Why Some People Sleep with Their Eyes Open: A Look into Nocturnal Lagophthalmos

Nocturnal lagophthalmos is a condition where you sleep with your eyes open, which can cause dry eyes. Learn of treatments to retain eye moisture during the night. 
 

WEB-944 – Why Some People Sleep with Their Eyes Open A Look into Nocturnal Lagophthalmos

It’s a saying long held as a warning when you’ve been wronged, ‘sleep with your eyes open.’ However, some people really do sleep with their eyes open, with reports finding that nocturnal lagophthalmos can affect up to 5% of people
 
Nocturnal lagophthalmos is not a wide-eyed and alert state, though; instead, those who sleep with their eyes open may only have a small slit, but this can still allow the eyes to dry out, causing irritation in the morning.  

What is Nocturnal Lagophthalmos? 

The act of sleeping with your eyes open goes by the term nocturnal lagophthalmos. Lagophthalmos refers to an inability to close the eyelids, and when it only happens when you’re sleeping, the term nocturnal lagophthalmos is applicable.  
 
When you sleep with your eyes open, it doesn’t mean that your eyes are wide open. In most cases, the lids are closed most of the way, but not completely. Unfortunately, even a small opening can cause your eyes to dry out overnight and cause problems over time. 
 
Keeping your eyes closed while you’re asleep is not an action that you need to think about. It naturally occurs, and your eyelids remain sealed shut during the night without you needing to concentrate on it. However, certain instances may cause someone’s eyelids to not close completely during the night, such as: 

  • Eyelid muscles that are damaged by inflammation, infection, or injury 
  • Being born with eyelids that do not close completely 
  • Having Graves’ disease, which causes the eyes to bulge forward. 
  • Having Bells’ palsy, tumor, stroke, or other conditions that paralyze some of the facial nerves 
  • Having surgery that changes how the eyelids move. 
  • Having an infection such as chickenpox, Lyme disease, mumps, polio, or botulism, although they are typically less common causes.  
  • Heavy alcohol or sedative use
  • Scarring on the eyelid that limits its function and keeps it from closing completely. 

Even though having your eyelids open may seem counterintuitive to sleep, it doesn’t keep someone from falling asleep. However, other problems can arise. 

Complications of Sleeping with Your Eyes Open 

Your eyes rely on moisture to protect themselves, but sleeping with your eyes open can cause your eyes to dry out, making them more susceptible to infection and injury, such as getting scratched.  
 
Some of the symptoms may indicate sleeping with your eyes open: 

  • Redness 
  • Itchy eyes 
  • Blurred vision 
  • Watery eyes 
  • Discharge from eyes 
  • Irritation 
  • Sensitivity to light 
  • Scratchiness 
  • Difficulty opening the eyes 

If your eyes remain dry for long periods of time, serious problems may occur, such as eye infections, vision loss, exposure keratopathy, and a risk of eye scratches.  
 
In addition to the effect on your eyes, sleeping with your eyes open may also affect your sleep quality. Research has found that nocturnal lagophthalmos is associated with poorer quality of sleep, potentially because the pain and discomfort of dried eyes causes someone to not sleep as well or wake more often during the night.  
 

Diagnosing Nocturnal Lagophthalmos 

If your doctor suspects nocturnal lagophthalmos, they often start by observing your eyes from a distance, discussing your symptoms, and talking through your family history.  
 
Following the initial consultation, your doctor may move on to a slit lamp examination, where a low-power microscope is used to examine structures in the eye. They can also check for signs of nerve dysfunction in the eyelids.  
 
Since nocturnal lagophthalmos can be hard to diagnose on your own or even with the help of a partner—since even small openings can go undetected—it’s recommended to see a doctor if you have any persistent eye symptoms, especially dry eyes that are at their worst in the morning. Seeking treatment is crucial for preserving the health of your eyes.  

Treatment Options for Nocturnal Lagophthalmos 

There are various treatment options for those who sleep with their eyes open, some being lifestyle changes and others involving help from a doctor.  

Lifestyle Changes 

There are various changes that you can make to prevent sleeping with your eyes open. For example, if you drink alcohol before bed or use a sleeping pill to fall asleep, avoiding either may reduce your likelihood of sleeping with your eyes open.  
 
Additionally, there are habits you can implement to help your eyes avoid drying out, even if you cannot control when they remain open while sleeping, such as using a humidifier. A humidifier can help keep the moisture in your bedroom up so that your eyes are less likely to dry out.  
 
You can also implement changes to improve your sleep, such as keeping your bedroom dark, cool, and quiet. Using a comfortable mattress can also improve your sleep. These habits lessen your odds of waking up during the night, which allows you to wake up more refreshed in the morning.  

Eye Products 

If you sleep with your eyes open, there are some products that you can use to retain moisture. For instance, there are moisture goggles and eye masks that can be worn at night to improve eye hydration.  
 
Another option that your doctor may suggest is an external eyelid weight, which helps to keep your eyes closed. Surgical tape can also be applied to the eyelids to achieve the same goal.  

Surgery 

In severe cases, your doctor may recommend surgery. In one type, a gold surgical implant is placed into the eyelid of the upper lid. It works similar to an eyelid weight, keeping the lid closed while you’re asleep.  

Sleeping With Your Eyes Open—Not an Enviable Trait 

For those who sleep with their eyes open, the small slit that typically remains from where their eyelids don’t close completely can cause dry eyes that are more susceptible to irritation, infection, and injury.   
 
It’s not common to sleep with your eyes open, and it can have many causes, from health conditions to using a sleeping pill to fall asleep. Knowing the possible causes can then inform the changes you make to try and limit open-eyed sleeping or, if it’s not something that can be stopped, creating a sleeping environment that helps to keep your eyes moist.  
 
Ultimately, if you frequently wake up with dry eyes, it may be wise to talk to a doctor to get to the bottom of the issue.  
 

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Written by

Jessica G

Medical writer freelancer who has written hundreds of articles on varying topics. Masters of Engineering degree in Biomedical Engineering.

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