Can you sleep with your eyes open?

We may have ever seen someone like our children, partner or friends sleep with their eyes open, or we ourselves sleep this way.

This is something that surprises us because we understand that you can only sleep by closing your eyes. We use our eyes to see and we cannot "turn them off at will", which is why we lower our eyelids and try to sleep.

Here we will answer the question of whether you can sleep with your eyes open, if it affects the quality of sleep, what problems may be behind and if there is treatment.

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Is it possible to sleep with your eyes open?

The normal thing is that, to be able to sleep, we close our eyes, we join in the dark and wait for the pleasant hug of Morpheus.

However, not everyone has their eyes fully closed while sleeping. There are those who keep them a little open and others, curiously, have them wide open. This is considered a medical problem and has a name: nocturnal lagophthalmos.

Nocturnal lagophthalmos is a fairly common medical condition. Apparently, about 20% of the population sleeps with their eyes open.

This can pose problems for both sleep quality and eye healthas well as being a sign of an underlying medical condition.

Although the person can sleep, keeping the eyes partially or completely open can damage them, since they do not hydrate properly and are exposed to environmental agents.

A) Yes, eyes become dry, infected, scratched by foreign objects such as nocturnal dust and insects, corneal damage, sores and ulcers, leading to ocular pathologies and, in the worst cases, loss of vision.

Why do we close our eyes when we sleep?

In normal sleep, the closed eyelids prevent light from being absorbed by the eyes and, in this way, the brain is prevented from stimulating.

During wakefulness light is absorbed through cells in the retina that contain the pigment melanopsin, a light sensitive protein. Its stimulation causes information to be transmitted to the brain, specifically to the suprachiasmatic nucleus, a region that regulates circadian rhythms, the sleep-wake cycle, and the timing of the processes of Body.

In addition to preventing brain activation, closing the eyelids hydrates the eyes while we rest. When we are asleep, we cannot blink, which is why it is better to have the blinds drawn. By having the eyelids lowered on one side, a correct hydration is obtained, preventing the eyes from drying out, and on the other side, they are protected from the external agents that swarm through the air.

Causes

There are several causes that can be behind nocturnal lagophthalmos. Next we will see the main ones.

Paralytic injury

In this case, the facial nerve responsible for transmitting nerve information to the muscle that closes the eyelids is paralyzed. This may be due to facial paralysis, tumors, trauma, or cerebrovascular disease. It can also be due to Möbius syndrome, which causes damage to the cranial nerves. The muscle loses strength, making it impossible to fully close the eyelid.

Mechanical injury

In the case of mechanical injury, this may be due to external factors. Among them we can find scarring of the eyelids or conjunctiva, eyelid laxity, and exophthalmos. All this can be due to a negligent surgical intervention on the face, a blow to the eyelid or a disease that has damaged it.

Thyroid problems

One of the medical problems associated with the thyroid is bulging eyes, a common symptom of Graves' disease. This disease is a form of hyperthyroidism, that is, have a very active thyroid, which can interfere with the ability to close the eyelids while he's asleep.

Genetics

It has been seen that nocturnal lagophthalmos is more frequent in those people who have a relative who has it.

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Treatment

Depending on how the nocturnal lagophthalmos is occurring and to what extent the person cannot completely close their eyelids, there are different therapeutic options for this condition. All of them must be supervised by an eye doctor and, preferably, follow-up in a hospital or authorized place to be able to observe the person while they are asleep.

The main therapeutic option is the use of artificial tears during the day. This treatment helps to create a more robust wet film on the eyeball and, thus, keep the eyes more hydrated for longer. In this way, in case the patient has them open at night, her eyes will be better prepared against environmental pathogens in addition to preventing them from drying out even if they do not close eyelids.

Eye masks or eye masks can protect eyes from damage and stimulation by acting as a physical barrier. for pathogens, dust and light rays. There are glasses specifically designed to generate moisture in the open eyes while sleeping.

Another option in the same vein as humidifying glasses is to use an ambient humidifier, making the room more humid and the eyes not at too much risk of drying out. Likewise, this option is not entirely recommended and must be closely monitored by a professional, since, if the humidifier is contaminated, the eye damage will be serious.

Finally, a curious but effective therapeutic option is, simply, closing the eyes using surgical tape. This measure must be closely supervised by a doctor, and it is preferable that it be carried out in a place controlled, to prevent the patient from improperly donning it or skipping the tape and its effect is null. In the most serious cases, surgical intervention will be necessary to solve nocturnal lagophthalmos.

Bibliographic references:

• Toledano-Fernández N, García-Sáenz S, Ortega-Gómez J, Sánchez Cruz J (2004): Ophthalmological evaluation of the patient with facial paralysis. Proceedings of the Spanish Society of Ophthalmological Nursing, vol. 1
• Latkany RL, Lock B, Speaker M (2006). Nocturnal lagophthalmos: an overview and classification. The Ocular Surface. 4 (1): 44–53. PMID 16671223.
• Shorr, N; Goldberg, RA; McCann, JD; Hoenig, JA; Li, TG (2003). Upper eyelid skin grafting: an effective treatment for lagophthalmos following blepharoplasty. Plast Reconstr Surg. 112 (5): 1444–8. doi: 10.1097 / 01.PRS.0000081477.02812.C9. PMID 14504530
• Nakazawa, H; Kikuchi, Y; Honda, T; Isago, T; Morioka, K; Yoshinaga, Y (2004). Treatment of paralytic lagophthalmos by loading the lid with a gold plate and lateral canthopexy. Scandinavian Journal of Plastic and Reconstructive Surgery and Hand Surgery. 38 (3): 140–4. PMID 15259671
• Breus, M. J. (2020). One in Five People Sleeps With Their Eyes Open. United States: Psychology Today. Recovered from https://www.psychologytoday.com/us/blog/sleep-newzzz/202001/one-in-five-people-sleeps-their-eyes-open