Irritated Eyes? Could Be a Complication of Sleep Apnea

It is not your imagination playing tricks. Your sleep apnea may be causing your eyes to feel dry and irritated. Several studies have shown a link between obstructive sleep apnea (OSA) and chronic (ongoing) dry eye disease. But first, let us make sure we understand each condition.^1,2

What is sleep apnea?

Sleep apnea occurs when a person routinely has trouble breathing while sleeping. People with sleep apnea have a harmful stop-and-start breathing pattern. This results in wear and tear to the body due to lower-than-normal oxygen levels.³

People with untreated sleep apnea often report feeling unrested after a night of sleep. They may awaken with dark circles or bags under their eye.³

There are several types of sleep apnea, but OSA is the most common. OSA occurs when tissues relax and block the airway during sleep.³

What is dry eye disease?

Dry eye disease occurs when your eyes can no longer make enough good-quality tears to wet your eyes. This can lead to feelings of stinging, burning, or scratching. People with dry eye disease may experience:⁴

• Sensitivity to light
• Dry, red, or tired eyes
• Eye irritation or feeling like there is something in your eye
• Blurry vision

Dry eyes can develop for a number of reasons. But the evidence is building that people with sleep apnea have a greater risk of developing it than people without sleep apnea.^1,2,4

What does the research show?

A recent study compared people with OSA to those without it. Members of the 2 groups were matched based on their age and gender to improve the comparison.¹

Not surprisingly, the study found that people with OSA ranked their sleep quality as worse than those without apnea. But it also found a strong link between those with OSA and physical signs of dry eye disease.¹

The researchers found these signs by using tests that evaluate the quality of participants’ tears and the function of their meibomian glands. This gland produces an important oil that prevents tears from evaporating away.¹

A second study found a strong link between OSA and an eye health indicator, non-arteritic anterior ischemic optic neuropathy. This condition is caused by reduced blood flow to the optic (eye) nerve. This lower-than-normal blood flow may be driven by OSA in some people.^5,6

A third study looked at healthcare records of people using a continuous positive airway pressure (CPAP) machine. This study uncovered some interesting trends.⁵

It found that 3.7 times more women with sleep apnea are treated for dry eye disease than men with sleep apnea. It also found that as people who use CPAP machines age, more are affected by dry eye disease. People who also had inflammatory or metabolic conditions were at the highest risk of developing dry eye disease.⁵

Last, a fourth study compared people with OSA to those without it and evaluated the eye conditions of both groups. It found that 45 percent of participants with OSA had some sort of eye condition. Those with OSA were found to have an overall risk of having dry eye disease that was 4.6 times greater than those without OSA.²

But the most interesting finding from this last study involved oxygen levels. The researchers found that very low oxygen levels were strongly linked to disorders that threatened healthy vision.²

What is the link between sleep apnea and dry eyes?

In some cases, a poorly fitting CPAP mask may blow air over the eye and cause temporary dryness. But the weight of evidence points to a different process. Disrupted blood flow caused by interrupted breathing during sleep is suspected to drive processes that harm eye health.¹

Lack of steady oxygen at the right levels may keep the eye from carrying out normal processes. These processes help it to make a film of tears that lubricate the eye and keep it moist.¹

What can I do?

If you think you have dry eye disease, make an appointment with an eye doctor. Tell the doctor about your sleep apnea and whether you use a CPAP machine.

Also, make sure your CPAP mask fits properly and that you are using the machine as directed.

Are your eyes irritated? Please share a comment.

To learn about health issues related to OSA, see Complications of Sleep Apnea.