Doesn’t Bring Lasting Happiness
You think happiness would arrive if you were to win the lottery, or would forever fade away if your home were destroyed in a flood. But human beings are remarkably adaptable. After a variable period of adjustment, we bounce back to our previous level of happiness, no matter what happens to us. (There are some scientifically proven exceptions, notably suffering the unexpected loss of a job or the loss of a spouse. Both events tend to permanently knock people down a notch.)

Our adaptability works in two directions. Because we are so adaptable, points out Sonja Lyubomirsky, a professor of psychology at the University of California, Riverside, we quickly get used to many of the accomplishments we strive for in life, such as landing the big job or getting married. Soon after we reach a milestone, we start to feel that something is missing. We begin coveting another worldly possession or eyeing a social advancement. But such an approach keeps us tethered to the “hedonic treadmill,” where happiness is always just out of reach, one toy or one notch away. It’s possible to get off the treadmill entirely, Lyubomirsky says, by focusing on activities that are dynamic, surprising, and attention-absorbing, and thus less likely to bore us than, say, acquiring shiny stuff.

Pain Is a Part of Happiness
Happiness is not your reward for escaping pain. It demands that you confront negative feelings head-on, without letting them overwhelm you. Russ Harris, a medical doctor-cum-counselor and author of The Happiness Trap, calls popular conceptions of happiness dangerous because they set people up for a “struggle against reality.” They don’t acknowledge that real life is full of disappointments, loss, and inconveniences. “If you’re going to live a rich and meaningful life,” Harris says, “you’re going to feel a full range of emotions.”

The point isn’t to limit that palette of feelings. After all, negative states cue us into what we value and what we need to change: Grief for a loved one proves how much we cherish our relationships. Frustration with several jobs in a row is a sign we’re in the wrong career. Happiness would be meaningless if not for sadness: Without the contrast of darkness, there is no light.

Mindfulness Brings Happiness
Mindfulness, a mental state of relaxed awareness of the present moment, marked by openness and curiosity toward your feelings rather than judgments of them, is a powerful tool for experiencing happiness when practiced regularly. “If you bring mindfulness to bear on negative feelings, they lose their impact. Just let them be there without struggling against them, and you’ll eventually feel less anxiety and depression,” Harris says. Don’t banish your negative feelings, but don’t let them get in the way of your taking productive actions, either.

Happiness Lies in the Chase
Action toward goals other than happiness makes us happy. Though there is a place for vegging out and reading trashy novels, easy pleasures will never light us up the way mastering a new skill or building something from scratch will.

And it’s not crossing the finish line that is most rewarding; it’s anticipating achieving your goal. University of Wisconsin neuroscientist Richard Davidson has found that working hard toward a goal, and making progress to the point of expecting a goal to be realized, doesn’t just activate positive feelings—it also suppresses negative emotions such as fear and depression.

Yes, Money Buys Happiness—At Least Some Money and Some Happiness
Money does buy happiness, but only up to the point where it enables you to live comfortably. Beyond that, more cash doesn’t boost your well-being. But generosity brings true joy, so striking it rich could in fact underwrite your happiness—if you were to give your wealth away.

Happiness Is Relative
Whether or not we are keeping up with the Joneses—a nagging thought known as status anxiety—affects how happy we are. Some are more obsessed with status than others, but we’re all attuned to how we’re doing in life relative to those around us. To stop status worries from gnawing at your happiness, choose your peer group carefully. Owning the smallest mansion in a gated community could make you feel worse off than buying the biggest bungalow in a less affluent neighborhood.

Options Make Us Miserable
We’re constantly making decisions, ranging from what to eat for dinner each night to whom we should marry, not to mention all those flavors of ice cream. We base many of our decisions on whether we think a particular preference will increase our well-being. Intuitively, we seem convinced that the more choices we have, the better off we’ll ultimately be. But our world of unlimited opportunity imprisons us more than it makes us happy. In what Swarthmore psychologist Barry Schwartz calls “the paradox of choice,” facing many possibilities leaves us stressed out—and less satisfied with whatever we do decide. Having too many choices keeps us wondering about all the opportunities missed.

Happiness Is Other People
Positive psychologist Chris Peterson, a professor at the University of Michigan, says the best piece of advice to come out of his field is to make strong personal relationships your priority. Good relationships are buffers against the damaging effects of all of life’s inevitable letdowns and setbacks.

Do Your Happiness Homework

You can increase positive feelings by incorporating a few proven practices into your routine. Lyubomirsky suggests you express your gratitude toward someone in a letter or in a weekly journal, visualize the best possible future for yourself once a week, and perform acts of kindness for others on a regular basis to lift your mood in the moment and over time. “Becoming happier takes work, but it may be the most rewarding and fun work you’ll ever do,” she says.

Happiness Hinges on Your Time Frame
Feeling happy while you carry out your day-to-day activities may not have much to do with how satisfied you feel in general. Time skews our perceptions of happiness. Parents look back warmly on their children’s preschool years, for example. But Daniel Kahneman of Princeton University found that childcare tasks rank very low on the list of what makes people happy, below napping and watching TV. And yet, if you were to step back and evaluate a decade of your life, would a spirited stretch of raising children or a steady stream of dozing off on the couch each day in between soap operas illustrate a “happier” time? Evaluate your well-being at the macro as well as the micro level to get the most accurate picture of your own happiness.

You’re Wrong About What Will Make You Happy and You’re Wrong About What Made You Happy
Harvard psychologist Daniel Gilbert discovered a deep truth about happiness: Things are almost never as bad—or as good—as we expect them to be. Your promotion will be quite nice, but it won’t be a 24-hour parade. Your breakup will be very hard, but also instructive, and maybe even energizing. We are terrible at predicting our future feelings accurately, especially if our predictions are based on our past experiences. The past exists in our memory, after all, and memory is not a reliable recording device: We recall beginnings and endings far more intensely than those long “middles,” whether they’re eventful or not. So the horrible beginning of your vacation will lead you astray in deciding the best place to go next year.

Gilbert’s take-away advice is to forgo your own mental projections. The best predictor of whether you’ll enjoy something is whether someone else enjoyed it. So simply ask your friend who went to Mexico if you, too, should go there on vacation.

Happiness Is Embracing Your Natural Coping Style
Not everyone can put on a happy face. Barbara Held, a professor of psychology at Bowdoin College, for one, rails against “the tyranny of the positive attitude.” “Looking on the bright side isn’t possible for some people and is even counterproductive,” she insists. “When you put pressure on people to cope in a way that doesn’t fit them, it not only doesn’t work, it makes them feel like a failure on top of already feeling bad.”

The one-size-fits-all approach to managing emotional life is misguided, agrees Julie Norem, author of The Positive Power of Negative Thinking. In her research, the Wellesley professor of psychology has shown that the defensive pessimism that anxious people feel can be harnessed to help them get things done, which in turn makes them happier. A naturally pessimistic architect, for example, can set low expectations for an upcoming presentation and review all of the bad outcomes that she’s imagining, so that she can prepare carefully and increase her chances of success.

Happiness Is Living Your Values
If you aren’t living according to your values, you won’t be happy, no matter how much you are achieving. Some people, however, aren’t even sure what their values are. If you’re one of them, Harris has a great question for you: “Imagine I could wave a magic wand to ensure that you would have the approval and admiration of everyone on the planet, forever. What, in that case, would you choose to do with your life?”

Once you’ve answered honestly, you can start taking steps toward your ideal vision of yourself. You can tape positive affirmations to your mirror, or you can cut up your advice books and turn them into a papier mache project. It doesn’t matter, as long as you’re living consciously. The state of happiness is not really a state at all. It’s an ongoing personal experiment.