Why Do Some People Sleep With Their Eyes Open?

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 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 condition that prevents one or both eyes from shutting during sleep.

“In severe cases, it can lead to pain and cause permanent eye damage,” says sleep medicine specialist Andres Santiago Endara-Bravo, MD. But treatments are available to protect your peepers while you sleep.

Signs of nocturnal lagophthalmos

Experts aren’t entirely sure how many people have nocturnal lagophthalmos, Dr. Endara-Bravo says. “But we think it’s underdiagnosed.”

Most people find out they have it when someone tells them their eyes stay slightly open during the night. But others are diagnosed after experiencing eye symptoms:

• 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 be scratched or damaged.

Nocturnal lagophthalmos causes

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.
• 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 problems. “If the dryness becomes severe, it can damage the cornea and impair vision,” Dr. Endara-Bravo says. “It can also cause significant pain.”

Nocturnal lagophthalmos treatments

Nocturnal lagophthalmos can be treated in several ways.

Lifestyle changes

First, your doctor may ask you about your lifestyle habits. Sleeping pills or alcohol use can make lagophthalmos worse. In some people, sleeping pills may even be the primary cause of the condition, Dr. Endara-Bravo says.

Poor quality sleep can also worsen the condition. He recommends that patients with lagophthalmos avoid sleeping pills and alcohol and take steps to prioritize healthy sleep.

Shut your eyelids

Two treatment methods can help keep your eyelids closed:

• Eyelid tape: The most low-tech treatment 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,” Dr. Endara-Bravo says.
• Eyelid weights: Many patients find relief from a tiny weight, often made of gold, that they tape to their upper eyelid at night (and remove in the morning). The weight makes the eyelid heavier, helping to hold it shut at night.

Protect the eyes

These treatments can help keep your eyes moist:

• Oil gland treatment: Tiny oil glands called meibomian glands line your eyelids. They produce oils that lubricate the eye and help the eyelids stick together. Patients with lagophthalmos often benefit from treatment to improve the function of these glands, Dr. Endara-Bravo says. This typically involves cleaning the eyes and applying a warm compress twice a day to help the oil flow.
• Gel drops: Doctors 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. But it can make your vision blurry until you wash it out in the morning.

Surgery

If other treatments don’t work, you might benefit from surgery to expand your eyelids so they’ll fully close when you doze.

Why else do people sleep with their eyes open?

Nocturnal lagophthalmos is not the only cause of sleeping with your eyes open. People who experience parasomnias — abnormal sleep behaviors — may sit up, talk or walk in their sleep. And they may open their eyes while it’s happening.

In those cases, though, the eyelids close when the person isn’t experiencing parasomnia symptoms. “People with parasomnias don’t experience symptoms like dry eyes, redness or irritation,” Dr. Endara-Bravo says.

If you suspect lagophthalmos, talk to your doctor. “We can find a solution — but the earlier, the better,” he says.