Healthy Sleep, Healthy Eyes

A global health concern that affects approximately 2 billion people worldwide¹: myopia prevalence continues to rise, particularly among children and adolescents in East and Southeast Asia.² Identifying modifiable risk factors that help control the onset and progression of the condition has become an urgent priority. In this regard, research has provided interesting and new insights into the relationship between sleep patterns and myopia.^3-6 This is emerging as an important area for myopia research.⁷

Sleep plays a crucial role in children’s overall health, serving as a foundation for optimal daily functioning, as well as physical and mental well-being. Insufficient sleep has been linked to various health issues, including childhood obesity and psychosocial challenges.⁸ Its role in myopia, however, is less well understood.  

Recent systematic reviews, collectively analysing data from over 250,000 participants, have explored the relationship between sleep patterns and myopia development.^3-5 While there is much work to be done to fully understand the relation between sleep and myopia, the findings suggest that sleep may be a modifiable risk factor for myopia.

Longer or sufficient nighttime sleep may lower the risk for myopia. A 37% reduction in risk was found with a meta-analysis.⁵ However, this finding remains to be validated with others not finding similar correlation. But importantly, short sleep duration has been more consistently linked to increased myopia risk, with the analysis reporting a 66% higher risk among children with insufficient sleep.⁵

Why might duration of sleep be an important factor? This association may be explained by the disruption of normal circadian rhythms, which play a critical role in regulating eye growth.⁹ Short sleep duration, particularly at night, may interfere with the natural growth and remodelling cycles of the eye, contributing to excessive elongation and myopia development.

In addition to duration, sleep quality has emerged as an important factor. Across studies, poor sleep quality has consistently been associated with higher myopia risk.^3-5 The mechanisms linking sleep quality and myopia may involve disruptions to circadian rhythms and alterations in dopamine signalling, both of which are known to influence eye development.^9,10

While the relationship between sleep timing and pattern and myopia is more complex and therefore less consistent than those of sleep duration and quality, emerging evidence suggests important connections. Later bedtimes have been associated with increased risk of myopia onset and progression in school-aged children.¹¹ The mechanism may involve disruption of circadian rhythms that regulate eye growth patterns. Recent research has revealed that myopic individuals demonstrate delayed circadian timing compared to non-myopes,¹² suggesting fundamental differences in their biological rhythms. This timing effect extends to physical eye changes: study found associations between late bedtimes and reduced diurnal variations in axial length, with delays in bedtime correlating with axial length increases.¹³

Sleep patterns and consistency also play crucial roles. Greater variability in sleep-wake schedules, particularly between weekdays and weekends, has been associated with myopia in children.¹⁴ This "social jetlag" effect may again disrupt the natural rhythms of eye growth and recovery, as normal eyes typically demonstrate consistent patterns of growth during the day and shrinkage at night. The evidence suggests that both timing and regularity of sleep may be important factors in eye development and myopia risk, highlighting the need for consistent sleep schedules aligned with natural circadian rhythms.

Several biological mechanisms may explain the connection between sleep and myopia:

The relationship between sleep and myopia offers an opportunity for addressing the global myopia epidemic. Sufficient sleep duration is consistently associated with reduced myopia risk, while poor sleep quality, late timing, and irregular sleep patterns appear to increase risk, particularly in children and adolescents. These findings underscore the potential of incorporating sleep health into comprehensive myopia prevention strategies.

Promoting sleep health represents a low-risk, cost-effective approach that complements existing prevention methods. This is especially relevant in East and Southeast Asian countries, where myopia prevalence is highest, and academic pressures often interfere with healthy sleep patterns. Although further research is required to fully understand the interactions between sleep and eye development, current evidence supports the integration of sleep health education into myopia prevention programs. Targeting the critical developmental years, this practical, evidence-based strategy could significantly contribute to curbing the myopia epidemic while simultaneously improving overall health and well-being.

Eye care professionals should include sleep-related factors in patient history-taking and educational efforts. Spending more time outdoors during the day—already a key recommendation for myopia prevention—can also improve sleep quality and circadian rhythm regulation,²⁰ further reducing myopia risk.

By integrating sleep health education into myopia prevention strategies, we can address the growing burden of myopia more comprehensively. This holistic approach not only targets myopia prevention but also supports broader public health goals, promoting better sleep habits for improved overall well-being.