[...Eye Strain When Sleeping

By W. H. Bates, M. D.

Many persons strain their eyes when sleeping. When they awake in the
morning, they feel pain in their eyes with imperfect sight and often
with severe headache. They may feel all tired out, not refreshed or
rested by a sleep of eight hours or longer. In some cases the sleep
may not have been disturbed by dreams. Dreams are not always
remembered for any great length of time. There are people who can
recall dreams in their early childhood twenty, thirty, forty years
ago, but their recent dreams cannot be remembered longer than a few
minutes or a few hours after awakening. To keep accurate records of
dreams requires that they be recorded as soon as possible. Pleasant
dreams do not always mean relaxation, but dreams of snakes,
nightmares, fighting, crimes and horrible experiences of all sorts are
usually followed by imperfect sight caused by eye strain.

Some of my patients with a severe trouble of the eyes have told me
some very awful dreams. During sleep the ticking of a clock or the
outside noises in the street may be the starting point of a very
exciting, disagreeable or uncomfortable dream which is due to strain.

I am tempted to relate my personal experiences in dreams. Recently I
awakened in the morning with a feeling that I had been dreaming. I got
into a fight with a drunken man and had soaked the bedpost with my
fist with disastrous results to the skin of my knuckles. Afterwards I
noticed that the white tiled floor instead of being white the blocks
were alternately pink and blue and this illusion continued for a half
hour when it gradually disappeared. On another occasion, I awakened
after a dreamless sleep and noticed that the ceiling was covered with
a very white cloud similar to a veil. This illusion disappeared in
five or ten minutes.

Many patients ask: "Why do I have so much pain, discomfort, imperfect
sight in the morning after a good sleep?"

My answer is: "Because you strain your eyes and all the nerves of your
body when you are asleep."

But for me to explain the facts further is something I cannot do. All
I know is the fact that it is so. New born babies, half an hour after
birth and later, by simultaneous retinoscopy produce a deformation of
the eyeball, nearsightedness (myopia), farsightedness (hypermetropia),
astigmatism of variable degree, at short intervals of a few hours. At
one time, myopia will be found of the same amount in each eye; or one
eye may be normal while the other eye may be myopic. At the second
examination, both eyes may be normal, hypermetropic, or with any form
of astigmatism. The child may produce any combination of errors of
refraction by eye strain when asleep which may persist for a longer or
shorter period when awake. At times the eyes become normal when the
child is awake. Squint or strabismus in its various forms always
occurs and is also variable. The use of strong atropine, 3 ½ per cent,
instilled into both eyes does not prevent the manifestations of eye
strain in new born children when asleep.

In adults, simultaneous retinoscopy demonstrates the production of
near-sightedness and other deformations of the eyeball by eye strain
during sleep but which usually become less or disappear and the eyes
resume their normal shape in a few hours after awakening. Just as in
babies atropine does not prevent, during sleep, the results of eye
strain.

Hypnotism, ether, chloroform and nitrous oxide gas are all accompanied
by well marked eye strain during sleep produced by these agents.

Eye strain during sleep may produce in the normal eye severe pain with
hardness of the eyeball simulating the increased tension of an attack
of glaucoma. In all diseases of the eyes, inflammations of the
eyelids, cornea, iris, lens (cataract) retina and optic nerve eye
strain during sleep increases the severity of the symptoms with a
corresponding loss of vision, temporary or more permanent. Detachment
of the retina has been aggravated or produced by eye strain during
sleep.

The results of eye strain during sleep are so disastrous that I
believe proper treatment is essential. Some patients have been
benefited by "Palming" for half an hour or longer before dropping off
to sleep. "Go to sleep while palming. Palm if you wake up during the
night. Practice the long or short "Swing" before retiring," I advise.

Some people seem to sleep longer than is necessary and the eye strain
may appear increased. Some observations made of a four hour period of
sleep during the night with or without a nap in the day time seemed to
show less eye strain.

Posture during sleep has been studied. Lying on the face has generally
been accompanied by an increase of eye strain. Sleeping on the back
with the arms and limbs extended with slight flexion is undoubtedly
better than sleeping on the right or left side. A cramped posture is
always wrong. The patient is not always conscious of his posture when
asleep. In a number of cases observed by friends of the patient, one
or both arms were held behind the head while asleep and strenuously
denied by the patient when awake.

The correction of this and other strained positions of the arms and
limbs has been followed by decided benefit to the vision.

Eye strain during sleep produces or increases the symptoms of strain
in various parts of the body. Some months ago I suffered from an
attack of the grippe and had a very strong cough without
expectoration. This cough was spasmodic and did not bother me very
much during the day and when it did it was very easy for me to obtain
sufficient relaxation to control it. But at night it was terrible, it
would wake me up a few hours after I had retired and the coughing
would be so severe and continuous that it was impossible for me to
obtain relaxation of the eye strain while the room was dark. I was
compelled to get out of bed and light the room in order to practice
the long swing which gave me relief in an incredibly short time, a few
minutes or less. I would then go back to bed and sleep for a few hours
or the rest of the night without being disturbed by the cough. It was
interesting to me that the relief of the eye strain was also a benefit
to the bronchial or other lung tension.

For some years I had been afflicted with a chronic tuberculosis of the
right elbow joint which at times caused great pain. When I became able
to relax the eye strain, to remember or imagine perfect sight, the
pain in the elbow disappeared. One evening I retired as usual and
slept very comfortably until one o'clock when I was awakened with an
intense pain in the elbow. The pain was so severe that I lost all
control of my mind and became practically insane. I was unable to
remember even my own name or any of the letters on the Snellen Test
Card which I read every day. The doctor who was summoned gave me a
hyperdermic with morphine every little while but without any
appreciable relief. I kept saying, "Somebody help me to remember
black," but my attendants sat around the room saying nothing and all
they seemed able to do was to watch me suffer and give me morphine.
This continued for four hours. During all this time I instinctively
was trying to remember or imagine something that I had seen before.
All of a sudden I remembered a large black C and the pain let up. In a
few minutes I became able to remember all the letters on the Snellen
Test Card and fell asleep. I woke up an hour later, six o'clock,
apparently perfectly well without any sign of pain or soreness in the
elbow. I dressed without any trouble, went downtown to the office and
did a day's work without any return of the eye strain or pain in the
elbow...]

- February, 1923

If someone actually measures a difference in vernier acuity, I will be
surprised.

-MT