SLEEP APNEA AND EYE PROBLEMS
The causes of red eyes can often be a mystery. Patients have reported dry eye problems induced by CPAP machines. Obstructive Sleep Apnea Disorder causes interruption of breathing at night in short repeated intervals. The resulting low levels of blood oxygen saturation cause daytime sleepiness and fatigue. It is often accompanied by very loud snoring and the affected person may awake with “air starvation” several times in a night. Sleep Apnea can result in serious health problems and mortality if untreated over time. Continuous Positive Airway Pressure, or CPAP, is used as the standard of care treatment. A CPAP keeps the upper airway open by providing a constant flow of air delivered through a face mask or “nasal pillows worn while sleeping. Compliance is frequently reported to be low with CPAP machine due to various problems. Resolving these issues is critical to your well being and continued use of a CPAP machine.
RED AND SWOLLEN EYES ARE COMMON WITH SLEEP APNEA
Sleep apnea and eye problems reported with CPAP therapy include dry eyes, red eyes, swollen eyes (skin around the eyes), and redness of the eyelids and face around the eyes. Any of these symptoms should be discussed with your Doctor who prescribed CPAP therapy and if needed you can request further help from your Optometrist.
You may be inclined to believe the origin of your dry eye, eye inflammation, pinkeye appearance, or swollen eye is caused by an allergy to the mask. Most masks today are latex free and made of silicone polymers. The incidence of true silicone allergy is almost negligible. Eye symptoms may be caused by a number of factors.
TREATMENT OF SLEEP APNEA AND EYE PROBLEMS
– A mask may be too tight exerting pressure on your face
– A mask may be too loose causing air to flow across your eye at night causing a dry eye and simulate Dry Eye Syndrome. The primary difference is CPAP induced dry eye will be worse upon awakening and improve as the day progresses while Dry Eye Syndrome usually worsens as the day progresses.
– A worn or defective mask may leak.
– Worn nasal pillows could start to blow air towards the eyes.
– It is postulated the air pressure could induce dry eye by forcing air though the tear puncta openings. Punctal plug occlusion by an Eye Doctor can be tried with temporary collagen punctual plugs to rule out this possibility.
– Occasionally an individual will have dry eyes already or sleep with partially opened eyes which will make leaky masks more symptomatic. Treating the primary Dry Eye Syndrome is essential in this case and should be done in consultation with your Eye Doctor. Sleep apnea patients also have an increased frequency of floppy eyelid syndrome. Floppy eyelid syndrome is a lax upper eyelid that everts or flips inside out easily. Patients with untreated sleep apnea often sleep on their side face down on a pillow in an unconscious effort to keep their airway open. Due to a loose eyelid the lid flips up exposing the conjunctival tissue lining the inside which can become chronically inflamed with papillary conjunctivitis. Treatment of the sleep apnea will help resolve the problem in conjunction with treatment of dry eye syndrome.
– Some people may be more sensitive to the pressure of the mask under the eyelids on a repetitive basis and could benefit by using different shaped masks on subsequent nights. The fit of a mask is so important this may not be an option and your Doctor may need to use prescription ointments (usually after removing the mask).
– Supplemental treatment by your Eye Doctor may be needed for the Eye dryness, artificial tears such as Thera Tears, some prescription eye drops.
– Your Optometrist may also prescribe eye treatment for the mask induced red eye conjunctivitis with eye medications like Patanol.
One recent finding by eye researchers in Denmark is an association between decreased blue light exposure and sleep disorders. As the lens inside the eye ages it becomes more yellow and transmits less blue light. Blue light is present during daylight hours and enhances melatonin release by the pineal gland in the brain. Melatonin is important in regulating the sleep cycle. Sleep seems to improve after cataract surgery. While it is too soon to draw any conclusions about sleep apnea with the current research, it is possible that cataract surgery could someday be considered helpful in lessening symptoms.
Discuss your problems with your Doctor. Simple measures may be all you need. Readjustment of the mask straps, replacement of a mask, or changing the mask type could completely resolve your eye symptoms. If you can’t resolve your problems after your visit an eye exam with your Optometrist should be the next step. Untreated sleep apnea also appears to be highly correlated with glaucoma that occurs with normal intraocular eye pressures.
OTHER EYE PROBLEMS SEEN WITH SLEEP APNEA IN THE OPTOMETRIST OFFICE
Glaucoma is about 4 times more common with sleep apnea. It is typically harder to diagnose and treat as it may occur with normal eye pressures, at least during the day when we typically take readings. The alterations in oxygen and the inflammatory compounds created by the episodes of apnea contribute to degenerative changes in the optic nerve. There is much thought today that glaucoma, especially this type of glaucoma, is a degenerative disease of the nervous system much like Alzheimer’s disease (though not associated with it). CPAP therapy may actually increase the eye pressure at night which also increase the risk for glaucoma. It may be necessary to lower the eye pressure at night with prescription eye drops, even if the readings are normal during the day.
Anterior ischemic optic neuropathy is a condition where the optic nerve supplying the eye has its blood supply transiently interrupted resulting in loss of sight. About three fourths of the people suffering the formed referred to as non arteritic anterior ischemic optic neuropathy have sleep apnea.
Papilledema is swelling of the area around the optic nerve where it enters inside the eye. Papilledema is the result of increased pressure in the brain, frequently from brain tumors. When papilledema caused by obstructive sleep apnea is treated with a CPAP, it resolves with a return to normal vision.
There may be an association between untreated sleep apnea and retinal vein occlusion. In one study about half of the patients experiencing a retinal vein occlusion reported snoring and daytime sleepiness prior to the occlusion. Retinal vein occlusion are a common cause of blindness.
Dr. David Kisling
Fort Collins, Co
Here at Harmony Eyecare we know you have many choices when it comes Eyecare and Eye Doctors in Fort Collins. We feel you will find your experience with us surpassed by none. Our staff is knowledgeable, friendly and truly enjoy what they do. We work as you Eye Care Center Team to develop a friendly, patient-oriented vision care and contact lens office. We are committed to delivering uncompromising personal service while utilizing state of the art technology. Our patients are the reason we are here and we want your experience with us to be a good one. Our optical assistants will explain every step of your eye exam experience and also assist you with the choice of your eyeglasses. Going to the optometrist should be a positive and relaxing experience
I would like to personally welcome you to our Optometry Practice, located in the Bank of the West Building at 181 W Boardwalk, Ste 201, Fort Collins, CO 80525. We are centrally located for your convenience in Fort Collins, also serving residents of Loveland, LaPorte, Wellington, Windsor, Timnath,Co. and surrounding areas of Larimer County. We strive to develop a relationship where you feel free to contact me or my staff with any questions or concerns about your vision. We look forward to serving as your Family Eye Doctor in Fort Collins. Dr. Kisling graduated with Summa Cum Laude honors from the University of Houston. He has been an Eye Doctor helping Fort Collins residents see better with vision care including eye exams, eyeglasses, contact lenses, glaucoma treatment, dry eye treatment and LASIK Surgery Consultations, since 1985