Obstructive Sleep Apnea and How It Can Affect Your Eyes

Sleep apnea is a common disorder that can cause serious health risks if left untreated, and it may even affect your eyes.

Sleep apnea causes you to stop breathing or have trouble breathing during sleep. The cause may be a physical issue in your head and neck or a problem with the signals your brain sends to tell your body to breathe. 

Several eye conditions are associated with sleep apnea, and some machines used to treat it may cause dry eye and other eye problems.

Learn more about sleep apnea, how it affects the eyes and how your eye doctor may help diagnose and treat this sleep disorder.

Types of sleep apnea

Sleep apnea may be caused by physical structures in your body, signals in your brain or a mix of the two. These are the three main types:

• Obstructive sleep apnea (OSA) – The upper airway gets blocked during sleep, causing breathing to slow down or stop many times while you sleep. 

• Central sleep apnea (CSA) – The airway isn’t blocked, but the brain doesn’t send the signals that tell the body to breathe. This can cause breathing to stop.

• Mixed sleep apnea – A patient may have both types of sleep apnea. This is known as having “mixed sleep apnea” or complex sleep apnea. 

Obstructive sleep apnea is the most common type. In fact, OSA makes up 84% of all cases.

What is obstructive sleep apnea?

In obstructive sleep apnea, the upper airway closes during sleep. This usually happens because the tongue slides onto the soft palate, and the soft palate relaxes into the back of the throat. This closes or narrows the upper airway.

When the airway gets blocked or constricted, your breathing stops or decreases. Your blood oxygen level goes down, and you wake up choking or gasping for air. This cycle repeats many times during the night. 

Most people with obstructive sleep apnea do not remember waking up and have no idea they have the condition. In fact, up to 80% of men and 90% of women with OSA have not been diagnosed.

Causes of obstructive sleep apnea

There are many possible causes of obstructive sleep apnea. The causes of OSA include:

• Obesity or being overweight – Fat deposits in the neck can press on and block the upper airway.

• Oversized tonsils – Large tonsils can block the upper airway and affect breathing during sleep.

• Heart or kidney problems – Patients with a heart or kidney condition may have fluid buildup that blocks the upper airway.

• Genetic syndromes – Some genetic syndromes, such as Down syndrome, can affect the size and shape of structures in the head and neck, leading to sleep apnea.

Men over 40 may be at higher risk for obstructive sleep apnea. Eating a poor diet, drinking alcohol and smoking cigarettes may also increase your OSA risk.

Eye conditions related to sleep apnea

There are several eye conditions that have been linked to sleep apnea. These eye problems include: 

• Floppy eyelid syndrome (FES)

• Glaucoma

• Idiopathic central serous chorioretinopathy (ICSC)

• Keratoconus

• Non-arteritic anterior ischemic optic neuropathy (NAION)

• Papilledema 

Read on for what you need to know about these eye problems.

Floppy eyelid syndrome

Floppy eyelid syndrome is a condition where the upper eyelids are relatively loose and can easily be everted (flipped over so they’re turned inside out).

Patients with FES have less elastin in the skin of the upper eyelids. Elastin is a substance in the skin that allows the skin to return to its original shape after being stretched or pinched.

Floppy eyelid syndrome symptoms may include: 

• Eye redness

• Eye discharge

• Eye itching 

• Irritation 

• Excess tears 

Treatments for floppy eyelid syndrome may include: 

• Using lubricating eye drops or ointment

• Wearing a sleep mask or eyelid shield 

• Taping the eyes closed while sleeping

Getting treated for sleep apnea may help reduce FES symptoms.

Glaucoma

Patients with glaucoma have damage to the optic nerve that usually happens because of high pressure within the eye. 

Glaucoma symptoms may include: 

• Blind spots

• Blurry vision

• Eye cloudiness

• Eye pain

• Eye redness

• Headaches

• Nausea and vomiting 

• A feeling of pressure in the eye 

Glaucoma treatment may include:

• Prescription eye drops

• Laser treatments 

• Surgery

Glaucoma will eventually cause vision loss if left untreated, so early diagnosis and treatment are key. 

Idiopathic central serous chorioretinopathy

Patients with ICSC have fluid that accumulates underneath the retina. 

Symptoms of ICSC may include: 

• Blurry or dark central vision

• Distortions in vision 

• Straight lines appearing bent or wavy

• A brownish or dull haze on white objects

The fluid usually goes away within a couple of months, so ICSC doesn’t normally require treatment. Your eye doctor will monitor the condition to see if the liquid will go away on its own. If it doesn’t, your eye doctor may prescribe oral medication or laser treatments.

Keratoconus

Patients with keratoconus have thinning cornea tissue, which causes the front surface of the eye to bulge. Keratoconus can become worse over time if not treated.

Contact lenses, including scleral lenses, custom soft contacts or gas permeable contacts, may be used to treat keratoconus. Other treatments include a procedure called corneal crosslinking that may strengthen the cornea. In some cases, a patient may need a cornea transplant.

Non-arteritic anterior ischemic optic neuropathy

Patients with NAION typically have sudden vision problems in one eye. There is no widely used effective treatment for this condition right now. However, NAION may improve on its own in some cases. Patients also may be able to enroll in clinical trials.

Papilledema

Patients with papilledema have excess fluid that causes swelling in the optic nerve, which sends information from the eye to the brain. 

Papilledema symptoms may include: 

• Blurry vision

• Temporary “blackout” of vision

• Headaches

• Nausea

• Vomiting 

• Ringing in the ears

It’s important to get a diagnosis because untreated papilledema can cause blindness. Treatment will depend on the cause and may include medication or surgery.

Given the number of eye conditions linked with sleep apnea, it’s important to tell your eye doctor if you have OSA and to seek immediate treatment for any changes in vision or other eye problems.

Signs of obstructive sleep apnea

One common sign of OSA is being very tired during the day. Your sleep partner may tell you that you snore. They may also notice that you gasp, choke or snort during the night.

Here are other signs to watch for:

• Anxiety or depression

• Difficulty concentrating on tasks

• Frequent daytime naps

• Headaches in the morning

• Irritability or other mood issues

Men are more likely to get sleep apnea, but women can get it too. Being overweight or having a neck circumference over 19 inches increases your risk.

Dangers of obstructive sleep apnea

Obstructive sleep apnea that goes undiagnosed and untreated can lead to various health problems. For example, patients with untreated sleep apnea may be at higher risk for:

• Car and work accidents

• Strokes

• Transient ischemic attacks or “mini strokes”

• Coronary heart disease

• Heart attacks 

• Irregular heartbeat

• High blood pressure

• Diabetes

How is obstructive sleep apnea diagnosed?

You may need to see a sleep specialist to get a diagnosis. Different types of doctors can study to become sleep specialists. Look for a specialist through the American Board of Sleep Medicine.

Your doctor may order a sleep study to diagnose obstructive sleep apnea. A sleep study (polysomnography) may be done at a sleep laboratory or at home.

A sleep study usually takes place overnight. It may include:

• An electroencephalogram (EEG) – An EEG measures your brain waves.

• An electrooculogram (EOG) – An EOG measures body movements that show changes in the phases of sleep.

• An electrocardiogram (EKG) – An EKG measures your heart rate and rhythm.

Your breathing, leg movement and the oxygen and carbon dioxide levels in your blood will also be measured during a sleep study. 

The sleep study results will show if you have sleep apnea. The results also will tell your doctor if you have a mild, moderate or severe case. 

Sleep apnea severity

The severity is measured based on your apnea-hypopnea index (AHI). The AHI is the number of apneas and hypopneas that last 10 seconds or longer each hour. An apnea is when you stop breathing. A hypopnea is when you aren’t breathing as deeply as normal.

Here is the sleep apnea severity scale based on your AHI:

• Mild – An AHI of 5 to 15.

• Moderate – An AHI of 15 to 30.

• Severe – An AHI of 30 or higher.

If you are diagnosed with mild, moderate or severe sleep apnea during a sleep study, your doctor will come up with a treatment plan.

Obstructive sleep apnea treatment

A doctor may prescribe lifestyle changes for mild sleep apnea first to see if that helps. You may be asked to:

• Cut down on drinking alcohol

• Eat a healthy diet

• Lose weight 

• Quit smoking

• Stop taking certain drugs such as muscle relaxants

Lifestyle changes may make a big difference for some patients. 

There are also special sleep apnea pillows and other devices that may help keep you from sleeping on your back, which can make obstructive sleep apnea worse. In some cases, a dental device may help keep your airway open.

The most common treatment for OSA is a machine that helps you breathe while you sleep. Common sleep apnea machines include: 

• A continuous positive airway pressure (CPAP) machine

• A variable positive airway pressure (VPAP) machine 

• An automatic positive airway pressure (APAP) machine

The CPAP and other machines all work in a similar way. You put on a mask connected to a tube connected to a machine. The machine blows air into your lungs to keep you breathing normally while you sleep.

Sleep apnea treatment and eye problems 

Sleep apnea treatment may help with some associated eye problems. But patients who are being treated with a CPAP, VPAP, APAP or other sleep apnea machine may have side effects related to the eyes.

Air can blow out of the mask while a CPAP or other machine is running. This continuously leaking air can lead to dry eye, eye irritation and a gritty feeling in your eyes. Treatment for dry eye and eye irritation may include artificial tears or prescription eye medication.

Patients who use CPAP and other machines for sleep apnea may also be more likely to get:

• Bacterial conjunctivitis – An eye infection that may be treated with antibiotic drops or eye ointment.

• Ocular hypertension – Higher-than-normal pressure in the eye, also known as increased ocular pressure (IOP), that may be treated with glaucoma eye drops or glaucoma surgery.

Your eye doctor can treat dry eye, conjunctivitis, ocular hypertension and other eye problems that may be caused by certain treatments for sleep apnea.

See your eye doctor regularly

Regular eye exams are important for overall eye health. They can also play a role in the diagnosis and treatment of sleep apnea. Your eye doctor may spot signs of sleep apnea in your eyes and can monitor your eyes for problems while you’re being treated.

READ NEXT: Effects of sleep deprivation on the eyes

Page published on Wednesday, May 12, 2021