Relationship Between Sleep Position and Glaucoma Progression

Kevin Kaplowitz; Justin Dredge; Robert Honkanen


Curr Opin Ophthalmol. 2019;30(6):484-490. 

In This Article

Abstract and Introduction


Purpose of review: As humans spend a considerable portion of life in the horizontal position, it is vital to better understand the effect of sleep position on glaucoma.

Recent findings: The mean positional increase from the supine position to the lateral decubitus position (LDP) in recent literature is less than 2 mmHg for each eye in its dependent position and less than 1 mmHg in the nondependent position. The right LDP is most commonly favored sleeping position. Some evidence suggests that the positional increases persist and so could lead to worse glaucomatous progression in the dependent eye. However, multiple studies failed to find a strong association. Ideally future research will identify risk factors for higher positional increases to identify patients who may benefit from a change in sleep position. To date, medications and argon laser trabeculoplasty have been ineffective in blunting the positional increase, although glaucoma surgery does reduce it. Raising the head of the bed has been linked with blunting the increase as well.

Summary: Certain sleeping positions appear to be associated with higher intraocular pressure, although the association between sleep position and glaucoma progression is not as clear.


Given that roughly one-third of our lives are spent sleeping,[1] investigating the relationship between sleep position and glaucoma is a promising area of recent research. Studies have focused on risk factors for the development and progression of glaucoma, such as the nocturnal rise in intraocular pressure (IOP) and IOP fluctuations in relation to body position. The main study outcomes include measuring both immediate changes in IOP as well as comparing sleep position to glaucomatous nerve damage.

This review will focus on the association between sleep position and glaucoma progression. The diurnal variation in IOP has already been reviewed and is receiving more attention with novel options for continuous IOP monitoring so that sleep is not disturbed by measurements.[2] The two topics with the most data are immediate IOP changes associated with different sleep positions, and glaucoma progression among groups with different sleep positions.