According to the GRF, “A good night’s sleep isn’t a luxury—it’s a necessity for a healthy life.” During sleep, our brains build and strengthen neural connections that allow our bodies to reset both physically and cognitively. With glaucoma, however, multiple factors can impact disease progression during sleep. Consider the following before laying your head down to rest.*

Glaucoma and sleep problems

A handful of sleep problems have been linked to glaucoma, either increasing disease risk or arising from the disease itself. These include:

• Sleep duration. Glaucoma has been shown to be three times more likely to occur in people who sleep 10 or more hours each night, versus those who sleep for seven hours per night.
• Sleep disorders. People with glaucoma tend to fall asleep either more quickly, in nine minutes or less, or more slowly, taking 30 minutes or longer, than people without the disease.
• Sleep apnea. Obstructive sleep apnea (OSA) is linked not only to greater risk of health issues such as high blood pressure and stroke, but also to 10 times greater odds of glaucoma.
• Daytime sleepiness. Glaucoma has been associated with significant daytime sleepiness.

Glaucoma and sleep positions

We know that intraocular (internal eye) pressure, or IOP, is higher when lying down than when sitting, and that this difference is greater in people with glaucoma. A study of 24 people who either had glaucoma, or were suspected of having glaucoma, showed that side and prone sleeping positions raised IOP significantly, especially in the prone position (lying flat on your chest).

While we don’t yet know exactly how this increase in IOP happens, GRF says it likely stems from changes in blood flow on the outer layer of the sclera (white part of the eye) and in the choroid (tissue layer between the retina and sclera). It’s believed these changes are largely related to sleep position, and may be independent of blood flow to the optic nerve.

People with worsening glaucoma in one eye have been found to prefer sleeping with the affected eye closer to the pillow. Some experts think this raises IOP in that eye, accelerating optic nerve damage. While GRF notes that sleeping position isn’t the sole cause of glaucoma progression, it can still have an impact.

Glaucoma and your pillow

Since IOP increases at night and when we lie down, GRF says, some doctors suggest that patients sleep in an upright position.

Research on pillow use revealed that when people turned their head into a pillow during simulated sleep, IOP rose significantly in the lower eye. In 11 people with primary open-angle glaucoma versus 11 healthy control participants, average IOP rose an estimated 19.6 mm Hg in patients and 28 mm Hg in controls. 

Other research has examined the relationship between head elevation and IOP. Eye pressure levels in 24 healthy young Korean participants were compared in the following scenarios:

• Sitting
• Lying face up with head flat
• Lying face up with head elevated 30 degrees using pillows
• Lying face up with head elevated 30 degrees using a bed-elevating device

Pillows were found to have no substantial effect on average IOP.

• • IOP was lower when sitting than when lying with the head flat. 

• IOP didn’t change when participants’ heads were raised with multiple pillows.

• IOP decreased when participants elevated their head with a bed mechanism.

The findings suggest that elevating your head 30 degrees using a bed-adjusting mechanism may not only be better than propping your head up with pillows to prevent an increase in your IOP while you sleep, but it may actually lower your IOP. 

*Glaucoma Research Foundation. (2023, October 15). Sweet Dreams: The Relationship Between Sleep and Glaucoma. https://glaucoma.org/sweet-dreams-the-relationship-between-sleep-and-glaucoma