It’s good to face new challenges with your eyes wide open. But sleeping with your eyes open? That’s not so good.
Maybe your bed partner has mentioned that your eyelids don’t fully shut when you snooze — or that you sleep with one eye open. Or you might find yourself waking up with dry, irritated eyes. The culprit could be nocturnal lagophthalmos, a surprisingly common condition that prevents one or both eyes from shutting during sleep.
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“In severe cases, it can lead to pain and cause permanent eye damage,” says sleep medicine specialist Christen Cheuvront, CNP. But treatments are available to protect your peepers while you sleep.
Should you close your eyes to sleep?
Surprising as it may be, many people sleep with one or both eyes open.
“Experts aren’t entirely sure how many people have nocturnal lagophthalmos,” Cheuvront says. “But we think it’s underdiagnosed.” That’s because, for most people with nocturnal lagophthalmos, the lid opening is quite small — sometimes, so small that, especially for people with thick lashes, it escapes notice.
But even a tiny bit of exposure to the elements during sleep can have an impact on the structure and function of your eye. It also wreaks havoc on your internal clock — AKA your circadian rhythm — which is sensitive to light.
So, while it makes for a great slumber party trick, sleeping with your eyes open is a problem. One that needs to be corrected as soon as possible.
Can you tell if you sleep with your eyes open?
Sleeping with your eyes open is rarely (if ever) a thing you notice about yourself, because … well … you’re asleep when it happens! You don’t actually see anything when you sleep with your eyes open because your brain has taken that function offline. In other words, your eyes aren’t sending your brain the information they take in while you’re awake. As a result, most people find out they have nocturnal lagophthalmos when someone else observes them sleeping and tells them about it.
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Others are diagnosed after experiencing eye symptoms, such as:
- Dry, gritty-feeling eyes.
- Irritation or burning.
- Redness.
- Blurred vision.
- Sensitivity to light.
Those symptoms are caused by the surface of your eye drying out during the night. When the outer layer of your eye doesn’t stay moist with tears, your eye may become scratched or damaged.
Why your eyes aren’t closing when you sleep
Nocturnal lagophthalmos rarely strikes out of the blue. It’s usually caused by damaged nerves or muscles in your face. The condition may be related to:
- Stroke.
- Bell’s palsy.
- Blepharoplasty (cosmetic eyelid surgery).
- Neuromuscular diseases like Kearns-Sayre syndrome and amyotrophic lateral sclerosis (ALS).
- Head or facial trauma or injury.
- Hyperthyroidism.
- Use of alcohol and/or sleeping pills.
Nighttime lagophthalmos can affect one eye or both. And if it goes untreated, it can lead to serious vision issues. “If the dryness becomes severe, it can damage the cornea and impair vision,” Cheuvront states. “It can also cause significant pain.”
While we’re focusing on nocturnal lagophthalmos here, it’s worth noting that that’s not the only reason a person might sleep with their eyes open. People who experience parasomnias — abnormal sleep behaviors — may sit up, talk or walk in their sleep. The official medical term for sleepwalking is somnambulism.
“People with parasomnias don’t typically experience symptoms like dry eyes, redness or irritation,” Cheuvront explains. That’s because — while some people open their eyes during parasomnia events — their eyelids close again when the person isn’t experiencing symptoms. Additionally, parasomnia behaviors tend to be too brief to result in eye symptoms.
How to stop sleeping with your eyes open
If you suspect you’re experiencing nocturnal lagophthalmos, Cheuvront encourages you to talk to a healthcare provider. And don’t put it off!
“We can find a solution — but the earlier we start that process, the better,” she says. Untreated, the condition can leave you with permanent damage, up to and including vision loss.
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That’s the bad news. The good news is that nocturnal lagophthalmos can be treated in several different ways. Cheuvront provides a rough sketch of the different options. Together with your provider, you can figure out where (and how) to get started.
Lifestyle changes
The first thing your provider is likely to do is ask you about your lifestyle habits. Sleeping pills or alcohol use can make nocturnal lagophthalmos worse. In some people, sleeping pills may even be the primary cause of the condition, Cheuvront says.
Poor quality sleep can also worsen the condition. She recommends that people with nocturnal lagophthalmos avoid sleeping pills and alcohol and take steps to prioritize good sleep hygiene.
Physically shutting your eyelids
According to Cheuvront, there are two noninvasive treatment methods that help keep your eyelids closed at night:
- Eyelid tape. The most low-tech treatment for nocturnal lagophthalmos involves taping your eyelids shut at night with a small piece of first aid tape. “It can work very well for some patients. But others find it claustrophobic,” Cheuvront says.
- Eyelid weights. It sounds like something out of a cartoon, but many people find relief with this method. It involves a tiny weight, often made of gold, that you tape to your upper eyelid at night and remove in the morning. The weight makes your eyelid heavier, helping to hold it shut at night.
Protect your eyes
When it comes to treating nocturnal lagophthalmos, it’s not just about getting your eyelid to fully close. It’s also about addressing the impact nocturnal lagophthalmos has on your eye itself. If you’re experiencing dryness or irritation, you should talk to your doctor about two treatment options to help keep your eyes moist:
- Oil gland treatment. Tiny oil glands called meibomian glands line your eyelids. They produce oils that lubricate your eye and help your eyelids stick together. People with nocturnal lagophthalmos often benefit from treatment to improve the function of these glands, Cheuvront notes. The process typically involves cleaning your eyes and applying a warm compress twice a day to help get the oil flowing.
- Gel drops. Providers can prescribe an ointment to apply to your eyes before bed. The gel protects the surface of your eye and also helps your eyelids stick together. Just be aware that it can make your vision blurry until you wash it out in the morning.
In addition to medical intervention, you can make small adjustments to your home. Consider purchasing a humidifier for your bedroom. It may also be a good idea to get a sleep mask or other eye covering you can comfortably sleep in. That will help keep irritants away.
Surgery
If none of the other treatments work, Cheuvront says you might benefit from surgery. In a nutshell, the procedure expands your eyelids. Once they’re larger, they’ll fully cover your eye or eyes when you sleep.
One way or another, your providers will help you get the “shut eye” you need to preserve your eye health and vision.
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