Ever heard the saying “to sleep with one eye open”? It’s generally used as a metaphor when advising one to stay vigilant. But sleeping with eyes open is a common eye and sleep disorder known as nocturnal lagophthalmos. In fact, the National Sleep Foundation estimates that about 1 in 5 people sleep with their eyes open.
This condition is problematic because it can interfere with sleep and impact eye health. People may not get as much sleep, or sleep as soundly as they’d like, due to the pain and discomfort caused by the eyes drying out during the night.
Nocturnal lagophthalmos generally indicates an underlying medical condition, such as a thyroid problem or an autoimmune disorder. If upon waking you experience irritated, dry, tired, red, or painful eyes, or if you suspect you might be sleeping with your eyes open, speak with Dr. Randall Sakamoto at Ala Moana Advanced Eye Clinic today.
What Happens When You Sleep With Your Eyes Open?
People who have nocturnal lagophthalmos may not even know they have it. It is difficult to evaluate whether your eyes are closed when you're actually asleep. However, some important indicators may point to the condition, including:
- Eyes that feel scratchy, irritated and dry
- Blurred vision
- Red eyes
- Eye pain
- Tired eyes
For those with nocturnal lagophthalmos, the eye loses the protection of a closed lid and becomes dehydrated, causing the tear layer to evaporate and the eyes to become dry. Nocturnal lagophthalmos also reduces the eye’s ability to discharge contaminants such as dust and debris that fall into the eye during the night. These contaminants can potentially lead to:
- Eye infections
- Corneal damage, such as corneal abrasion, sores and ulcers
- Eye dryness and irritation
- Poor quality sleep
- Loss of vision
Why Do We Close Our Eyes to Sleep?
There are several reasons why it’s important to close our eyes while we sleep. Closed eyelids block light, which stimulates the brain to wakefulness.
Closing our eyes also protects and lubricates the eyes while we sleep. If your eyelids don’t close, your eyes become more susceptible to dryness, infections, and debris that can scratch and damage the cornea.
Why do Certain People Sleep With Their Eyes Open?
There are a number of reasons people might sleep with their eyes open. The most common reasons for nocturnal lagophthalmos include:
Problems With Facial Nerves and Muscles
Issues with facial nerves and muscles surrounding the eyelid can cause the lid to remain open during sleep. Weakness in facial nerves can be attributed to several factors.
- Injury or trauma
- Bell’s palsy, a condition that causes temporary paralysis or weakness of facial
- Autoimmune disorders and infections, such as Lyme disease, chickenpox, Guillain-Barre syndrome, mumps, and several others.
- Moebius syndrome, a rare condition that causes problems with cranial nerves.
Eyelids can become damaged as a result of surgery, injury or illness, making it difficult to fully close the eyes during sleep. Furthermore, a condition known as floppy eyelid syndrome can also interfere with eye closure, and is often associated with obstructive sleep apnea (OSA). OSA is commonly linked to eye diseases like glaucoma and optic neuropathy.
Thyroid-Related Eye Problems
A common symptom of Grave’s disease, a form of hypothyroidism, is protruding eyes. The bulging eyes, known as Graves’ ophthalmopathy, can prevent the eyes from closing.
There also tends to be a genetic component to nocturnal lagophthalmos, as it often runs in families. Whatever the cause, the symptoms of nocturnal lagophthalmos are uncomfortable and the consequences can lead to ocular complications.
Can Nocturnal Lagophthalmos Be Treated?
This condition can be treated in several ways, depending on the underlying cause and severity of symptoms. Treatments include:
- Administering artificial tears throughout the day, providing a film of moisture around the eyes that protects them at night.
- Wearing an eye mask or goggles to protect the eyes from external debris and visual stimulation. These items are uniquely designed to generate moisture for the eyes while you sleep.
- Using a humidifier, which provides a moisture-rich environment to prevent your eyes from drying out.
- Wearing eyelid weights to help keep the eyelids closed.
- In acute cases, surgery may be recommended.
Make sure to consult your eye doctor before undertaking any of these treatments.
Because nocturnal lagophthalmos sometimes signals an underlying condition, it is especially important to contact Dr. Randall Sakamoto at Ala Moana Advanced Eye Clinic in Honolulu for a proper diagnosis and to receive prompt treatment. If nocturnal lagophthalmos is left untreated for an extended period, patients risk seriously damaging their eyes and vision.