In the April 2017 issue (“How sleep affects the ocular surface”) I explored the relationship between sleep and dry eye/ocular surface dease. Since then, interest in this association has prompted additional research.
At every age each person needs adequate, uninterrupted sleep for optimal wakeful functioning.
Insufficient sleep is associated with a number of chronic diseases and conditions, such as diabetes, cardiovascular disease, obesity, and depression.1 Similarly, traditional medicine considers appropriate sleep, among other factors, essential to maintain ocular health.2
Related: How sleep apnea affects the eye
Data now suggests that suggests sleep quality may play an important role in the development of dry eye disease (DED) by influencing tear secretion and tear film stability and/or by indirectly aggravating anxiety and depression, leading to higher self-reported symptom scores.
In a recent murine model, sleep deprivation was demonstrated to induce dry eye through abnormal superficial corneal epithelial cell microvilli morphology.3,4
In another sleep deprivation mouse model, researchers found that sleep deficiency resulted in decreased aqueous tear secretion, increased corneal epithelial cell defects, increased corneal sensitivity and apoptosis; and induced squamous metaplasia of the corneal epithelium.5
A systematic review and meta-analysis of sleep outcomes associated with found that DED patients may have poorer sleep quality; greater daytime sleepiness; less sleep; more sleep disturbances; and an increased prevalence, incidence, and severity of sleep disorders compared to non-DED patients.6
Patients may also suffer from a number of sleep disorders, including:
• Dyssomnias (insomnia, hypersomnia, sleep apnea)
• Parasomnias (disorders characterized by abnormal or unusual behavior of the nervous system during sleep, such as sleepwalking and [rapid eye movement] REM behavior disorder)
• Sleep bruxism (nocturnal tooth grinding may be associated disturbed sleep)
• Circadian rhythm sleep disorders
1. Centers for Disease Control and Prevention. Sleep and Sleep Disorders. Available at: https://www.cdc.gov/sleep/index.html. Accessed 5/29/19.
2. Haji-Ali-Nili N, Khoshzaban F, Karimi M. Lifestyle determinants on prevention and improvement of dry eye disease from the perspective of Iranian traditional medicine. Iran J Med Sci. 2016 May;41(3 Suppl):S39.
3. Tang L, Wang X, Wu J, Li SM, Zhang Z, Wu S, Su T, Lin Z, Chen X, Liao X, Bai T, Qui Y, Reinach PS, Li W, Chen Y, Liu Z. Sleep deprivation induces dry eye through inhibition of PPARα expression in corneal epithelium. Invest Ophthalmol Vis Sci. 2018 Nov 1;59(13):5494-5508.
4. Karaca I, Yagci A, Palamar M, Tasbakan MS, Basoglu OK. Ocualr surface assessment and morphological alterations in Meibomian glands with meibography in obstructive sleep apnea Syndrome. Ocul Surf. 2019 Jun 18. pii: S1542-0124(19)30061-8. doi: 10.1016/j.jtos.2019.06.003.
5. Au NH, Mather R, To A, Malvankar-Mehta MS. Sleep outcomes associated with dry eye disease: a systematic review and meta-analysis. Can J Ophthalmol. 2019 Apr;54(2):180-189. doi: 10.1016/j.jcjo.2018.03.013.
6. Li S, Ning K, Zhou J, Guo Y, Zhang H, Zhu Y, Zhang L, Jia C, Chen Y, Sol Reinach P, Liu Z, Li W. Sleep deprivation disrupts the lacrimal system and induces dry eye disease. Exp Mol Med. 2018 Mar 2;50(3):e451.
7. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report: March 4, 2011. Available at: https://www.cdc.gov/mmwr/PDF/wk/mm6008.pdf. Accessed 5/29/19.
8. National Sleep Foundation. Healthy Sleep Tips. Available at: https://sleepfoundation.org/excessivesleepiness/sleep-tools-tips/healthy.... Accessed 5/29/2019.
9. Centers for Disease Control and Prevention. Sleep and Sleep Disorders: About our program. Available at: https://www.cdc.gov/sleep/about_us.html. Accessed 5/29/19.
10. Lomeli HA, Perez-Olmos I, Talero-Gutierrez C, Moreno CB, Gonzalez-Reyes R, Palacios L, de la Pena F, Munoz-Delgado J. Sleep evaluation scales and questionaries: a review. Actas Esp Psiquiatr. 2008 Jan-Feb;36(1):50-9.