Is Sleeping with Eyes Open Linked to Any Underlying Medical Conditions?

Is Sleeping with Eyes Open Linked to Any Underlying Medical Conditions?

Sleep is a crucial aspect of human life, essential for physical and mental well-being. Typically, sleeping involves closing one’s eyes, but for some individuals, the phenomenon of sleeping with eyes open occurs. This peculiar behavior has sparked curiosity and concern regarding its potential connection to underlying medical conditions. In this comprehensive exploration, we delve into the phenomenon of sleep with their eyes open and examine its possible associations with various medical conditions.

Understanding Sleeping with Eyes Open

Sleeping with eyes open, scientifically known as nocturnal lagophthalmos, is a phenomenon where an individual sleeps with their eyelids partially or fully open. This condition can occur intermittently or persistently throughout the night and may lead to several consequences such as eye irritation, dryness, and increased susceptibility to eye infections.

Normal Sleep Physiology vs. Sleeping with Eyes Open

In normal sleep physiology, the body undergoes various stages of sleep, including rapid eye movement (REM) sleep and non-REM sleep. During REM sleep, the eyes typically move rapidly behind closed eyelids, while during non-REM sleep, the eyes remain still. However, in individuals with nocturnal lagophthalmos, the eyes fail to close fully during sleep, disrupting this natural process.

Potential Causes of Sleeping with Eyes Open

Several factors may contribute to nocturnal lagophthalmos, including:

  1. Facial Anatomy: Anatomical variations in the face, such as shallow eye sockets or weak eyelid muscles, may prevent complete closure of the eyelids during sleep.
  2. Underlying Medical Conditions: Certain medical conditions, such as Bell’s palsy, a condition that causes facial paralysis, can result in the inability to close the eyes fully during sleep.
  3. Neurological Disorders: Neurological disorders like Parkinson’s disease or facial nerve disorders can affect the control of eyelid muscles, leading to nocturnal lagophthalmos.
  4. Eyelid Inflammation: Inflammation of the eyelids, known as blepharitis, can interfere with the normal functioning of the eyelid muscles, potentially causing them to remain open during sleep.

Medical Conditions Associated with Sleeping with Eyes Open

While sleeping with eyes open itself may not always indicate a serious underlying medical condition, it can be associated with various disorders, including:

  1. Bell’s Palsy: This condition causes temporary paralysis of facial muscles, including those responsible for closing the eyes, leading to involuntary eyelid opening during sleep.
  2. Graves’ Disease: An autoimmune disorder that affects the thyroid gland, Graves’ disease can cause eye-related symptoms, such as bulging eyes (exophthalmos) and difficulty closing the eyelids completely.
  3. Parkinson’s Disease: Individuals with Parkinson’s disease may experience difficulties in controlling facial muscles, including those involved in eyelid closure, resulting in sleeping with eyes open.
  4. Facial Nerve Disorders: Damage or dysfunction of the facial nerve, such as in cases of facial nerve paralysis, can impair the ability to close the eyes fully during sleep.
  5. Eye Infections and Injuries: Conditions such as corneal abrasions or conjunctivitis (pink eye) can cause discomfort or pain, leading to difficulty in closing the eyes during sleep.

Diagnostic Evaluation and Treatment

Diagnosing the underlying cause of sleeping with eyes open often requires a comprehensive evaluation by a healthcare professional. This may include a thorough medical history, physical examination, and possibly specialized tests, such as electromyography (EMG) or imaging studies.

Treatment for sleeping with eyes open focuses on addressing the underlying cause:

  1. Management of Underlying Conditions: Treating conditions such as Bell’s palsy, Graves’ disease, or neurological disorders may alleviate symptoms of nocturnal lagophthalmos.
  2. Eyelid Moisturization: Lubricating eye drops or ointments can help prevent dryness and irritation associated with sleeping with eyes open.
  3. Protective Measures: Wearing an eye mask or using tape to gently close the eyelids during sleep can help maintain moisture and protect the eyes from potential damage.
  4. Surgical Interventions: In severe cases or when conservative measures fail, surgical procedures such as eyelid weights or eyelid repair surgery may be considered to improve eyelid closure.

Are there any evolutionary reasons behind sleeping with eyes open?

Sleeping with eyes open, known as nocturnal lagophthalmos, might seem like an odd quirk, but there could be evolutionary reasons behind it. While humans typically close their eyes when they sleep, some individuals, particularly those with certain medical conditions or genetic predispositions, may find themselves sleeping with their eyes partially or fully open.

One plausible evolutionary explanation for this phenomenon relates to survival instincts. Throughout human history, maintaining awareness of one’s surroundings, even during sleep, would have conferred a survival advantage. In ancient times, when humans lived in more hostile environments, being able to detect potential threats while resting would have been crucial for survival. Sleeping with eyes open would have allowed our ancestors to remain vigilant against predators, rival tribes, or other dangers during vulnerable periods of rest.

Additionally, sleeping with eyes open may have provided protection against environmental hazards such as dust, debris, or irritating insects. By keeping their eyes partially open, individuals could quickly detect and respond to these threats, reducing the risk of eye damage or infection.

Furthermore, from an evolutionary perspective, variations in sleep behaviors and patterns are not uncommon across different species. For example, some birds and marine mammals engage in unihemispheric sleep, where one hemisphere of the brain remains awake while the other sleeps, allowing for continuous vigilance and movement. While humans do not exhibit unihemispheric sleep, sleeping with eyes open could be considered a vestigial trait—a remnant of an ancestral behavior that persists in some individuals due to genetic variability or environmental factors.

It’s important to note that while there may be evolutionary explanations for sleeping with eyes open, individual variation and medical conditions also play significant roles. Conditions such as lagophthalmos or certain neurological disorders can disrupt normal eyelid function, leading to unintended eye exposure during sleep. In such cases, the behavior may not confer any evolutionary advantage and may instead be a result of genetic predisposition or underlying health issues.


Sleeping with eyes open, although uncommon, can be a concerning phenomenon associated with various underlying medical conditions. Understanding the potential causes and implications of nocturnal lagophthalmos is essential for appropriate diagnosis and management. Individuals experiencing persistent symptoms of sleeping with eyes open should seek evaluation by a healthcare professional to determine the underlying cause and receive appropriate treatment. By addressing the root cause, it is possible to mitigate the discomfort and potential complications associated with this condition, ultimately promoting better sleep quality and ocular health.

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