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We all close our eyes to sleep at night, but we may not think very much about the connection between our eyes and sleep. For those who experience vision loss, however, the connection is all too obvious. That’s because vision loss can negatively impact sleep by interfering with a person’s circadian rhythm. Associated mental health issues, like depression and anxiety, can also lead to trouble sleeping.
The National Institutes of Health estimates 3.2 million Americans live with visual impairment and this number is expected to rise as baby boomers age. The good news is that vision loss is typically preventable, treatable or can be slowed. In this guide, we’ll define vision loss, explore its causes, look at how it impacts sleep and outline ways to get better sleep with vision loss.
Vision loss is a broad term and can include various types of vision issues. In general, people with vision loss have trouble seeing even when using corrective lenses. Severity can range from relatively minor issues with sight to complete blindness.
Different types of vision loss show up differently. Loss of acuity, or clarity of vision, can manifest as blurred vision and trouble making out objects, shapes and words. Individuals can also lose vision in one part of the eye or experience a loss of peripheral vision that only allows them to see what’s directly in front of them.
The American Optometric Association defines low vision as anyone with acuity of 20/70 or lower while wearing corrective lenses. Legal blindness includes anyone with acuity of 20/200 or lower and/or a field of vision restricted at 20 degrees or fewer. Individuals who are completely unable to see may or may not be able to make out light and dark, depending on the cause of their vision loss.
Vision loss can be caused by a variety of contributing factors, including age, disease and injury. In this section, we’ll discuss the most common causes.
A person’s risk of experiencing vision loss increases significantly with age. That’s because age is a risk factor for several different conditions that impact vision, including:
There are certain diseases that can lead to vision loss over time. The most common of these is diabetes, which can lead to diabetic retinopathy, the leading cause of blindness in those over 50. Diabetic retinopathy occurs when high blood sugar causes damage to the blood vessels found in the retina, which is in charge of detecting light and sending signals to the brain to form a visual image. Blood vessels eventually leak or bleed, which leads to spots in one’s vision. Scar tissue may form in advanced stages, further distorting vision. Diabetic retinopathy can also lead to diabetic macular edema (DME), which is increased fluid around the macula. Damage from diabetic retinopathy cannot be reversed, but if caught early, vision loss can be slowed or stopped. Proper diabetes management is the best way to prevent the disease.
Other diseases can lead to vision loss, including strokes, tumors, autoimmune diseases or infections.
We often think of vision loss as being related to damage within the eye, but the brain plays a central role in our ability to see. Traumatic brain injury (TBI) can lead to vision loss if there’s damage to a part of the brain that is involved in vision. Common issues include blurred vision, decreased peripheral vision and double-vision. Those with a TBI may also have trouble coordinating eye movement, and nerve damage can cause issues with the muscles that regulate our eyes. Compounding the issue is the fact that trauma also negatively impacts sleep, which can exacerbate vision issues.
Vision loss related to a TBI may be treated with surgery or individuals may find help with occupational therapy. Corrective lenses or patching may also help.
While increasing age is a risk factor for vision loss, some conditions are congenital, or present from birth. There are a variety of conditions that may show up before a child is born or soon after. The majority of cases of infant blindness are from genetic conditions, including congenital cataracts, congenital glaucoma, retinal degeneration, optic atrophy and eye malformations. Even conditions that impact adults, like glaucoma and macular degeneration, are often inherited. Early detection and treatment are key to preventing long-term vision loss or blindness.
There are certain sleep disorders that can also lead to vision loss. One of the more studied relationships in this arena is the impact of Obstructive Sleep Apnea (OSA) on vision. OSA results in interrupted breathing, meaning oxygen levels vary greatly over the course of the night. These large changes in oxygen levels can impact eye health. Resulting conditions can include floppy eyelid syndrome, nonarteritic anterior ischemic optic neuropathy, central serous retinopathy, retinal vein occlusion, and glaucoma. Screening for eye problems can actually be a way to spot OSA.
Studies show that vision loss is linked to both poor sleep quality and sleep duration, with individuals sleeping for much longer or shorter periods than what is considered healthy. This link is especially prominent in older adults. Vision loss is sometimes caused by disorders like OSA that lead to fragmented sleep, but vision loss itself can also cause sleep issues. The most common issues experienced by individuals with vision loss are related to circadian rhythm and mental health, which we discuss in more detail below.
The circadian rhythm is essentially a person’s internal clock that dictates when they’re alert or ready to sleep. For most of is, it operates on a 24-hour cycle, and it’s what tells us it’s time for bed or time to wake up. Your circadian rhythm is controlled by your hypothalamus, but environmental factors, such as exposure to light, play a big role in regulating it. That’s why we tend to sleep at night when it’s dark and why we’re warned to stay away from bright screens right before bedtime. Social activities during the day also signal to us that it’s time to stay alert.
Those with vision loss may experience a disruption in their particular circadian rhythms. Because light is so integral to synchronizing circadian rhythms, individuals with little to no perception of light are most impacted. Those with no light perception may even suffer from Non-24 sleep-wake disorder, meaning their internal clocks are longer than 24 hours. Such issues can have very negative impacts on a person’s well-being. An out-of-synch circadian clock can lead to trouble falling asleep or fragmented sleep and therefore exhaustion during the day. Non-24 can even lead to disruptions in daily life when individuals are ready to sleep when they need to be at work, school or engaging in other activities.
Even those with milder vision loss can experience issues with their circadian rhythms. Vision loss can lead individuals to be more isolated and stay inside. This is especially true for older individuals. Not only does this limit exposure to light, it also means fewer stimulating activities that may keep a person alert during the day and ready to sleep at night.
Vision loss, mental health and sleep are all closely related. Studies show that individuals who experience vision loss have higher rates of mental illness, especially depression. One study even found that rates of depression and anxiety in older adults were higher for those with vision impairment than for those with other conditions, like heart conditions or asthma.
The study goes on to explore the various reasons vision loss can contribute to depression and anxiety. Many individuals experience a reduction in quality of life along with vision loss. Daily activities are simply more difficult to complete, and they may feel isolated from friends and family. At the same time, vision loss may cause individuals to be more dependent on others for help, which can be very difficult for some to reckon with. Add to these the fact that progressive vision loss can simply be distressing and upsetting.
Mental health has a big impact on sleep and is closely related to various sleep disorders. For example, one study found that 40 percent of individuals who experience insomnia also have a psychiatric condition. Depression and anxiety, issues most often associated with vision loss, can lead to sleep issues like insomnia, hypersomnia (oversleeping) or not spending enough time in restorative, deeper sleep. In turn, a lack of sleep can make depression and anxiety even worse, creating a vicious cycle.
Lack of sleep can also negatively impact vision. Like other parts of our bodies, our eyes need sleep to recover and work properly. Insufficient sleep can lead to issues like eye twitches, dry eye or redness and even more serious conditions like glaucoma.
While vision loss can make it difficult to get a good night’s sleep, there are steps you can take to ensure you get the best sleep possible. In this section, we’ll cover various approaches, from seeking professional treatment to practicing good sleep hygiene.
Regular and appropriate medical treatment is the best way to combat vision loss and the sleep issues it can cause. The first step is prevention. The World Health Organization estimates that 80 percent of vision impairment around the world is avoidable. While the majority of these cases are refractive errors that can be solved with corrective lenses, there are still many conditions that can be prevented or will respond well to treatment. Regular eye exams will ensure that if you do experience some sort of vision loss, your doctor can catch it early enough to reverse it or at least slow its progression.
If you currently experience vision loss, the treatment you seek will depend on your particular condition:
Most eye diseases can be treated by an eye doctor. The vision loss from some conditions, like cataracts, can usually be reversed with surgery. Vision loss associated with other diseases, like glaucoma, macular degeneration and diabetic retinopathy, is usually irreversible and treatment is used to stop or slow its progression. That’s why early detection is key.
If your vision loss is associated with another disorder, like diabetes or OSA, then managing these conditions will help prevent or slow vision loss. Properly regulating sugar levels is vital for preventing diabetic retinopathy. Even if you already have the condition, blood sugar control can stop its progression and will sometimes even reverse some vision loss. Managing your OSA through CPAP (continuous positive airway pressure) or similar treatment can help reverse, stop or slow vision loss.
Treatment is also vital if your vision loss leads to mental health issues, like depression or anxiety. Therapy and other forms of treatment can ease your symptoms and also help you get a good night’s sleep.
In addition to medical treatment, vision rehabilitation is important for those who experience vision loss, especially those for whom vision loss is irreversible. Vision rehabilitation encompasses a variety of services that aim to help individuals use their remaining vision as effectively as possible and provide the tools to do so. Services might include everything from occupational therapy to mental health counseling and provide tools like low vision aids, mobility training and environment modification. These services not only improve quality of life, but may also help lower rates of depression and anxiety that can negatively impact sleep.
Good sleep hygiene is important for everyone, especially individuals with vision loss who already experience barriers to restorative sleep. Sleep hygiene refers to the rituals and behaviors we all have around sleep, and it has a big impact on our quality of sleep.
Environment plays a big role in good sleep hygiene. In general, you want to sleep in an area that’s a comfortable temperature, dark, quiet and includes a comfortable place to sleep. Here are a few other factors that contribute to good sleep hygiene:
Vision loss can impact every area of a person’s life, including sleep. Depending on what causes vision loss and its severity, individuals can experience various issues with circadian rhythm. Vision loss can also lead to mental health challenges, which can in turn cause insomnia and other sleep disorders. Regular eye exams and appropriate treatment are key to preventing, reversing or slowing vision loss. With the right treatment and good sleep hygiene, individuals experiencing vision loss can find relief through a good night’s sleep.
For other resources on health and sleep, check out these Tuck guides: