How Thyroid Eye Disease Impacts Sleep and What You Can Do
Thyroid eye disease can disrupt sleep through discomfort, anxiety, and vision changes, but targeted management can help you rest easier.
Thyroid Eye Disease and Its Significant Impact on Sleep
Thyroid eye disease (TED) is a complex autoimmune condition with widespread effects beyond vision changes. A prominent, often overlooked challenge for people with TED is troubled sleep. Understanding why TED affects sleep, identifying specific symptoms, and knowing which steps to take can make a tangible difference in a person’s quality of rest—and overall well-being.
Understanding Thyroid Eye Disease (TED)
Thyroid eye disease—sometimes called thyroid-associated ophthalmopathy or Graves’ ophthalmopathy—is an autoimmune disorder distinguished by inflammation and swelling of ocular tissues, including the muscles, fats, and connective tissues around the eyes.
- TED most frequently accompanies Graves’ disease but may develop with other forms of thyroid dysfunction or even in those whose thyroid hormone levels are normal.
- The hallmark features result from tissue swelling and fibrosis, which can push the eye forward (proptosis), alter eyelid position, and compromise eye movement.
Main Symptoms of Thyroid Eye Disease
- Dry, gritty, or irritated eyes
- Red, inflamed eyes
- Watery eyes
- Puffy or swollen eyelids
- Light sensitivity
- Bulging eyes (proptosis) and lid retraction
- Double vision or blurred vision
- Pain or pressure in or around the eyes
- Trouble fully closing the eyes (in severe cases)
Notably, symptoms often fluctuate and may be worse in one eye than the other. People may cycle between periods of active inflammation and quiescence.
How TED Directly and Indirectly Degrades Sleep Quality
Sleep impairment is a frequent, but under-recognized, problem in TED. Research suggests up to 60% of TED patients experience sleep disturbances.
The reasons are multi-faceted:
- Ocular discomfort and pain: People with TED may constantly feel a foreign body sensation, burning, or dryness, making it hard to get comfortable at night or stay asleep.
- Difficulty closing the eyes: In some cases, particularly when eyelid retraction or proptosis is more pronounced, people cannot entirely close their eyes during sleep. This can cause or worsen dry eye, corneal exposure, and even corneal ulcers.
- Sensitivity to light: Artificial or early-morning light entering the partially closed eyes may contribute to early awakening or poor-quality rest.
- Psychological distress: The visible appearance changes, vision loss risk, and chronic discomfort associated with TED can lead to anxiety and depression. These, in turn, are strongly associated with insomnia.
- Visual impairment: Double vision and blurry vision affect daily functioning and social life, which can fuel anxiety and further disturb sleep.
- Hormonal imbalances: Thyroid dysfunction itself can disturb sleep-wake patterns, especially if the underlying thyroid condition is not well-controlled.
Interacting Mechanisms: TED, Anxiety, and Sleep
What others are reading
Multiple studies have demonstrated that the link between TED and sleep problems is complex and can be bidirectional:
- Anxiety and mood disorders are common in TED and may worsen sleep quality.
- Impaired sleep, in turn, increases stress levels and may further exacerbate mood changes and TED severity.
- Brain imaging shows overlapping neural pathways for sleep regulation and emotion processing. Thus, interventions targeting one may impact the other.
Specific Nighttime and Sleep-Related Symptoms in TED
People living with thyroid eye disease can face several particular challenges during the night that interfere with sleep and next-day function:
- Nocturnal corneal dryness or pain: Failure to close the eyelids can leave the ocular surface exposed, drying out the cornea overnight.
- Eye irritation on waking: People often report burning, excessive tearing, or scratchiness upon waking because of inadequate overnight lubrication.
- Vision blurring in the morning: Temporary morning blurring may occur as the cornea recovers from nighttime dryness.
- Disrupted sleep cycles: Pain, irritation, or anxiety can cause frequent awakenings and reduced deep sleep.
Risks of Not Managing Nighttime Eye Exposure
- Persistent exposure of the cornea can lead to recurrent erosions, infection, chronic pain, and—rarely—permanent vision loss.
- People who experience significant sleep fragmentation may face daytime drowsiness, impaired cognitive function, and worsening mood symptoms.
Why TED-Related Sleep Disruption Happens
To understand, it’s helpful to break down the three key contributors:
| Factor | Examples of Impact |
|---|---|
| Physical Eye Changes | Eyelid retraction, proptosis (bulging), restricted eye movement, and swollen orbital tissues make it hard to close eyes, increase discomfort, and lead to dryness, especially at night. |
| Psychological Effects | Chronic visibility of changed appearance, anxiety about symptoms, and fear of vision loss perpetuate worry and insomnia. |
| Thyroid Hormone Levels | Uncontrolled hyperthyroidism is associated with restlessness, increased metabolism, and disturbed circadian rhythms, all of which can disrupt sleep. |
Who Is Most at Risk for Sleep Problems With TED?
Anyone with TED can develop sleep-related issues, but certain factors increase risk:
- Greater eyelid retraction or bulging: More severe structural changes magnify risk of incomplete eyelid closure and nightly dryness.
- Longer disease duration: Chronic TED may foster anxiety, depression, and sleep disturbance.
- Poorly controlled thyroid dysfunction: High or fluctuating thyroid hormone levels raise the likelihood of sleep and mood disorders.
- Concurrent dry eye syndrome or pre-existing sleep apnea (patients with TED are at higher risk for this condition).
Managing Sleep Problems When You Have Thyroid Eye Disease
Fortunately, several strategies can help alleviate TED-related sleep disturbances. Your approach should be tailored based on your unique symptoms, severity, and overall health. Here are some widely recommended steps:
1. Addressing Ocular Surface Discomfort
- Use lubricating artificial tears during the day to relieve dryness and irritation.
- Apply thicker ointments or gels before sleeping to protect the cornea overnight.
- If incomplete eyelid closure is present, talk to your doctor about moisture chamber goggles or eye patches for nighttime use to minimize evaporation.
2. Elevate Your Head During Sleep
- Sleeping with the head of the bed raised, or using extra pillows, can help reduce swelling around the eyes overnight.
3. Treat the Underlying Thyroid Disorder
- Work closely with your endocrinologist to achieve stable thyroid hormone levels, as both overactive and underactive states can worsen sleep and TED symptoms.
4. Manage Anxiety and Depression
- Consider counseling, support groups, or psychiatric consultation if emotional distress persists.
- Mindfulness practices, relaxation techniques, and cognitive behavioral therapy for insomnia (CBT-I) can significantly improve sleep quality.
5. Medical and Surgical Interventions
- For persistent, severe vision changes or pain, specialized treatments such as steroids, immunosuppressive therapy, or—rarely—surgery may be indicated.
- Your ophthalmologist may recommend eyelid or orbital surgery if corneal protection cannot be achieved by other means.
6. Optimizing Sleep Hygiene
- Keep a consistent bedtime and wake-up schedule, even on weekends.
- Limit caffeine, screen time, and heavy meals in the evening.
- Ensure your sleeping environment is dark and free of distractions. If nocturnal light sensitivity is a problem, consider blackout curtains or an eye mask, provided you can close your eyes fully or protect the eyes with a patch.
When to See Your Doctor
Consult your healthcare provider promptly if:
- You notice persistent or worsening eye discomfort, redness, or dryness—especially if you wake up with significant irritation or vision changes.
- You have difficulty closing your eyes at night or your partner notices your eyes are partially open during sleep.
- You develop double vision, substantial vision loss, or new pain/pressure sensations in or around the eyes.
- Home remedies do not relieve symptoms after several nights.
Frequently Asked Questions (FAQs)
Can thyroid eye disease cause you to sleep with your eyes open?
Yes. Proptosis (eye bulging) and eyelid retraction can keep you from fully closing your eyes, leading to exposure of the cornea during sleep.
What risks are associated with sleeping with partially open eyes?
Corneal dryness, irritation, erosions, ulcers, and—in rare cases—vision loss can occur. Prompt treatment is important to prevent complications.
Can treating my thyroid problem make my sleep better?
Addressing thyroid hormone imbalances often improves sleep quality, but eye symptoms may persist and will likely require separate management strategies.
Are sleep problems in TED only caused by eye discomfort?
No. Anxiety, depression, and stress associated with changes in appearance, pain, or vision loss can independently disrupt sleep patterns.
What should I do if my eyes are very dry or painful at night?
Use thick lubricating ointments, a moisture chamber, or a soft eye patch overnight. Consult your eye doctor if symptoms are severe or don’t improve.
Personal Tips and Lifestyle Approaches
- Stay hydrated and avoid environments with dry air, especially overnight.
- Humidifiers can reduce nighttime dryness in arid climates.
- Practice gentle eyelid massage (after consulting your doctor) to reduce swelling.
- Share your struggles with loved ones—social support helps reduce stress.
Conclusion
Thyroid eye disease affects far more than vision. Its persistent discomfort, appearance changes, and psychological impact create a substantial risk for disturbed sleep. By understanding the causes and employing targeted strategies, people with TED can often improve both their rest and their overall quality of life. Coordinated care among endocrinologists, ophthalmologists, and mental health professionals is key to successful management.
References
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12131440/
- https://preventblindness.org/thyroid-eye-disease/
- https://raymonddouglasmd.com/what-doctors-want-women-over-50-to-know-about-thyroid-eye-disease-symptoms-and-the-link-to-menopause
- https://my.clevelandclinic.org/health/diseases/17558-thyroid-eye-disease
- https://www.umkelloggeye.org/conditions-treatments/thyroid-eye-disease-what-expect
- https://www.aace.com/trending-topics/patient-news/focusing-thyroid-eye-disease-ted-people-living-graves-disease
- https://www.asoprs.org/thyroid-eye-disease
- https://news.cuanschutz.edu/ophthalmology/warning-signs-and-treatment-for-thyroid-eye-disease
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8423342/
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