February 18, 2024 zqfuor

Does sleeping with an eye mask improve learning and alertness?

Red old-fashioned alarm clock next to black sleep mask against a turquoise and white background

All of us have an internal clock that regulates our circadian rhythms, including when we sleep and when we are awake. And light is the single most important factor that helps establish when we should feel wakeful (generally during the day) and when we should feel sleepy (typically at night).

So, let me ask you a personal question: just how dark is your bedroom? To find out why that matters — and whether sleeping in an eye mask is worthwhile — read on.

How is light related to sleep?

Our circadian system evolved well before the advent of artificial light. As anyone who has been to Times Square can confirm, just a few watts of power can trick the brain into believing that it is daytime at any time of night. So, what’s keeping your bedroom alight?

  • A tablet used in bed at night to watch a movie is more than 100 times brighter than being outside when there is a full moon.
  • Working on or watching a computer screen at night is about 10 times brighter than standing in a well-lit parking lot.

Light exposure at night affects the natural processes that help prepare the body for sleep. Specifically, your pineal gland produces melatonin in response to darkness. This hormone is integral for the circadian regulation of sleep.

What happens when we are exposed to light at night?

Being exposed to light at night suppresses melatonin production, changing our sleep patterns. Compared to sleeping without a night light, adults who slept next to a night light had shallower sleep and more frequent arousals. Even outdoor artificial light at night, such as street lamps, has been linked with getting less sleep.

But the impact of light at night is not limited to just sleep. It’s also associated with increased risk of developing depressive symptoms, obesity, diabetes, and high blood pressure. Light exposure misaligned with our circadian rhythms — that is, dark during the day and light at night — is one reason scientists believe that shift work puts people at higher risk for serious health problems.

Could sleeping with an eye mask help?

Researchers from Cardiff University in the United Kingdom conducted a series of experiments to see if wearing an eye mask while sleeping at night could improve certain measures of learning and alertness.

Roughly 90 healthy young adults, 18 to 35 years of age, alternated between sleeping while wearing an eye mask or being exposed to light at night. They recorded their sleep patterns in a sleep diary.

In the first part of the study, participants wore an intact eye mask for a week. Then during the next week, they wore an eye mask with a hole exposing each eye so that the mask didn't block the light.

After sleeping with no light exposure (wearing the intact eye mask) and with minimal light exposure (the eye mask with the holes), participants completed three cognitive tasks on days six and seven of each week:

  • First was a paired-associate learning task. This helps show how effectively a person can learn new associations. Here the task was learning related word pairs. Participants performed better after wearing an intact eye mask during sleep in the days leading up to the test than after being exposed to light at night.
  • Second, the researchers administered a psychomotor vigilance test, which assesses alertness. Blocking light at night also improved reaction times on this task.
  • Finally, a motor skill learning test was given, which involved tapping a five-digit sequence in the correct order. For this task, there was no difference in performance whether participants had worn an intact eye mask or been exposed to light at night.

What else did the researchers learn?

No research study is ever perfect, so it is important to take the conclusions above with a grain of salt.

According to sleep diary data, there was no difference in the amount of sleep, nor in their perceptions of sleep quality, regardless of whether people wore an eye mask or not.

Further, in a second experiment with about 30 participants, the researchers tracked sleep objectively using a monitoring device called the Dreem headband. They found no changes to the structure of sleep — for example, how much time participants spent in REM sleep — when wearing an eye mask.

Should I rush out to buy an eye mask before an important meeting or exam?

If you decide to try using an eye mask, you probably don’t need to pay extra for overnight shipping. Instead, follow a chronobiologist’s rule of thumb: “bright days, dark nights.”

  • During the daytime, get as much natural daylight as you possibly can: go out to pick up your morning bagel from a local bakery, take a short walk during your afternoon lull at work.
  • In the evening, reduce your exposure to electronic devices such as your cell phone, and use the night-dimming modes on these devices. Make sure that you turn off all unnecessary lights. Finally, try to make your bedroom as dark as possible when you go to bed. This could mean turning the alarm clock next to your bed away from you or covering up the light on a humidifier.

Of course, you might decide a well-fitted, comfortable eye mask is a useful addition to your light hygiene toolkit. Most cost $10 to $20, so you may find yourself snoozing better and improving cognitive performance for the price of a few cups of coffee.

About the Author

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Eric Zhou, PhD, Contributor

Eric Zhou, PhD, is an assistant professor at Harvard Medical School. His research focuses on how we can better understand and treat sleep disorders in both pediatric and adult populations, including those with chronic illnesses. Dr. … See Full Bio View all posts by Eric Zhou, PhD

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February 17, 2024 zqfuor

One more reason to brush your teeth?

A trio of bright green, pink, and blue toothbrushes showing blue and white bristles in closeup against an orange and yellow background

Maybe we should add toothbrushes to the bouquet of flowers we bring to friends and family members in the hospital — and make sure to pack one if we wind up there ourselves.

New Harvard-led research published online in JAMA Internal Medicine suggests seriously ill hospitalized patients are far less likely to develop hospital-acquired pneumonia if their teeth are brushed twice daily. They also need ventilators for less time, are able to leave the intensive care unit (ICU) more quickly, and are less likely to die in the ICU than patients without a similar toothbrushing regimen.

Why would toothbrushing make any difference?

“It makes sense that toothbrushing removes the bacteria that can lead to so many bad outcomes,” says Dr. Tien Jiang, an instructor in oral health policy and epidemiology at Harvard School of Dental Medicine, who wasn’t involved in the new research. “Plaque on teeth is so sticky that rinsing alone can’t effectively dislodge the bacteria. Only toothbrushing can.”

Pneumonia consistently falls among the leading infections patients develop while hospitalized. According to the Agency for Healthcare Research and Quality, each year more than 633,000 Americans who go to the hospital for other health issues wind up getting pneumonia. Air sacs (alveoli) in one or both lungs fill with fluid or pus, causing coughing, fever, chills, and trouble breathing. Nearly 8% of those who develop hospital-acquired pneumonia die from it.

How was the study done?

The researchers reviewed 15 randomized trials encompassing nearly 2,800 patients. All of the studies compared outcomes among seriously ill hospitalized patients who had daily toothbrushing to those who did not.

  • 14 of the studies were conducted in ICUs
  • 13 involved patients who needed to be on a ventilator
  • 11 used an antiseptic rinse called chlorhexidine gluconate for all patients: those who underwent toothbrushing and those who didn’t.

What were the findings?

The findings were compelling and should spur efforts to standardize twice-daily toothbrushing for all hospitalized patients, Dr. Jiang says.

Study participants who were randomly assigned to receive twice-daily toothbrushing were 33% less likely to develop hospital-acquired pneumonia. Those effects were magnified for people on ventilators, who needed this invasive breathing assistance for less time if their teeth were brushed.

Overall, study participants were 19% less likely to die in the ICU — and able to graduate from intensive care faster — with the twice-daily oral regimen.

How long patients stayed in the hospital or whether they were treated with antibiotics while there didn’t seem to influence pneumonia rates. Also, toothbrushing three or more times daily didn’t translate into additional benefits over brushing twice a day.

What were the study’s strengths and limitations?

One major strength was compiling years of smaller studies into one larger analysis — something particularly unusual in dentistry, Dr. Jiang says. “From a dental point of view, having 15 randomized controlled trials is huge. It’s very hard to amass that big of a population in dentistry at this high a level of evidence,” she says.

But toothbrushing techniques may have varied among hospitals participating in the research. And while the study was randomized, it couldn’t be blinded — a tactic that would reduce the chance of skewed results. Because there was no way to conceal toothbrushing regimens, clinicians involved in the study likely knew their efforts were being tracked, which may have changed their behavior.

“Perhaps they were more vigilant because of it,” Dr. Jiang says.

How exactly can toothbrushing prevent hospital-acquired pneumonia?

It’s not complicated. Pneumonia in hospitalized patients often stems from breathing germs into the mouth — germs which number more than 700 different species, including bacteria, fungi, viruses and other microbes.

This prospect looms larger for ventilated patients, since the breathing tube inserted into the throat can carry bacteria farther down the airway. “Ventilated patients lose the normal way of removing some of this bacteria,” Dr. Jiang says. “Without that ventilator, we can sweep it out of our upper airways.”

How much does toothbrushing matter if you’re not hospitalized?

In case you think the study findings only pertain to people in the hospital, think again. Rather, this drives home how vital it is for everyone to take care of their teeth and gums.

About 300 diseases and conditions are linked in some way to oral health. Poor oral health triggers some health problems and worsens others. People with gum disease and tooth loss, for example, have higher rates of heart attacks. And those with uncontrolled gum disease typically have more difficulty controlling blood sugar levels.

About the Author

photo of Maureen Salamon

Maureen Salamon, Executive Editor, Harvard Women's Health Watch

Maureen Salamon is executive editor of Harvard Women’s Health Watch. She began her career as a newspaper reporter and later covered health and medicine for a wide variety of websites, magazines, and hospitals. Her work has … See Full Bio View all posts by Maureen Salamon

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

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February 10, 2024 zqfuor

Still confused after Flovent discontinuation? What to know and do

An angled pink counter holding two types of asthma inhalers, one a purple disk, the other silver and frosted plastic and has a white top next to it

What happens when a widely used medicine is no longer available at pharmacies across the US? Until recently, Flovent (fluticasone) inhalers were frequently prescribed to help control asthma. If you or your child relied on these products, you may be scrambling to find medicines that will help you stay healthy without breaking the bank.

What’s essential to know, and what questions should you ask your health care provider? We checked in with Dr. William B. Feldman, a physician in the Division of Pulmonary and Critical Care Medicine at Harvard-affiliated Brigham and Women’s Hospital to get answers.

Which medicines are discontinued?

In January, GlaxoSmithKline stopped producing Flovent, which was available as a prescription metered-dose inhaler (Flovent HFA) and a dry powder inhaler (Flovent Diskus).

Both contain fluticasone, a steroid. Fluticasone reduces inflammation and swelling in the airways. Both types of inhalers are FDA-approved to help prevent asthma attacks.

However, children under age 5 and adults with particularly poor lung function may not be able to use a dry powder inhaler. They may lack the lung power necessary to breathe in deeply enough to pull the medicine into their airways, Dr. Feldman explains. A metered-dose inhaler could be the best choice for them.

Now that Flovent is discontinued, is a generic product available?

Yes, the drug manufacturer has licensed an authorized generic of both Flovent products: the metered-dose inhaler and the dry powder inhaler.

However, insurance coverage may not pay for the authorized generic because it may cost an insurer more than some other branded medicines. So, you may need to switch to another brand to stay healthy. Call your insurance company to check.

What are your alternatives?

This is a good chance for you and your doctor to review your asthma treatment plan. It may be a good time to make changes.

If you had been using Flovent daily for symptom control, your doctor may recommend:

  • Trying an inhaled steroid similar to Flovent. Many types of steroids will work, including beclomethasone (Qvar RediHaler), budesonide (Pulmicort Flexhaler), ciclesonide (Alvesco), and mometasone (Asmanex Twisthaler, Asmanex HFA). “These products use different molecules to do the same job as fluticasone,” says Dr. Feldman.
  • Switching to a combination inhaler. New studies suggest this approach may help many people who use Flovent daily for symptom control and only use a short-acting medicine to open airways when an asthma flare occurs (see here and here). If you have intermittent asthma symptoms, talk with your provider about whether you could use a combination inhaler when you start to wheeze or have shortness of breath. This combines a medicine called formoterol with a steroid. Symbicort provides this combination in one inhaler. Although not yet approved by the FDA for this specific use, it is approved in many other countries.

What else do asthma specialists advise people to do?

If your insurance covers the authorized generic, this may be a good choice because you already know how to use the product. But what if insurance won’t cover this?

“Any other inhaled steroid should work for most — but not all — people,” says Dr. Feldman. “There are brand-name metered-dose and dry powder inhalers available, such as those mentioned above.”

Here’s what else to know and do

  • Discuss whether it’s safe to switch medicines or type of device. For many people, the answer will be yes. But if your health care provider believes that a metered-dose inhaler is the best choice due to age or poor lung function, ask your insurance company for a formulary exception to cover the authorized generic fluticasone or another metered-dose inhaler. Ask your provider to make the same request.
  • If you have a child under 5, you and your doctor should also ask your insurance company for a formulary exception to cover a metered-dose inhaler with a steroid.
  • For anyone who needs to switch brands, your new inhaler may look and feel different and may require a new technique when you use it to get the full benefit of the medicine. “When folks switch from one type of inhaler to another, it’s very important to get proper education, ideally from their prescriber. But you can also do this online to understand how to properly use this new product,” says Dr. Feldman.

If you do switch, ask your health care provider to show you how to use the new inhaler in an in-person or virtual visit. If that’s not possible, check your technique by watching these videos created by National Jewish Health, a leading US hospital for respiratory care.

What if you’re not feeling as good on a new asthma medicine?

If you’ve switched and notice worsening symptoms or more asthma attacks, contact your health care provider, Dr. Feldman advises. “They should make sure this isn’t due to improper technique with the new device. It may not be, but it’s important to check and to keep your doctor aware of changes like these.”

Is there a difference between an authorized generic and independent generic medicines?

“With an authorized generic, the brand-name company produces the generic or licenses another company to do that. It’s the exact same medicine as the original brand-name drug. It just doesn’t have the label,” says Dr. Feldman.

Independent generics encourage price competition if several companies make them. “With authorized generics, you don’t see those price decreases to the same extent, because you typically just have one product and it’s totally controlled by the branded company,” he adds.

What if you don’t have insurance, or insurance won’t cover a medicine you need?

“These inhalers have extraordinarily high list prices — $200, $300, $400 per month for the product,” notes Dr. Feldman. Manufacturers negotiate rebates with insurers that may substantially lower the price for an insurance plan.

If you don’t have insurance, you won’t get that lower price. So, it’s worth checking prices for all options: you may find the authorized generic will cost you less than other brand-name inhalers.

About the Author

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Francesca Coltrera, Editor, Harvard Health Blog

Francesca Coltrera is editor of the Harvard Health Blog, and a senior content writer and editor for Harvard Health Publishing. She is an award-winning medical writer and co-author of Living Through Breast Cancer and The Breast … See Full Bio View all posts by Francesca Coltrera

About the Reviewer

photo of Howard E. LeWine, MD

Howard E. LeWine, MD, Chief Medical Editor, Harvard Health Publishing

Dr. Howard LeWine is a practicing internist at Brigham and Women’s Hospital in Boston, Chief Medical Editor at Harvard Health Publishing, and editor in chief of Harvard Men’s Health Watch. See Full Bio View all posts by Howard E. LeWine, MD

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