A habit as banal as the height of your pillow could affect the development of glaucoma. Recent work suggests that the way the head rests at night influences pressure inside the eye, a key parameter in this silent, sight-threatening disease.
Glaucoma and pillow: why head position matters at night
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glaucoma is an eye condition characterized by progressive deterioration of the optic nerve, influenced by various elements. The most common factor is ocular hypertension, which is excessive pressure inside the eye. This disease is the second leading cause of blindness in industrialized countries. Currently, although treatments exist to slow its progression, they cannot restore vision once the disease is advanced.
Intraocular pressure follows a 24-hour rhythm and often peaks at night, especially when lying down. Work has shown that lying the body on its back, side or stomach modifies this pressure by a few millimeters of mercury. For a long time, some ophthalmologists recommended sleeping with your head a little higher, thinking of reducing pressure in the eye.
A team in China followed 144 patients, comparing a flat lying position to a position with the head raised by 20 to 35° by two conventional pillows. Unexpected result: two cushions seem to slightly increase eye pressure, which raises the question of the best way to sleep when you have glaucoma.
An increase in intraocular pressure with two pillows
Between October 2023 and April 2024, researchers measured the pressure in one eye every two hours in 144 adults with glaucoma, sitting during the day and lying down at night. At each nocturnal measurement, intraocular pressure (IOP) was first taken lying flat, then ten minutes after elevating the head by 20 to 35° with two pillows, before the patients lay flat again.
In this cohort, 96 out of 144 patients, or approximately 67%, experienced an increase in IOP when moving from the flat to two-pillow position, with an average increase of 1.61 mmHg. The ocular perfusion pressure decreased in parallel, while the pressure variations over 24 hours became greater. The authors conclude their study by stating that: “Patients with glaucoma may therefore benefit from avoiding sleep postures that induce jugular venous compression to attenuate postural elevation of intraocular pressure. Such behavioral adjustments represent a simple but potentially effective strategy to optimize long-term management of intraocular pressure in clinical practice.“.
Sleeping without a pillow: an option to consider, without replacing treatment
To explain these results, the team suggests that two pillows flex the neck and compress the jugular veins, which hinders venous return of aqueous humor and can raise IOP. The study remains observational and does not define an ideal position.
Before changing the way you sleep without a pillow or with, it is advisable to discuss it with your ophthalmologist, who will take into account the type of glaucoma and comfort.