- Understanding Visual Impairment Spectrum: Recognizing the various degrees of blindness, from total blindness to low vision and color blindness, is essential for providing appropriate assistive technologies and accommodations.
- Common Sleep Challenges for the Visually Impaired: Visually impaired individuals often face disrupted circadian rhythms, difficulty establishing nighttime cues, non-24-hour sleep-wake disorder, challenges with the sleep environment, increased nighttime awakenings, anxiety, and lack of daytime activity—all impacting their sleep quality.
- Sleep Tips for the Blind and Visually Impaired: Implementing a consistent sleep-inducing environment, leveraging other senses, utilizing technology and tools, maintaining a routine, considering diet and exercise, practicing relaxation techniques, and, when necessary, exploring pharmacological treatments can significantly enhance the sleep quality for individuals with visual impairments.
Our mind and body need sleep to repair and rejuvenate. It is the time that everyone needs to recharge, including those who are blind or visually impaired.
However, for those who can’t see, a restful night’s sleep can pose unique challenges without visual cues. Our body uses light to maintain circadian rhythms — our body’s internal biological clock and that’s the exact thing that makes falling asleep challenging for the blind and the visually impaired.
And it’s not an uncommon issue, either. According to the CDC, vision disability is disabilities among adults 18 years and older.
Let’s discuss some tips to help the blind or visually impaired fall asleep.
Understanding Blindnesssubstantial or total vision loss that significantly impacts everyday function and independence. However, blindness exists on a spectrum, and legal definitions do not always align with functional vision abilities.
Complete lack of light perception in both eyes is considered total, or absolute blindness. People with total blindness rely predominantly on their other senses to navigate the world.
Whileis rare, partial vision loss encompasses a wide range of conditions that can significantly impact daily living skills and independence. Understanding the gradations of blindness can help ensure appropriate assistive technologies and accommodations are provided.
All totally blind people are legally blind, but not everyone who meets the legal definition of blindness is 100 percent without vision.
The legal definition focuses on visual acuity, which relates to clarity of vision. In the U.S., legal blindnessas visual acuity of 20/200 or worse in the better-seeing eye with the best correction.
This means a legally blind person has to be 20 feet from an object to see it as clearly as a fully sighted person can from 200 feet away. Legal blindness can include some usable vision.
Low Visionis a significant loss of vision that cannot be corrected with standard eyeglasses, contact lenses, medication or surgery. However, a person with low vision still has some usable sight for tasks like reading large print or walking with a cane. Visual acuity for low vision can range from 20/70 to 20/200 or worse.
Color Blindnessmeans having difficulty distinguishing between colors in the normal visual spectrum. It is most often inherited and impacts men more frequently than women. There are different types, from red-green color blindness being most common to full color blindness (extremely rare).
Here’s a quick look at the types of color blindness:
- Red-Green Color Blindness (Protanopia and Deuteranopia): Protanopia is the difficulty perceiving red hues. Deuteranopia is the impaired ability to see green tones.
- Blue-Yellow Color Blindness (Tritanopia): Difficulty distinguishing between blue and green colors.
- Monochromacy (Achromatopsia): Rare and severe form where individuals see the world in grayscale.
- Total Color Blindness (Cone Monochromacy): Extremely rare; seeing the world in shades of black, white, and gray.
- Anomalous Trichromacy: Altered perception of colors, often affecting the intensity of red, green, or blue.
Cortical Visual Impairmentresults from damage to the brain’s visual processing centers rather than an issue with the eyes themselves. People with CVI may have normal acuity but struggle to make sense of what they see. Symptoms can include difficulty with visual memory, tracking movement, and processing busy environments.
Also known as nyctalopia, night blindnessin darkness or dim lighting. The eyes struggle to adjust from light to dark environments. It can exist from birth or be acquired from eye diseases like retinitis pigmentosa that damage light receptors in the retina.
Understanding Visual Impairment
Visual impairment is a condition that significantly hinders a person’s ability to see and engage with the visual world around them. This term encompasses a broad spectrum of visual challenges, ranging from mild to severe, and can be caused by various eye disorders or conditions.
Individuals with visual impairment may experience difficulties with visual acuity, peripheral vision, depth perception, or color recognition.
Onepredicted that visual impairment cases in the U.S. may double by 2050. They also estimate that one million Americans qualified as legally blind in 2015, while 3.2 million had visual impairment.
The terms “vision impairment” and “visual impairment” are often used interchangeably, but some subtle distinctions exist.
Vision impairment is a broad term encompassing any degree of reduction or limitation in vision, ranging from mild to severe. It serves as an umbrella term that includes various eye conditions or disorders that affect a person’s ability to see. This can include nearsightedness, farsightedness, color blindness, and other visual challenges that may not necessarily result in complete blindness.
Visual impairment, on the other hand, is a more specific term referring to a significant reduction in vision, often to the extent of legal blindness. Visual impairment implies a more substantial and noticeable degree of vision loss compared to the broader term “vision impairment.”
Common Sleep Challenges for Visually Impaired
In individuals with visual impairment, the common challenges of achieving restful sleep often start from a disruption in the body’s natural sleep-wake cycle — circadian rhythm.
Some of the most common challenges are:
- Disrupted Circadian Rhythms: Our body’s internal clock is influenced by light exposure. For those who are blind or have limited vision, the absence or reduction of light perception can disrupt this internal clock, causing irregular patterns.
- Difficulty Establishing Nighttime Cues: For many individuals, the transition from day to night is a visual process that depends on natural cues. Without these cues, visually impaired individuals experience challenges in establishing a routine that signals to their bodies that it’s time to wind down and sleep.
- Non-24-Hour Sleep-Wake Disorder: Individuals with complete blindness are often at a higher risk of developing a non-24-hour sleep-wake disorder, which is characterized by an extended sleep cycle, typically more than the 24-hour period, leading to constant gradual shifts in sleep times.
- Challenges with Sleep Environment: Adjusting the sleep environment for safety and comfort can be more challenging without sight. Ensuring a consistent and hazard-free space is crucial but can be difficult to maintain and manage.
- Increased Nighttime Awakening: Visually impaired or blind people experience more frequent awakenings during the night — causing interruptions in deep and restorative sleep.
- Anxiety and Stress: Daily activities with visual impairment can become a hassle. It can cause anxiety that makes it difficult to fall asleep or stay asleep.
- Lack of Daytime Activity: Blindness causes restrictions and limitations in physical activities during the day. Daytime activities are important for regulating sleep patterns and promoting fatigue at bedtime.
- Medication Side Effects: Some medications prescribed for eye conditions or other health issues may have side effects that impact sleep quality or schedule.
Because of the complex nature of sleep and vision, it requires a multi-faceted approach that includes creating strong non-visual bedtime routines and more. Coordinating with a doctor can help you create a more refined approach to better sleep.
7 Sleep Tips for the Blind and Visually Impaired
Create a Sleep-inducing Environment
The foremost sleep-routine tip is to maintain a sleep-inducing calm environment. It includes sleeping in a familiar room without any unfamiliar changes. If you make the blind person sleep in a room without a consistent layout, it might heighten anxiety, making it more challenging to fall asleep.
As the visually impaired can’t respond to light cues, it is advised to use tactile cues, such as specific textures on bedding or a unique rug beside the bed, to signal it’s time to sleep. Moreover, keep the room at a comfortable temperature, preferably cooler, to signal the body to wind down.
Role of Other Senses in Sleep
Blind individuals often have heightened sensitivity to other senses. Soft, comfortable bedding can be pleasing to the touch while calming scents can signal to the brain that it’s time to wind down. Peaceful background noise or a quiet place can also be an auditory cue for sleep.
Technology and Tools
Advanced technology and tools can also be beneficial and help one fall asleep. Wearables that monitor sleep and provide audio feedback, apps designed for calming activities, and talking alarm clocks can all support a healthy sleep routine. These devices help in forming a predictable pattern, which is particularly valuable for those who lack visual cues.
Routine is Key
A consistent routine is crucial to maintaining your body’s internal clock. This includes waking up and going to bed and having meals at the same time every day. When nature’s light-dark cycle is not perceivable, this lack of predictability of routine can greatly disrupt the body.
Diet and Exercise
Diet and exercise are also determining factors of your sleep hygiene and quality. Ensure you are not having the last meal of the day right before bedtime. Having dinner too close to bedtime can impact sleep, digestion, and comfort.
Regular exercise promotes physical tiredness by evening. But timing is key when it comes to exercise—physical activity should be avoided too close to bedtime to prevent overstimulation.
Different relaxation techniques like deep breathing, listening to an audiobook, or any other activity can be effective for transitioning to sleep. For people who are visually impaired, guided meditations can focus on the senses of sound and touch, such as the feel of the breath or the weight of the body against the mattress.
Progressive muscle relaxation can also be an excellent method to relieve tension and prepare the body for sleep for those who are visually impaired.
Adding these tips to their nightly routine can help the visually impaired enhance their sleep quality. Striking the right balance between environment, technology, and personal practices can foster restful night sleep.
Pharmacological Treatments for Better Sleep
If non-drug therapies are insufficient to improve sleep disturbances in those who are blind and visually impaired, medical management under a doctor’s supervision may be required. However, prescription medication should be closely monitored by a doctor due to the potential for side effects and dependence.
Melatonin supplements help initiate sleep by mimicking the natural rise in darkness. Doses between 1-10 mg given 2-4 hours before bedtime are often effective. Time-release formulas can help sustain sleep.
Melatonin is generally well-tolerated, even for extended use. It is available as an over-the-counter medication, though it’s still wise to talk with your doctor before you begin taking it as it’s not a suitable option for everyone. If you are taking melatonin, be mindful of increased wakings overnight. If that starts to occur at 4 am or other times in the morning, it is time to wean off melatonin and consider an alternative.
Those who should be cautious about taking melatonin include:
- Pregnant or Breastfeeding Women: Melatonin’s safety during pregnancy and breastfeeding hasn’t been thoroughly studied, so it’s advisable for pregnant or breastfeeding women to avoid melatonin supplements.
- Children and Adolescents: Melatonin given to kids can affect hormonal development, and its long-term effects on young individuals are not well understood. It’s recommended to consult with a pediatrician before giving melatonin to children.
- People with Autoimmune Disorders: Melatonin may stimulate the immune system, potentially worsening symptoms in individuals with autoimmune disorders. Those with autoimmune conditions should consult their healthcare provider before using melatonin.
- Individuals with Bleeding Disorders: Melatonin can have anticoagulant effects, so individuals with bleeding disorders or those taking blood-thinning medications should exercise caution and consult with a healthcare professional.
- Those with Allergies or Sensitivities: Individuals who have known allergies or sensitivities to melatonin or related substances should avoid its use to prevent adverse reactions.
- People with Severe Allergies to Lactose or Other Ingredients: Some melatonin supplements may contain allergens such as lactose. Individuals with severe allergies to these components should carefully check the product’s ingredients or choose a melatonin supplement without allergens.
- Individuals with Liver Conditions: Melatonin is metabolized in the liver, so people with liver conditions should use melatonin with caution and under the guidance of a healthcare professional, as impaired liver function may affect its metabolism.
- Those Taking Certain Medications: Melatonin may interact with various medications, including blood thinners, anticonvulsants, and immunosuppressants. Individuals taking these medications should consult their healthcare provider before using melatonin.
“Because melatonin is available over the counter, many people consider it to be completely harmless and safe,” says Dr. Nilong Vyas. “Although it can be used occasionally as needed, it must be taken into consideration that it is still a medication that has implications for other bodily functions. Taking this medication should be discussed with a physician.”
Medications like Zolpidem (Ambien), Zaleplon (Sonata), and Eszopiclone (Lunesta) can help shorten the time to fall asleep and decrease awakenings. However, tolerance can develop with prolonged use, and side effects like drowsiness may persist into waking hours. These should be reserved for short-term or intermittent use.
Originally developed to treat high blood pressure, low doses of Clonidine at bedtime can aid sleep maintenance. It has fewer risks than other prescription sleep medications and is sometimes used off-label for sleep disorders in children. Drowsiness in the morning is the most common side effect.
Some tricyclic antidepressants like amitriptyline promote sleepiness as a side effect. When taken 1-2 hours before bedtime, the drowsiness helps initiate sleep. However, anticholinergic effects like dry mouth and constipation may also occur.
How do you help a blind person sleep?
To help a blind person sleep, start with creating a consistent sleep routine in a comfortable and familiar sleeping environment. Create a relaxing environment to help them fall asleep. Encourage soothing activities like listening to a book to help the mind in winding down.
What is the sleep schedule for blind people?
A structured sleep schedule with fixed sleep and wake times can often help blind people. Consistency is key when optimizing the body’s internal clock —especially when visual cues from light can’t help to regulate the circadian rhythm.
Establishing a structured routine with consistent sleep and wake times, along with non-visual cues throughout the day such as meal times, work, and exercise, helps anchor their internal body clock. Additionally, relaxation techniques and a comfortable sleep environment can contribute to a more regular sleep pattern for individuals.
Do blind people sleep easier?
In fact, blind people often experience difficulties with sleep. The inability to perceive light can disrupt their circadian rhythms, and remember, circadian rhythms affect sleep. Establishing a consistent sleep routine with other non-visual cues can help those with vision difficulties avoid inconsistent sleep patterns.
Enhanced sensitivity to sound, touch, and smell can aid in creating a sleep-conducive atmosphere. We must also note that ease of sleep varies among individuals and is influenced by factors beyond visual impairment, including overall health and lifestyle.
Can a blind person dream while sleeping?
Absolutely, blind people can experience vivid dreams during sleep. Dreaming is a complex neurological process unrelated to visual stimuli, and blind individuals engage in dream experiences similar to those with sight. Their dreams are shaped by their unique experiences, emotions, and subconscious mind, much like in the sighted population.
Those who were born blind may not have visual dreams but can still experience dreams involving their other senses, such as sound, touch, and emotion. Those who lost their ability to see later in life may have visual dreams.
Do blind people need less sleep?
No, blind individuals do not generally need less sleep. Generally, blind people need the same amount of sleep as sighted individuals, typically 7-9 hours per night. Like sighted people, their sleep requirements are influenced by factors such as age, health, and lifestyle rather than their visual ability.
Blindness itself does not inherently alter the basic need for adequate sleep. However, they may experience disruptions in sleep patterns due to non-24-hour Sleep-Wake Disorder, a commonly found condition in totally blind.
Can eye problems cause sleep problems?
Eye problems can indeed contribute to sleep difficulties. Conditions like chronic dry eyes, glaucoma, or macular degeneration may cause discomfort, making it challenging to relax and fall asleep. Additionally, digital eye strain from excessive screen time can disrupt the sleep-wake cycle due to the exposure to blue light emitted by devices.
What sleep disorder is associated with blindness?
Blindness can be linked to a sleep disorder known as Non-24-Hour Sleep-Wake Disorder (Non-24). This disorder affects the circadian rhythm, the body’s internal clock. In individuals with Non-24, the natural daily rhythm extends beyond the typical 24-hour cycle, leading to irregular sleep patterns, making it challenging to maintain a consistent sleep-wake schedule.
Individuals who have lost their sight, whether partially or completely, need creative strategies to help them maintain a good night’s sleep routine. They are more prone to develop sleep disorders because of the way a lack of visual cues impacts their internal body clock or circadian rhythms.
Navigating the realm of sleep for the visually impaired requires a nuanced approach, combining environmental considerations, reliance on heightened senses, and embracing technological solutions. The journey involves harmonizing the non-visual cues, establishing steadfast routines, and leveraging creative strategies to ensure a restful night’s sleep.
Good sleep can also help maintain vision. Staying in good health is a commitment to understanding, adapting, and, when needed, seeking personalized guidance from healthcare providers for a holistic approach to sleep well-being.