Sleep plays a crucial role in regulating various physiological functions, including those of the nervous, cardiovascular, and eye systems. Disrupted sleep has been associated with a range of chronic conditions, such as hypertension, diabetes, cardiovascular disease, and impaired cognitive function (Cappuccio et al., 2010).1

In recent years, increasing attention has turned to the relationship between poor sleep and eye diseases, particularly glaucoma.

Recent Epidemiological Findings

A large cross-sectional study published by the American Academy of Ophthalmology in 2023 examined data from over 6,700 adults aged 40 and older. The study identified a statistically significant association between glaucoma and several self-reported sleep disturbances, including short or long sleep duration, insomnia symptoms, excessive daytime sleepiness, and snoring (Mukamal, 2023).2

Individuals with glaucoma were more likely to report both insufficient sleep (less than 3 hours) and prolonged sleep (more than 10 hours), suggesting a U-shaped association.

While the findings are observational and do not establish causality, they support a growing body of literature indicating that sleep patterns may be both a contributing factor to and a consequence of glaucomatous optic neuropathy.

Potential Pathophysiological Mechanisms

Several plausible biological mechanisms may explain the observed relationship between sleep disturbance and glaucoma:

1. Intraocular Pressure (IOP) Fluctuations: Nocturnal increases in IOP, particularly in the supine position, may contribute to glaucomatous damage, especially in individuals with obstructive sleep apnea (OSA) (Liu et al., 2003).3
2. Optic Nerve Perfusion: Obstructive sleep apnea (OSA) may reduce blood flow to the optic nerve due to intermittent hypoxia and poor vascular regulation, making retinal ganglion cells more vulnerable to damage. Recent studies show reduced optic nerve head perfusion in patients with both OSA and normal-tension glaucoma, supporting this link (Chaitanya et al., 2024; Khandwala et al., 2022).4
3. Circadian Rhythm Disruption: Glaucoma can damage a specific subset of retinal cells, known as intrinsically photosensitive retinal ganglion cells (ipRGCs), which play a crucial role in regulating circadian rhythms. These cells transmit light-based signals to the brain’s central clock, the suprachiasmatic nucleus (SCN), to help maintain proper sleep-wake cycles and melatonin secretion. Damage to ipRGCs may lead to circadian misalignment and impaired melatonin production, contributing to poor sleep quality in patients with glaucoma. A foundational hypothesis by Nuzzi and Vitale (2009) suggests that this retinal damage reduces input to the SCN, leading to circadian rhythm dysfunction and potentially establishing a bidirectional link between sleep disturbance and glaucoma progression.5
4. Neurohormonal Effects: Dysregulated cortisol and melatonin levels in patients with chronic sleep deprivation may contribute to oxidative stress and neuroinflammation, potentially impacting optic nerve health (Khalyfa et al., 2017).6

However, not all studies have found consistent associations. A recent investigation using full polysomnography reported no significant differences in sleep architecture between glaucoma patients and matched controls after adjusting for confounding factors (Bec et al., 2024), underscoring the need for further longitudinal and mechanistic studies.7

Clinical Implications

Given the global burden of glaucoma, affecting over 76 million people worldwide (Tham et al., 2014), understanding modifiable risk factors such as sleep quality has important implications for prevention and management.8

Clinicians should consider screening patients with glaucoma or those at risk for coexisting sleep disorders, particularly OSA. Early identification and treatment of sleep-related conditions may offer an adjunctive strategy for preserving visual function.

A Holistic Approach to Glaucoma Care

At Nova Eye Institute, our team remains committed to incorporating emerging evidence into personalized care. We recognize that glaucoma is not an isolated ocular condition, but rather often reflects broader systemic health issues. Our approach encompasses not only advanced diagnostic imaging and surgical expertise, but also a focus on whole-person care, addressing lifestyle factors, sleep hygiene, and comorbid conditions to optimize long-term outcomes.

References

1. Cappuccio, F. P., D’Elia, L., Strazzullo, P., & Miller, M. A. (2010). Sleep duration and all-cause mortality: A systematic review and meta-analysis of prospective studies. Sleep, 33(5), 585–592. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2864873/
2. Mukamal, R. (2023). Relationship Between Glaucoma and Poor Sleep. American Academy of Ophthalmology. Retrieved from https://www.aao.org/eye-health/news/study-relationship-between-glaucoma-poor-sleep
3. Liu, J. H. K., Kripke, D. F., & Weinreb, R. N. (2003). Comparison of the nocturnal effects of once-daily timolol and latanoprost on intraocular pressure. American Journal of Ophthalmology, 136(3), 449–456. https://www.ajo.com/article/S0002-9394(04)00403-9/abstract
4. Chaitanya, A., Pai, V. H., Mohapatra, A. K., & Ve, R. S. (2016). Glaucoma and its association with obstructive sleep apnea: A narrative review. Oman Journal of Ophthalmology, 9(3), 125–134. https://doi.org/10.4103/0974-620X.192261 PubMed+1
5. Nuzzi, R., & Vitale, A. (2009). Circadian rhythm dysfunction in glaucoma: A hypothesis. Medical Hypotheses, 73(4), 594–596. https://doi.org/10.1016/j.mehy.2009.03.040
6. Khalyfa, A., Poroyko, V. A., Qiao, Z., Gileles-Hillel, A., Khalyfa, A. A., Akbarpour, M., … & Gozal, D. (2017). Exosomes and Metabolic Function in Sleep Apnea: A New Horizon in the Pathophysiology of Sleep-Disordered Breathing. Sleep, 40(1), zsw033. https://pmc.ncbi.nlm.nih.gov/articles/PMC5673652/
7. Bec, L., Herber, R., Bailly, S., Brouri, F., Tamisier, R., Chiquet, C., & Pépin, J. L. (2024). Sleep quality in glaucoma patients. Scientific Reports, 14, Article 25593. https://www.nature.com/articles/s41598-024-76368-z
8. Tham, Y.-C., Li, X., Wong, T. Y., Quigley, H. A., Aung, T., & Cheng, C. Y. (2014). Global prevalence of glaucoma and projections of glaucoma burden through 2040: A systematic review and meta-analysis. Ophthalmology, 121(11), 2081–2090. https://doi.org/10.1016/j.ophtha.2014.05.013