Raised Head in Bed May Worsen Glaucoma

Conventional thinking among ophthalmologists has been to tell their patients with glaucoma to sleep with their head elevated, but doing so may contribute to the progression of the eye disorder and, in some patients could be harmful, new data showed.

Previous studies of the sleep patterns of patients with glaucoma focused on intraocular pressure (IOP), which, when elevated, is a key biomarker of primary open-angle glaucoma. The new research focused on mean ocular perfusion pressure (MOPP), a measure of blood flow to the eye.

“We found that lying down increases eye pressure but also improves blood flow to the eye,” said Natasha Gautam, MD, an ophthalmologist at the University at Buffalo Jacobs School of Medicine and Biomedical Sciences in Buffalo, New York told Medscape Medical News. “Since better blood flow is important for eye health, the common advice to sleep with the head elevated might actually be harmful for some glaucoma patients rather than helpful.”

Gautam, who was at the Mayo Clinic in Rochester, Minnesota, when she conducted the research, presented the findings at the 2025 annual meeting of the American Glaucoma Society. The prospective, randomized case-control study enrolled 80 patients, evenly split between people with glaucoma and healthy control individuals. All patients with glaucoma were on medical therapy for the condition.

“Study participants had their blood pressure and IOP measured between 6:30 AM and 9 AM to avoid any diurnal fluctuations,” Gautam said. Patients were evaluated in seven positions: Sitting, supine flat, supine with a pillow, left lateral decubitus, right lateral decubitus, prone with head turned to the right, and prone with head turned to the left.

The study found significant increases in IOP from the sitting to recumbent position in both groups, Gautam said. Pressure measurements in either eye were similar, regardless of the position.

When MOPP was evaluated, the researchers found a similar pattern of elevated pressure from the sitting to the recumbent position. However, the patients with glaucoma had lower readings in both eyes in all the recumbent positions, with the most significant variations between arms in both prone positions, Gautam said.

“Our study found that in recumbent positions, blood pressure in the eye increased more than IOP,” Gautam said. “As a result, MOPP increases in all recumbent positions compared to the sitting position.”

That finding suggests head elevation during sleep may not help patients with glaucoma because impaired blood flow has been associated with progression of the condition, she said.

“Head elevation could potentially be detrimental in some patients, particularly those who have a drop in blood pressure during sleep,” Gautam said.

The study established the groundwork for shifting the focus from postural change in IOP to MOPP, she said. “Future prospective studies examining MOPP fluctuations would provide insights into its role,” she said.

The study is the first to explore how various recumbent positions influence MOPP in patients with glaucoma, Isha Ingle, MD, a glaucoma specialist at the University of Massachusetts Chan Medical School in Worcester, Massachusetts, said.

“Unlike other previous studies, this study recommends not sleeping in a head-elevated position as it decreases ocular perfusion pressure and IOP,” she said. “There is limited data regarding postural variation’s effect on MOPP.”

Further prospective studies with larger populations would be needed to better understand the relationship between sleep positions and MOPP, Ingle added.

The study was independently supported. Gautam and Ingle reported no relevant financial disclosures.

Richard Mark Kirkner is a medical journalist based in Philadelphia.