Can I wear contacts while I sleep?

Sleeping, napping, or wearing contact lenses for longer than recommended by your optometrist can dramatically increase the risk of serious complications.

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Can I wear contacts while I sleep? Optometrist
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Wearing contact lenses while sleeping or longer than instructed, has been shown in multiple studies to increase risks of complications. While there are lenses approved for extended or night time wear, always follow the specific instructions of your optometrists and stop use and schedule an appointment if you are experiencing any discomfort or complications.  If you are reading this because you accidentally wore your lenses for the night, take your contact lenses out for a few hours before wearing them again. An isolated event will usually be nothing to worry about, however if you experience any symptoms at all, then schedule an appointment with an optometrist.

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What Can Happen If I Sleep In Contact Lenses?

Sleeping in contact lenses can dramatically increase the risk of serious complications such as: 

  • Keratitis-inflammation of the cornea which can result from reduced oxygen, allergies, infections, scratches, and irritation
  • Bacterial Keratitis (a bacterial eye Infection of the cornea) -Sleeping in contact lenses can change the tear film composition or cause minor trauma, which creates a more conducive environment for bacteria adhesion.  
  • Hypoxia-lack of oxygen 
  • Corneal Edema-swelling of the cornea  
  • Corneal Vascularization-new blood cells in the cornea due to the lack of oxygen
  • Red eyes-usually due to the lack of oxygen that reaches the eye, other potential causes include allergies, scratched eye, and infection
  • Corneal ulcers- a painful sore on the cornea
  • Scratched eye (corneal abrasion) or a feeling of sand in the eye (foreign body) 
  • Giant papillary conjunctivitis (GPC)-inflammation of the conjunctiva, which is the clear membrane covering the white part of the eye (sclera) and the inner surface of the eyelids, that can cause itching, redness, pain, blurred vision, or discharge. 
  • Other eye infections- sleeping in contact lenses increases the risks of other, more serious forms of eye infection such as fungal keratitis and acanthamoeba keratitis.
What to Do If You Accidentally Sleep in Your Contacts?

What to Do If You Accidentally Sleep in Your Contacts?

Accidentally falling asleep with your contact lenses is a situation many lens wearers find themselves in at some point. While it's not ideal, knowing what steps to take can minimize risks and discomfort.

Upon Waking Up

Don't Panic: First and foremost, don't panic. The chances of causing significant harm to your eyes from a single instance are relatively low but not non-existent.

Assess Your Eyes: Do your eyes feel dry, irritated, or painful? Check for any redness or discharge. If you have symptoms, especially if they persist, call an optometrist to get specific recommendations or to schedule an eye exam. 

Use Rewetting Drops: If your eyes feel dry or you experience discomfort, use sterile rewetting drops or saline to lubricate your eyes before attempting to remove the lenses.

Remove Contacts Carefully: After applying the rewetting drops, gently remove your contact lenses. Avoid pinching or tugging, which could cause further irritation or even scratch your cornea.

Don’t Wear Contact Lenses Right Away: After a night sleeping with contact lenses it is important to give your eyes a break to get oxygen, if you are able to wait the amount of time that you slept that is 

Do Not Reuse The Same Contacts Before Cleaning: To minimize risk of infection, avoid reusing the same contacts that you slept in until they have been properly disinfected and cleaned according to the directions given to you by your optometrist.

Persistent Discomfort: If you experience ongoing discomfort, increased sensitivity to light, or any changes in vision, consult an eye care provider immediately for an evaluation.

Consider Other Lenses: If you find yourself in this situation often, schedule a contact lens exam with an optometrist to discuss lenses such as extended wear lenses or ortho k lenses to reduce the risks of sleeping in your contact lenses.

Can I at Least Nap While Wearing Contacts?

Napping while wearing your contact lenses is a question that many wearers often ponder. While a short nap may not pose as high a risk as a full night's sleep, there are still some concerns you should be aware of.

Reduced Risk but Not Risk-Free

A brief nap of 20-30 minutes is generally considered to be less risky than an extended period of sleep. However, the same basic problems still apply, albeit to a lesser extent.

Types of Contacts Matter

If you're wearing daily disposable lenses or lenses made from silicone hydrogel (which allows more oxygen to pass through), the risk associated with a short nap may be lower. Still, it's not entirely risk-free and is not recommended. 

Precautions to Take

  • Limit Nap Time: If you must nap in your contacts, try to keep it brief to minimize potential issues.
  • Switch to glasses: For those who find themselves needing to nap regularly or for extended periods, it's advisable to switch to glasses before napping to eliminate any risks associated with contact lens wear during sleep.
Contact Lenses Approved for Overnight Wear

Contact Lenses Approved for Overnight Wear

While it's generally advised to avoid sleeping in your contact lenses, there are certain types of lenses that have been approved by the FDA for extended or overnight wear. However, even these come with their own sets of risks and guidelines.

Contacts that Can be Worn Overnight

There are three categories of lenses that can be worn while sleeping: 

  • Ortho K or CRT night time lenses 
  • Extended wear or continuous wear lenses
  • Bandage contact lenses or lenses used post surgery 

Ortho K or CRT Lenses

Ortho-K or CRT lenses, are specially designed contact lenses which are worn only while sleeping. These lenses gently reshape the cornea at night leaving the patient with great vision the following day without the need to wear glasses or contact lenses. Ortho K or Orthokeratology lenses (ortho k for short) are extremely effective at slowing down the increase in prescription for children, teens and young adults with myopia (nearsightedness). While the benefits of wearing ortho k for myopia management greatly outweigh the risks associated with night time wear, it is extremely important to closely follow your eye doctor's instructions and let your doctor know right away if you experience any symptoms. 

Ortho k lenses are also prescribed for adults who are looking for a non-surgical alternative to LASIK. Many people find great benefit from these lenses, some examples include athletes, military personnel, and people who do not want to wear glasses or contacts but do not want surgery.

Extended Wear and Continuous Wear Contact Lenses

These lenses are made from materials that are more permeable to oxygen, allowing for a greater amount of oxygen to reach the cornea during sleep. 

Extended wear or continuous wear contact lenses each have specific guidelines on how long they can be worn for, always follow the instructions of the manufacturer and your optometrist's instructions. These lenses are typically soft and made from materials that allow for a lot of oxygen to reach the cornea. There are also a small number of rigid gas permeable lenses specifically created and approved for overnight use.

Important recommendations about extended wear contact lenses

-The FDA recommends that overnight wear soft hydrogel lenses be removed and not worn overnight at least once a week for overnight cleaning and disinfection.

-Extended wear and continuous wear contact lenses increase the risk of infection

-Due to additional risks associated with wearing contact lenses while sleeping, it is extremely important to ensure that you follow instructions for storing, cleaning, replacing, and length of wear. 

-If you experience any symptoms, even seemingly small symptoms such as red eyes, see your eye doctor promptly to prevent complications.Some brands of extended wear lenses are approved for continuous wear for up to 30 nights. However, it is crucial to have regular check-ups with your eye care provider to ensure that your eyes are responding well to the lenses.

Contact lens materials and designs are continuously changing and deciding on the right lens to use and the amount of time that it is safe to use as extended wear should always be discussed with an eye doctor. 

Here are some examples of lenses that may be appropriate for overnight use after speaking with an eye doctor (note that guidelines for extended use may change, the following is not intended to replace recommendations by your eye doctor or the manufacturer): 

  • Acuvue Oasys-Up to 6 nights as recommended by our eye doctor 
  • Air Optix Night and Day Aqua-for daily wear and up to 30 nights of continuous wear
  • Biofinity Monthly Wear Lenses-Up to 7 nights of continuous wear
  • Biofinity Toric-Up to 7 nights of continuous wear
  • AIR OPTIX for Astigmatism-Up to 24 hours 
  • Bausch + Lomb PureVision-Up to 30 days of continuous wear
  • Bausch + Lomb ULTRA-Up to 7 nights of continuous wear
  • PureVision 2 HD-Up to 30 days of continuous wear
  • Biomedics 38-Up to 7 nights of continuous wear with approval from your eye doctor

Despite these options, it's important to note that wearing contact lenses overnight will always carry some level of risk, including infection and other complications.

Bandage Contact lenses

Overnight contact lenses, also known as extended wear contact lenses, may be prescribed by our eye doctor for specific medical reasons. One of these reasons is to treat corneal abrasions or scratches. In such cases, we may recommend the use of a bandage contact lens that is left in the eye overnight. The purpose of the bandage lens is to protect the cornea from further irritation or damage caused by blinking or rubbing the eye. The lens acts as a barrier, allowing the cornea to heal naturally and reducing the risk of infection.

Another reason why overnight contact lenses may be prescribed is after certain eye surgeries, such as PRK or LASIK. These procedures can cause dryness and irritation in the eyes, making it uncomfortable for patients to wear traditional contact lenses during the healing process. Extended wear contact lenses may be prescribed to help with the discomfort and to promote the healing process by providing a moist environment and reducing friction on the cornea.

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The contact lens materials for preventing complications cannot be overstated

The contact lens materials for preventing complications cannot be overstated

One of the major causes of complications from wearing contact lenses at night is the lack of oxygen that your eyes need, this in turn can lead to a variety of symptoms and in more extreme cases permanent vision loss.

A comprehensive meta analysis of studies examining the risk of corneal edema from contact lens use during the day, while napping, and while sleeping showed that the risks are greatest in low oxygen permeability contact lenses. For example, for someone that sleeps one day a week in low oxygen permeable lenses, the edema load was double.  However there was little difference shown with contact lenses that have high oxygen permeability.

With regards to symptoms of redness from sleeping in contact lenses, multiple studies, which are summarized in more detail below, show that contact lenses worn overnight which are made from materials that allow for high levels of oxygen to reach the eye, limit or prevent the symptom of redness in the white part or sclera of the eye.

In summary, while it is always best to not sleep in contact lenses unless directed to do so by your optometrist, if you find yourself sleeping in contacts, then speak with an eye doctor about contact lenses that will lower your risk of complications.

Why You Shouldn't Sleep With Contacts In?

Sleeping with your contact lenses in place might seem like a convenient option, especially after a long, tiring day. However, it's important to understand that this practice comes with considerable risks to your eye health.

Bacterial Keratitis

Bacterial keratitis is an eye infection that affects the cornea and can result in vision loss if not promptly treated. When you sleep with your contacts in, the reduced oxygen supply and tear exchange create a favorable environment for bacteria to grow.

Acanthamoeba Keratitis

This is a relatively rare but extremely severe infection caused by a microscopic, free-living amoeba commonly found in water. If you sleep in your contacts and expose them to tap water, either by swimming, showering, or rinsing them, you are at a higher risk of this infection. The association between Acanthamoeba keratitis and contact lens wear is firmly established. Contact lenses have a great impact on corneal epithelium integrity. This, added to the greater affinity of Acanthamoeba to adhere to either corneal or lens surfaces, increases the risk of keratitis in contact lens wearers. Acanthamoeba keratitis is known for being difficult to diagnose and treat, and it can result in permanent vision loss or the need for a corneal transplant.

Fungal Keratitis

Fungal keratitis is less common than bacterial keratitis but can be more severe. The risk factors are similar—reduced oxygen supply and lack of tear exchange. Fungi thrive in warm, moist environments, making a contact lens a potential breeding ground if worn overnight. Treatment for fungal keratitis is more complicated than for bacterial infections, often requiring antifungal medications and, in extreme cases, surgical intervention

What to Do If You Accidentally Sleep in Your Contacts?
Contact Lenses Approved for Overnight Wear

Hypoxia-Making sure your eyes get enough oxygen

If you sleep with your contact lenses you might also experience something called hypoxia, which is when your eyes lack oxygen, causing them to swell and begin to grow new blood vessels, which can really affect your vision. In general, our eyes obtain oxygen from the air around us. However, when we put a contact lens over our eye, the amount of oxygen that can get into the eye is reduced. Therefore, it is extremely important to use a contact lens that has a high oxygen permeability. This is also why it is extremely important that you get a contact lens exam before purchasing contact lenses. Because that exam will make sure that your eye doctor is giving you contact lenses that are fitting properly on your eyes. A good fit means that the contact lens is not too tight, and that you have the right type of lens, meaning you have a lens that allows for a lot of oxygen permeability, which will reduce problems of this sort. Sleeping with contact lenses in your eye may cause your eyes to swell the next morning and cause hazy vision. It is therefore important to remove your contact lenses before going to bed.
Even if you are following these instructions, it is recommended that you allow for some time during the evening or one day per week when you wear glasses instead of contact lenses. This allows for your eyes to get more oxygen, further reducing your risk of hypoxia. 

Ocular hypoxia in the eye can lead to symptoms such as: 

  • Blurry Vision: A common symptom of ocular hypoxia is blurry or distorted vision. The reduced oxygen supply can affect the eye's ability to focus properly.
  • Eye Discomfort: Some individuals may experience eye discomfort, a gritty sensation, or dryness due to hypoxia.
  • Photophobia: Increased sensitivity to light, known as photophobia, can occur as a result of ocular hypoxia.
  • Redness: Ocular hypoxia can sometimes lead to red or bloodshot eyes.

Ocular hypoxia can lead to more significant long term damage such as: 

  • Cell Damage: Prolonged or severe hypoxia can damage the cells in the eye, including the cornea and retina. This can lead to impaired vision or even permanent vision loss.
  • Corneal Edema: Hypoxia can cause the cornea to swell, resulting in corneal edema. This can blur vision and cause discomfort.
  • Retinal Ischemia: In severe cases, hypoxia can affect the retina, potentially leading to retinal ischemia, a condition where the retina doesn't receive enough oxygen. This is a serious issue that can cause vision loss.
  • Corneal Vascularization: Ocular hypoxia can trigger the growth of abnormal blood vessels into the cornea, known as corneal vascularization. This condition can obstruct light transmission through the cornea and lead to visual impairment.
  • Macular Edema: In severe cases of ocular hypoxia, the macula, the central part of the retina responsible for detailed vision, can develop edema (swelling). This can lead to a condition called macular edema, which can significantly impair central vision.
  • Optic Nerve Damage: Chronic or severe ocular hypoxia can harm the optic nerve, which carries visual information from the eye to the brain. Optic nerve damage can result in irreversible vision loss.

Corneal Vascularization

Corneal vascularization is the growth of new blood vessels into the transparent cornea of the eye, which is normally avascular. One study showed an increase of 24% risk for corneal vascularization from extended wear of contact lenses.  Corneal vascularization can lead to vision impairment due to the obstruction of light transmission through the cornea. It can also lead to corneal edema, or swelling of the cornea

Corneal vascularization can lead to symptoms such as: 

  • Redness: One of the most noticeable symptoms is the appearance of red or bloodshot eyes. This redness is due to the presence of new blood vessels in the normally clear cornea.
  • Blurry Vision: Corneal vascularization can disrupt the normal transparency of the cornea, leading to blurry or hazy vision.
  • Discomfort: Some individuals may experience eye discomfort or a foreign body sensation due to the presence of these abnormal blood vessels.
  • Sensitivity to Light: Increased sensitivity to light (photophobia) can occur as a result of corneal vascularization.

Corneal vascularization can lead to more significant long term damage such as: 

  • Visual Impairment: When new blood vessels grow into the cornea, they can obstruct light transmission, leading to visual impairment.
  • Corneal Scarring: In severe cases, corneal vascularization can cause corneal scarring. This scarring can further impact vision quality and is often more challenging to treat.

Corneal Edema

If you imagine your cornea, the clear front part of your eyes as a delicate balloon filled with water, then corneal edema is when that balloon swells in size. This can be caused by corneal vascularization, when your eyes create new blood vessels due to stress, which then causes swelling. It can also be caused by hypoxia, or lack of oxygen, which in turn may stress the eye and prevent the corneal endothelium, responsible for pumping excess water out of the cornea, to stop working properly. When it becomes less efficient in removing water, this in turn causes fluid to accumulate within the cornea.

Corneal edema can lead to symptoms such as: 

  • Blurry Vision: One of the most common symptoms of corneal edema is blurry vision. The swelling of the cornea disrupts its clarity, leading to visual distortion.
  • Halos and Glare: Some people with corneal edema may experience halos or glare, especially when looking at bright lights at night.
  • Eye Discomfort: Corneal edema can cause eye discomfort, including a feeling of fullness or pressure in the eye.
  • Sensitivity to Light: Increased sensitivity to light (photophobia) can occur due to corneal edema.
  • Eye Redness: In some cases, there may be associated redness of the eye.

Corneal edema can lead to more significant long term damage such as: 

  • Long-Term Damage: Prolonged or severe corneal edema can potentially lead to permanent damage to the corneal tissue, affecting vision in the long term.
  • Corneal Scarring: In some cases, corneal edema can result in corneal scarring, which can further impact vision quality.
  • Reduced Corneal Function: Chronic corneal edema can impair the cornea's ability to function properly, potentially affecting its role in focusing light onto the retina for clear vision.

Red eyes

Several studies have shown limited or no increase in redness from overnight wear of contact lenses with high oxygen permeability. This indicates that the primary cause of redness in the eyes from wearing contact lenses when sleeping is due to the lack of oxygen that goes through the contact lenses. The good news is that if you are experiencing red eyes from your contact lenses, you can speak to your eye doctor about finding a lens that has a higher rate of oxygen transmissibility. 

These studies include:

  • Covey et al. (2001): In this 9-month study, researchers compared wearers of an experimental, highly oxygen transmissible lens with a control group who wore no contact lenses. They found no significant differences in either limbal redness or the vascular appearance of the peripheral cornea.
  • Dumbleton et al. (2001): This study examined the vascular response to extended wear of hydrogel lenses with high and low oxygen permeability. They found that limbal redness was not significantly increased in subjects wearing lenses with high oxygen permeability.
  • Brennan et al. (2002): In a 1-year prospective clinical trial, researchers studied the performance of balafilcon A (PureVision) silicone-hydrogel contact lenses used on a 30-day continuous wear schedule. They found no significant changes in corneal vascularization compared to a control group.
  • Stern et al. (2004): This study compared the performance of 6- or 30-night extended wear schedules with silicone hydrogel lenses over 3 years. They observed no significant differences in limbal redness between the two groups over the observation period.
  • Aakre et al. (2004): In a 6-month follow-up study, successful refits from daily disposable soft contact lenses to continuous wear of high-Dk silicone-hydrogel lenses were examined. Bulbar redness significantly increased in the low transmissibility group but remained unchanged in the refitted subjects after 3 months.

These studies collectively suggest that contact lenses with high oxygen permeability can minimize or prevent significant increases in redness associated with overnight wear, making them a more comfortable and safer option for extended wear.

Dry Eyes

Dry eye is a condition with symptoms such as dryness, feeling like something is in your eye, blurry vision, excessive tears, and inflammation. Sleeping in contact lenses can cause or exacerbate existing dry eye through several mechanisms: 

  • Change the composition of your tear film, which can lead to faster evaporation, unstable tear film or discomfort 
  • Reduced blink rate, which is essential for ensuring that your tear film is healthy and keeping your eyes moist 
  • Absorption of tear film by your contact lenses 

Corneal Ulcers

A more severe risk is the formation of corneal ulcers. These are open sores on the cornea that can cause permanent vision loss if not promptly treated. Studies show that sleeping in contact lenses increases your risk of developing a corneal ulcer by as much as 6.5 times.

Reduced Lens Effectiveness

When you sleep with your contacts in, you're also likely to reduce their effectiveness. Lenses can warp over time if they're not properly cared for, leading to blurry vision and discomfort.

Corneal Abrasion

Contact lenses can move out of place when your eyes are closed during sleep. If they get lodged under your eyelids, they could scratch your cornea. Also extended wear lenses can build up organic matter that may cause friction which can lead to a scratch.  Known as a corneal abrasion, this condition can be painful and requires immediate treatment to prevent further complications.

Allergic Reactions

Some people have heightened sensitivity to the lens material or the cleaning solutions used for contact lenses. Prolonged exposure, such as when sleeping in contacts, can trigger an allergic reaction that might result in itching, burning, and excessive mucus discharge.

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