Herbie Murray
Sleep is critical for overall health and wellbeing, so it is understandable that glaucoma patients often ask about the impact of poor sleep on their condition. Research has indicated that sleep problems may worsen glaucoma, and untreated sleep apnea may even lead to vision loss from glaucoma. Many over-the-counter sleep medications carry warnings for glaucoma patients, and certain prescription sleep aids may also be unsuitable. This article will explore the relationship between glaucoma and sleep, including the safety of specific sleeping tablets for people with glaucoma.
| Characteristics | Values |
|---|---|
| Sleeping tablets that may increase the risk of glaucoma | Zolpidem |
| Sleeping tablets that are not recommended for people with glaucoma | Doxepin (Silenor), Ramelteon (Rozerem) |
| Safe sleeping tablets for people with pigment-dispersion syndrome | Most over-the-counter medications |
| Other treatments for insomnia | Estazolam (Prosom), Eszopiclone (Lunesta), Triazolam (Halcion) |
| Risk factors | Prolonged sleep-onset latency, sleep apnea, sleeping 10 or more hours per night |
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What You'll Learn
Zolpidem may increase glaucoma risk
While a good night's sleep is critical for healthy well-being, it is essential to understand the relationship between sleep and glaucoma. Glaucoma patients often ask how poor or inadequate sleep affects their condition. Sleep time and duration influence several endocrine, metabolic, and neurological functions critical for maintaining health. Research has shown that sleep problems may worsen glaucoma, and untreated sleep disorders can lead to vision loss from glaucoma.
In a Taiwanese population-based case-control study, researchers investigated the association between the use of zolpidem and the risk of developing glaucoma. The study found a positive correlation between zolpidem dosage and glaucoma risk, suggesting that zolpidem use may increase the likelihood of subsequent glaucoma. However, it is important to note that the study had some limitations, including the accuracy of diagnoses and the lack of data on potential confounding factors such as socioeconomic status and family history.
Zolpidem is a medication commonly prescribed for insomnia and other sleep disorders. It belongs to a class of drugs called sedative-hypnotics, which act on the brain to induce sleep. While zolpidem can be effective in treating sleep problems, its potential impact on glaucoma risk is a concern. The study's findings indicate that zolpidem may contribute to an increased risk of glaucoma, particularly with higher dosages.
It is worth noting that the relationship between zolpidem use and glaucoma risk is complex and not yet fully understood. While the Taiwanese study suggests a link, further confirmatory studies are recommended to clarify the nature of this association. Additionally, the study focused on a Taiwanese population, and different ethnic groups may yield varying findings. As a result, healthcare professionals and patients should carefully consider the benefits and risks of using zolpidem, especially for those with glaucoma or at risk of developing the condition.
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Doxepin (Silenor) is not recommended for glaucoma patients
Doxepin, available as Silenor and generic doxepin, is a tricyclic antidepressant (TCA) that works on the central nervous system (CNS) to increase levels of certain chemicals in the brain. It is used to treat major depressive disorder (MDD) and anxiety disorders, and is also beneficial for treating insomnia.
Doxepin is not recommended for glaucoma patients as it may increase pressure inside the eye and cause or worsen narrow-angle glaucoma, which can lead to blindness. Glaucoma patients with untreated glaucoma and a history of urinary retention should also avoid using doxepin cream. Furthermore, doxepin may cause a rare, dangerous heart rhythm problem called QT prolongation and torsade de pointes. Elderly patients taking doxepin are more likely to experience unusual drowsiness, which may be detrimental. Doxepin may also cause sleep-related behaviours such as driving, walking, having sex, making phone calls, or preparing and eating food while asleep or not fully awake.
It is imperative that patients consult their healthcare provider and disclose their medical history and current medications before taking doxepin or any other medication.
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Estazolam (Prosom) for insomnia
Estazolam, sold under the brand name Prosom, is a tranquilizer medication of the triazolobenzodiazepine (TBZD) class. It is a benzodiazepine medication with anxiolytic, anticonvulsant, hypnotic, sedative, and skeletal muscle relaxant properties. It is used for the short-term treatment of insomnia and is not a first-choice treatment option for sleep troubles. It is meant to be taken orally right before bed and is available only as a generic drug.
Estazolam is effective in increasing sleep time and reducing awakenings at night. It is also used as a preoperative sleep aid. It is important to note that estazolam has a high potential for misuse, abuse, addiction, and dependence, even with prescribed doses, and can lead to fatal overdose. It should be used with extreme caution, and in case of overdose, immediate medical help should be sought. Alcohol should be avoided when taking estazolam as it enhances the sedative hypnotic properties of the drug.
Estazolam should only be used short-term and at the lowest effective dose to avoid complications related to long-term use. Common side effects of estazolam include drowsiness, diminished body movement, dizziness, abnormal coordination, nervousness, headaches, weakness, and hangover. It is important to consult a doctor before starting or stopping the medication to ensure proper usage and avoid withdrawal symptoms.
Estazolam is not recommended for pregnant or breastfeeding women as it can cause fetal harm and withdrawal symptoms in newborns. It is also important to note that estazolam may not be safe for use for more than four months, and there is a lack of clarity on its effectiveness beyond this duration.
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Triazolam (Halcion) for insomnia
Triazolam, sold under the brand name Halcion®, is a medication used to treat insomnia. Insomnia is a sleep problem characterised by difficulty falling and staying asleep, and/or getting enough restful sleep. Triazolam is a benzodiazepine that produces a calming effect on the brain and nerves, helping individuals fall asleep faster and stay asleep through the night.
Triazolam is typically prescribed for short-term use and should not be taken for longer than 10 consecutive nights without medical advice. It is important to consult a healthcare provider before taking triazolam to discuss any health conditions, medications, vitamins, minerals, herbal products, and supplements currently in use. This is especially important for those with mental health problems, particularly depression, thoughts of suicide or dying, or a history of suicide attempts.
Triazolam can cause several side effects, including drowsiness and dizziness, which may last longer in older adults. In rare cases, triazolam may cause severe allergic reactions, suicidal thoughts or actions, and physical dependence. Misuse of triazolam, including taking it without a prescription or in a manner other than prescribed, can lead to serious side effects like overdose, coma, or death. Additionally, taking triazolam with opioid medications or alcohol can slow or stop breathing, leading to severe drowsiness, breathing problems, coma, or death.
It is important to store triazolam at room temperature, between 68°F and 77°F (20°C to 25°C), and to avoid activities that require alertness or coordination until understanding how the medication affects you. If any concerning side effects occur, individuals should seek medical advice and/or contact their healthcare provider.
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Sleeping position and glaucoma
Glaucoma is caused by a constant increase in intraocular pressure (IOP) in the eye. IOP is known to rise when the body is in a horizontal position, and this effect is exacerbated in glaucoma patients. Studies have found that the eye with worse visual field damage from glaucoma is often the eye that the patient sleeps on. This correlation is not fully understood, but it is suspected that it relates to blood flow changes within the eye.
There is also a link between glaucoma and sleep duration. Glaucoma was found to be three times more prevalent in participants who slept for 10 or more hours per night than those who slept for seven hours. People with glaucoma were also more likely to experience excessive daytime sleepiness and take longer to fall asleep.
While sleeping position is not the sole cause of worsening glaucoma, it is recommended that glaucoma patients take steps to reduce IOP while sleeping. Doctors often advise glaucoma patients to sleep in an upright position, with their head raised above their heart. It is believed that an elevation of 30 degrees or more could help reduce IOP. This can be achieved through the use of a 15-degree wedge pillow or by adjusting the angle of the bed.
Additionally, wearing protective glasses that sit on the orbital rim has been shown to prevent IOP elevation, even when lying horizontally. Turning the head into the pillow on the side of the affected eye has been shown to increase IOP, so this position should be avoided.
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Frequently asked questions
It is important to consult a doctor to help resolve any sleep issues. Many over-the-counter medications have warnings for patients with glaucoma, and they can shallow the front chamber of the eye in patients with narrow-angle glaucoma. However, patients with pigment-dispersion syndrome can safely take most over-the-counter medications.
Doxepin, sold under the brand name Silenor, is not recommended for people with glaucoma. Zolpidem may also increase the risk of glaucoma, although further studies are needed to confirm this.
Eszopiclone (Lunesta) and Ramelteon (Rozerem) are generally safe, but they carry a risk of misuse and dependency.
