Sleeping with your eyes open – is that even possible

The treatment given for nocturnal lagophthalmos varies depending on its cause and the severity of symptoms. If possible, it is important to correct any underlying condition contributing to the problem. For example, a person with nerve damage might consult a neurologist, or someone with a thyroid disorder may require endocrine therapy.

Sleeping With Your Eyes Open

Dr. Abhinav Singh Sleep Medicine Physician Dr. Singh is the Medical Director of the Indiana Sleep Center. His research and clinical practice focuses on the entire myriad of sleep disorders. Read Full Bio

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Table of Contents

Table of Contents

• Why Do We Close Our Eyes During Sleep?
• What Causes You to Sleep With Your Eyes Open?
• Signs You May Be Sleeping With Your Eyes Open
• Diagnosing Lagophthalmos
• Treatment for Sleeping With Your Eyes Open
• When To Talk to Your Doctor

Closing your eyes is a defining feature of sleep. For that reason, it may be surprising to learn that some people sleep with their eyes partially or fully open. This condition, known as nocturnal lagophthalmos, is relatively common. Research studies indicate that about 1 in 20 people do not shut their eyes while sleeping.

Why Do We Close Our Eyes During Sleep?

Our eyelids play an important role in getting a good night’s sleep. Eyelids act as a protective barrier, keeping the eyes safe from debris. They also provide lubrication and prevent the eyes from drying out.

Closing our eyes also blocks light, which is crucial for calibrating the body’s internal 24-hour clock. Specific cells Trusted Source National Institute of Neurological Disorders and Stroke (NINDS) NINDS aims to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. View Source in the retina process light and send information to the hypothalamus, signaling that it’s time to be awake. When we experience darkness, melatonin is produced, telling our body it’s time to sleep.

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What Causes You to Sleep With Your Eyes Open?

Nocturnal lagophthalmos can have many causes, including faulty eyelid mechanics, facial nerve disorders, and structural changes in the face. Numerous conditions Trusted Source Science Direct The leading platform of peer-reviewed literature that helps you move your research forward. View Source can predispose individuals to these issues:

• Proptosis (Bulging Eyeball): When the eyeball protrudes, it creates more surface area for the eyelids to cover. Possible causes of proptosis include thyroid disorders like Graves disease, congenital conditions affecting the anatomy of the face, an infection, or a tumor.
• Short or Weak Eyelids: Numerous conditions can either shorten the eyelids or decrease their muscle tone, thereby preventing the eyelids from fully closing. Medical procedures like eyelid-tightening surgery, Botox injection, and fat removal around the eyes can compromise eyelid height and tone.
• Scarring: Physical trauma, chemical burn, and certain diseases such as ocular pemphigoid and Stevens-Johnson syndrome, can scar components of the eyelids and limit their function.
• Nerve Problems: A range of problems Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source affecting facial nerves can prevent the eyelids from functioning properly. These problems include Bell’s palsy, Lyme disease, and injuries.
• Sedatives: Excessive alcohol and sedatives, including some sleeping pills, can sometimes cause nocturnal lagophthalmos.
• Idiopathic: When there is no known cause for nocturnal lagophthalmos, it is classified as idiopathic.

In some circumstances, a person’s eyes can be open while they’re asleep without it meaning they have nocturnal lagophthalmos. For example, people who sleepwalk frequently have their eyes open during sleepwalking episodes. However, sleepwalking is considered a separate issue Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source from nocturnal lagophthalmos.

Signs You May Be Sleeping With Your Eyes Open

Not everyone with nocturnal lagophthalmos notices symptoms. The symptoms a person experiences depend on the severity of the condition and a person’s age. Because ocular lubrication mitigates the drying effect of nocturnal lagophthalmos, older adults are more likely to have symptoms due to age-related reduction in tear quality and production.

Nocturnal lagophthalmos symptoms are usually the worst in the morning and improve over the course of the day. Possible symptoms include:

• Dry eyes
• Sore or painful eyes
• A feeling of irritation
• Watery eyes
• Blurry vision
• Red eyes

Over time, nocturnal lagophthalmos may damage the cornea from persistent dryness — a condition called keratitis — and increase the risk of corneal ulcers, perforation, and vision loss Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Studies have found that people who experience nocturnal lagophthalmos have poor sleep quality Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source , mostly likely due to discomfort. Some research indicates that the light entering through open eyelids causes sleepers to awaken from visual stimulation Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source .

Diagnosing Lagophthalmos

If a doctor suspects nocturnal lagophthalmos, they typically begin the diagnostic process by observing the eyes from a distance. They also thoroughly discuss symptoms, predisposing conditions, and family history with the person experiencing symptoms.

Based on the initial consultation, the doctor may recommend a slit lamp examination. This procedure uses a low-power microscope to examine structures in the eye. The doctor may also ask the person experiencing symptoms to blink, and use gloved hands to move the eyelids and check for signs of nerve dysfunction.

A special assessment is often done since this is an important component of developing a patient’s treatment plan.

Treatment for Sleeping With Your Eyes Open

The treatment given for nocturnal lagophthalmos varies depending on its cause and the severity of symptoms. If possible, it is important to correct any underlying condition contributing to the problem. For example, a person with nerve damage might consult a neurologist, or someone with a thyroid disorder may require endocrine therapy.

The first goal of treating nocturnal lagophthalmos is to improve dry-eye and prevent keratitis Trusted Source National Library of Medicine, Biotech Information The National Center for Biotechnology Information advances science and health by providing access to biomedical and genomic information. View Source . People experiencing symptoms may be given eye drops to provide lubrication for waking hours and an ointment for bedtime. In more severe cases, doctors may recommend using special tape to keep the eyes shut at night, or a goggle-like device that provides moisture during sleep.

If you’re diagnosed with nocturnal lagophthalmos, it may be appropriate to make adjustments to your sleeping environment to counteract its effects. Make sure the room is kept dark so that light does not enter and contribute to awakenings. Using a humidifier or moving your bed away from dry airflow can also lessen dry-eye.

People experiencing nocturnal lagophthalmos are encouraged to limit alcohol or sedatives before bed. It’s also important to keep the eyes clean and free of debris since insufficient lubrication increases the risk of infection. People with nocturnal lagophthalmos might find it helpful to practice blinking Trusted Source Medline Plus MedlinePlus is an online health information resource for patients and their families and friends. View Source more frequently and fully during waking hours to ensure the eyes have sufficient moisture.

Some people may require surgical intervention to treat nocturnal lagophthalmos. Relevant surgical techniques include skin grafting, sewing the eyelids closer together, or implanting tiny gold weights in the eyelids. Although these approaches may sound drastic, they are generally well-tolerated and effective.

When To Talk to Your Doctor

Nocturnal lagophthalmos can be hard to diagnose on your own. Even if another person observes you while you sleep, very small eyelid openings may be obscured by eyelashes and go undetected.

If you’re having persistent eye symptoms, particularly dry-eye that is worse in the morning, it may be helpful to see a doctor for specialized testing. If left untreated, nocturnal lagophthalmos can significantly affect your eye health and compromise sleep. Getting a proper diagnosis and tailored treatment plan will help you get the quality shut-eye you need.

Sleeping with your eyes open – is that even possible?

Sleeping with your eyes open seems to be a contradiction in itself. After all, every child knows that when you are tired and your body is preparing for a good night’s rest, your eyes close by themselves. But as a matter of fact, it happens in exceptional cases that some people keep their eyes open overnight. But what exactly causes insufficient eyelid closure? We have some fascinating answers.

1. Sleeping with eyes open: a contradiction?
2. When do people sleep with their eyes open?
3. What signs indicate that I sleep with my eyes open at night?
4. What to do if the eyelids do not sufficiently close during the night?

Sleeping with eyes open: a contradiction?

As humans, we associate good sleep with complete relaxation. Our body muscles relax and our eyelids close completely. Sleeping with your eyes open therefore seems impossible at first. We all know from our own experience that our eyelids become heavier and heavier when we are overcome by tiredness. At the end of the first sleep phase, our eyes then remain completely closed – and we begin to dream. Staying open overnight is anatomically not intended for our eyes. Even during the day, we blink several times a minute, and our eyes never stay open for a long time at a stretch. This is the only way that sufficient tear fluid can be distributed on our cornea and normal blinking is made possible. Blinking is also important for another reason: it protects the eye from foreign bodies and unpleasant air drafts. At night, however, our brain needs complete darkness, and our eyes should therefore remain completely closed. While daylight makes us awake, it is a hindrance at night because it causes our body to not release enough of the sleep hormone melatonin. In exceptional cases, however, it still happens that the eyes do not close completely during sleep – and thus the quality of sleep suffers.

When do people sleep with their eyes open?

Have you ever watched a baby doze off without closing its eyes? It is indeed possible for people to sleep with their eyes open. However, there is a crucial difference: while this behavior is harmless in infancy, it signals a serious problem in adults. If you don’t sleep with your eyes closed as an adult, there can be several reasons behind it. The most common are:

• Not enough deep sleep
  The real reason why babies sometimes dream with their eyes open, as mentioned above, is that their sleep sometimes remains shallow. When they don’t reach the deep sleep stage, their eyes stay open. Although it must look strange to you, there is no need to worry about it.
• Stress
  Stress is one of the biggest antagonists to healthy sleep, as it is often accompanied by problems of falling asleep and subsequently staying asleep. The reason for this is that you can’t fully relax even when you’re asleep if you are stressed. A bunch of returning negative thoughts keep you awake. As a result, during the REM phase, your eyes may not stay completely closed.

• Sleep paralysis
  As we sleep, our muscles are normally loose and relaxed. This is not the case for people affected by sleep paralysis. That passive state can persist for them even after awakening. Then, for example, the eyes may be open while the affected person sees himself lying in bed, unable to lift a finger. Rather frightening!
• Lagophthalmos
  Lagophtalmus describes people who have damage to the 7th cranial nerve and, as a result, do not have full control of their facial muscles. For example, affected individuals cannot completely close one or even both eyelids. Commonly, the disease is also called hare’s eye, which goes back to the old misconception that hares would never close their eyes even when sleeping. Today, of course, we know that this is not the case, but the name has persisted.
• Vegetative state
  Unfortunately, those who are in a vegetative state have often suffered severe neurological damage. The damage also affects the control of the eye muscles and patients are then no longer able to perform eye movements. This also includes the voluntary closing of the eyelids, leaving the eyes open.

What signs indicate that I sleep with my eyes open at night?

How can you know if you open your eyes at night? People who share their bed with a loved one are sure to notice sooner or later if they sleep with their eyes open at night. But single sleepers usually don’t monitor themselves during the night’s rest, so it’s hard for them to know if they’re affected by this sleep problem. However, some signs may indicate that you’re not closing your eyelids all the way at night:

• You suffer from increased lacrimation (teary eyes)
• Your eyes are constantly dry or irritated
• Your eyes itch and burn
• Your eyes are often red
• The eyeballs feel strangely cold or warm

Have you noticed one or more of these symptoms in yourself? There is no need to panic. The best thing to do is to make an appointment with your ophthalmologist to have your eyes examined. If the doctor finds abrasions on your cornea during his examination, this could indicate insufficient eyelid closure during the night.

What to do if the eyelids do not sufficiently close during the night?

We can reassure you: In a large number of cases, stress and tension are responsible for people sleeping with their eyes open at night. These causes are temporary and there are a few tools that will improve the quality of your sleep and make it more comfortable:

• Heat pads
  Heat pads for the eyes? Even though most people associate heat treatments with other parts of the body, the eye is ultimately a muscle. And a heat mask can relax your eye muscles before bedtime, so you’ll have less trouble closing your lids all the way afterwards.
• Relaxation techniques
  If you sleep with your eyes open due to stress, relaxation techniques such as yoga or meditation before bedtime can provide better quality sleep by helping you calm down and eliminate tension.

• Sleep mask
  A sleep mask provides complete darkness and protects your eyes from foreign objects. Thereby, the popular sleep accessory helps you to have a more comfortable sleeping experience. Since it exerts a slight pressure on your eyes, it also helps you keep your eyelids closed.
• Medical intervention
  For stubborn cases, a treatment with Botox or an upper eyelid treatment like eyelid loading can help you close your eyes again.