One of the first steps for falling asleep is to close your eyes. There's no greater association to sleep than having your eyes closed.
So it might be a bit unusual to see someone sleeping with their eyes open or to find out you’ve been sleeping that way.
You might think that sleeping with eyes open is out of the ordinary, but the National Sleep Foundation estimates that the phenomenon actually occurs in one in every five people.
In this article, we take a look at why some people sleep with their eyes open, what it means, and what it does to your sleep and eye health.
What is Nocturnal Lagophthalmos?
Nocturnal lagophthalmos is a common eye and sleep disorder where the eyes remain open even when a person is sleeping.
Being unable to close your eyes during sleep can cause pain and discomfort throughout the night which leads to disrupted sleep, as well as being more exposed to bright light in the mornings and waking up earlier.
Eyes should normally stay shut when sleeping. This is because eyelids block light that causes you to wake up before you may need to, and to protect your eyes from irritation, dryness, dust and debris.
What causes you to sleep with your eyes open?
Your eyelid structure
For some people who sleep with their eyes open, it's just the shape of their upper eyelids that's causing the nocturnal lagophthalmos.
For these physiological defects, some doctors would recommend a cosmetic surgery to reconstruct the eyelids for them to close properly.
Not all people who have issues with their eyelid structure are required to undergo surgery, but if eye infections and other eye problems occur frequently, then that's reason to consider having a procedure done.
You might have a problem with your facial nerves
Your eyelids are controlled by the facial nerves surrounding your lids, so any weakness in those facial nerves may lead to less control of your eyelid movement.
The weakness in your facial nerves may be caused by various factors such as injury, stroke, presence of a tumour, or other systemic diseases.
One of the most common associated conditions is Bell's Palsy, which is a condition which causes a temporary paralysis or weakness of your facial muscles.
Nocturnal lagophthalmos is also evident in some autoimmune diseases like Lyme disease, Guillain-Barre syndrome, mumps, and other infections.
In rare cases, it can also be caused by Moebius Syndrome, an uncommon condition that badly affects the cranial nerves.
Whatever the case may be, if you suspect that it's an issue with your facial nerves it's best to consult a physician or a neurologist for medical advice.
We mentioned earlier that eyelid surgery can help to alleviate nocturnal lagophthalmos, but at the same time, a procedure can also cause it.
Blepharoplasty is the surgical procedure wherein some of the excess skin on the upper eyelids is being removed to appear younger and in some cases, help patients see better.
Not all cosmetic surgeries are entirely successful. When too much of the skin is removed, lagophthalmos may possibly develop. It’s important to do your research and go with a reputable surgeon you trust if you’re considering this procedure.
It might be thyroid-related
People suffering from thyroid related conditions such as hypothyroidism or Graves’ disease may experience bulging eyes, which is a common symptom.
Due to the thyroid imbalance, one or both eyes may protrude forward of the socket; this condition is called Graves' ophthalmopathy.
Because of the extra bulge from the eye, the eyelids would have trouble to fully close. This can lead to added pain and discomfort for the eyes and may also cause sleep problems.
Is it safe to sleep with your eyes open?
Your eyelids play an important role to your general eye health - whether you're sleeping or awake, your eyelids serve as the eye's protection from debris and foreign bodies.
More than protecting your eyes, the eyelids also spread tears on the corneal surface of your eyes, keeping it lubricated and healthy every time you blink or whenever you close your eyes.
When you take away that protection, you subject your eyes to different eye diseases and complications.
Exposure keratopathy and corneal ulcers can occur among people with nocturnal lagophthalmos, due to foreign bodies and debris being able to reach the corneal surface when you're sleeping.
Likewise, dry eyes are prevalent in people who sleep with their eyes open as the tears can evaporate quickly, since they're not covered by the eyelids.
When the tear film isn't spread and appropriately distributed, it opens the eyes to vulnerabilities and infections.
How can I treat nocturnal lagophthalmos?
Apart from treating the underlying medical conditions or undergoing surgical procedures, there are many ways to manage the symptoms of nocturnal lagophthalmos. We’ve listed some of the most common methods, but be sure to check with your doctor before starting anything new.
Use artificial tears
Pay a visit to a doctor or ophthalmologist and inform them of your condition. They would usually prescribe artificial tears that are most suited to your needs.
Artificial tears, also known as eye drops, can be used throughout your wakeful hours to ensure that you have a healthy tear film and enough moisture in your eyes to protect them at night.
The eye drops are also best used right before bed, to give your eyes sufficient lubrication and nourishment right before you sleep.
It might sound funny, but it's common to use surgical tape to manually give yourself some shut-eye. The tape would prevent your eye from opening up when you sleep, therefore giving your cornea the protection it needs.
Wear an eye mask or goggles
Wearing eye protection during your sleep allows you the comfort of knowing that no foreign bodies or debris can enter your eye when you sleep.
Some specialised goggles are also used by people who sleep with their eyes open that generate moisture to ensure that your eyes don't dry up in your sleep.
Turn your humidifier on
Although a humidifier won't directly moisturise your eyes, having one in your room would create a moisture-rich environment.
Having enough moisture in the air lessens the likelihood of your eyes from drying out and manifesting dry eye symptoms in the morning.
To sum things up, it's quite common to sleep with your eyes open with one in five people experiencing it. But, this doesn't mean you should do nothing about the problem.
Your eye health is essential, and it's best to seek medical advice and take action as soon as possible to ensure that you maintain your eye's safety.