Having trouble falling asleep can be extremely frustrating. If you’re living with tinnitus, the medical term for the ‘ringing’ in your ear, it can sometimes seem nearly impossible. To help you get a good night’s sleep, every night, we’ve talked to hearing health experts about tried-and-true strategies to help combat sleep disturbances and insomnia caused by tinnitus.
While ‘ringing’ is the most common description of tinnitus, many people will also report buzzing, static, humming, pulsating, whistling, hissing or white noise to name a few. In his paper on Tinnitus Retraining Therapy (TRT), Pawel Jastreboff from Emory University defined tinnitus as “the perception of sound in the absence of an external source”.
Each tinnitus case is unique and there are many possible causes. Two common factors are hearing loss and noise exposure. Tinnitus can also be caused by many other factors including certain medications, ear infections, neck pain, jaw problems, heart disease and stress to name a few.
But for many, it becomes a permanent fixture and they hear it all day, every day. Our ears and brain are usually very good at filtering out sounds that are unimportant, but they sometimes get confused and focus on and attribute meaning to these internal noises.
This can happen ‘once in a blue moon’ for some, for others, the brain becomes hyper-focused on this sound and responds to it emotionally, usually with fear or irritation. You may not mean to, but once you start to attend to the noise and ask yourself ‘is it there today?’, you are telling your brain that it is meaningful and interesting. And the brain responds by increasing perception and awareness.
For many, the tinnitus will have a significant impact on their quality of life and can become quite debilitating.
The presence of tinnitus can lead to:
Once sleep begins to be affected, a vicious cycle starts: Being tired leads to worse tinnitus and worse tinnitus means it is harder to sleep. Insufficient sleep is associated with poor health outcomes including poor memory, cognitive issues, cardiovascular disease and more, so it is very important to address this as soon as possible.
If this sounds like you then keep reading to find out how you can improve your sleep and reduce the impact tinnitus is having on your life.
Many patients are told that nothing can be done about tinnitus, and they must ‘learn to live with it’. This can be detrimental to long term outcomes, delay the patient seeking expert help and being referred to an audiologist for a tinnitus consultation.
Firstly, an audiological examination is crucial as tinnitus can sometimes be an early indicator of medical problems in the ear, hearing pathways or brain and it is important to rule this out. Once a medical issue has been excluded, the degree and type of hearing loss will be considered as research shows that tinnitus is associated with hearing loss in as many as 90 per cent of cases.
Secondly, your audiologist can provide tinnitus counselling and teach you strategies to help cope with the tinnitus. Seeing a hearing professional also gives you a chance to feel like you are in control and ‘doing something’ about the noise and for many people, this will be very comforting.
Having the tinnitus recognised and validated can provide a lot of stress relief and learning about it and understanding that the noises are not threatening or dangerous can help you shift your perception of the tinnitus. This can feel like a weight being lifted off the shoulders and should allow you to start sleeping better right away.
A common tinnitus trigger is noise exposure and it is therefore very crucial to protect your hearing. It is never too late to start wearing hearing protection. This is still important even if you already have hearing loss or tinnitus – every additional exposure can make it worse.
It’s important to understand ‘how loud is too loud’ and know when to use hearing protection and there are lots of great resources out there to learn more about this. Even a single exposure to loud noise can be enough to damage your hearing and cause tinnitus hence why it is important to always wear protection like earmuffs or earplugs, even for short exposure.
Consider not only the intensity of the sound but also the length of time you are exposed. For example, vacuuming your home is generally safe but if you are working as a cleaner and exposed to this noise all day, it can be detrimental to your hearing. Preventing further damage is vital to tinnitus treatment and will go a long way in helping you get a good night’s sleep.
The importance of a good sleep routine cannot be underestimated when it comes to tinnitus management. Sleep hygiene is the set of behavioural and environmental factors you can modify to ensure quality sleep. Keeping in control of your sleep habits helps your body maintain healthy circadian rhythms, which is the internal body clock that allows wakefulness during the day and sleepiness at night.
Good sleep hygiene includes going to bed and waking up at the same time each day and doing this in a comfortable, darkened environment so ambient light doesn’t interrupt sleep. Studies have also shown that the temperature of the room is very important and while most of us enjoy a warm, cosy room at bedtime, a cool room temperature is more conducive to good sleep. If the room is too warm you are more likely to wake up through the night and this can start the tinnitus cycle all over again.
Research into the use of melatonin for tinnitus treatment has also been very positive and it may be worth speaking to your GP about this. Melatonin is a naturally occurring hormone in the human body that helps regulate sleep cycles. If you don’t produce enough Melatonin it can negatively impact sleep, thus supplementing it may improve sleep quality and reduce the impact of tinnitus. It may take a few weeks to notice an improvement but once you establish a good sleep routine you will find it easier to relax and fall asleep at night despite the tinnitus.
One of the best strategies to help you cope with your tinnitus and sleep better is using a distraction. Most people will report that their tinnitus isn’t as bad during the day when they are busy. This is because the auditory pathways are being stimulated with more important sound such as friends, family, colleagues, your favourite television show and ambient noise in the environment.
Therefore, one of the easiest techniques for managing tinnitus and allowing you to get a good night’s sleep is keeping the brain busy. A popular form of distraction overnight is listening to relaxation music such as birds, rainfall, thunderstorms or the ocean as this gives the brain something better to focus on than the internal noises and keeps the brain distracted.
Any sound will work for this provided you find it relaxing, comforting and more interesting than the tinnitus. You may like to try television, radio, white noise, the fan on in the room or even a sound therapy app on your phone that generates personalised relaxation music. Once your brain is distracted from the tinnitus it is much easier to relax and fall asleep.
Stimulants like caffeine, nicotine, and alcohol are all well known to reduce sleep quality and are also tinnitus triggers for many people. Caffeine is the most widely used psychoactive substance in the world and can be found in many products such as coffee, tea, chocolate and energy drinks. Caffeine stimulates the central nervous system and causes the body to be more active and alert.
Nicotine, whether from smoking or via nicotine patches or pills, has a stimulating effect and promotes arousal and wakefulness which is counterproductive when trying to sleep. Alcohol also negatively affects sleep and prevents the sleep from being as deep and restful. Therefore, abstaining from these products will have a positive effect on sleep and tinnitus. If abstinence is difficult then reducing the quantity of consumption and avoiding these products in the hours leading up to bedtime would be a great start.
Evidence shows that regular exercise has a positive impact on sleep quality, provided that the exercise doesn’t occur too close to bedtime where it may then have a stimulating effect (Stepanski, 2003). Exercise will relax the body, provide an outlet for stress release and help to release feel-good chemicals to the body.
Exercising with a friend may also give you the chance to improve both your mental and physical well-being at the same time. Studies have proven that regular exercise will result in an overall improvement in general health as well as quality of life and can reduce stress and tinnitus severity. So start moving and soon you will see the benefits.
We have already discussed the importance of the naturally occurring hormone melatonin for promoting good sleep so it is important to avoid activities that will impact its natural production. Humans maintain a cycle of day and night (circadian rhythms) where during the day, sunlight causes our body to produce daytime hormones that keep us awake, while at night the absence of light stimulates melatonin production and tells the brain it’s time for sleep.
The blue light coming from screens on our devices will therefore reduce sleepiness and increase the time it takes to fall asleep. A good rule is to avoid screen time in the last two hours before bedtime and instead use this time for relaxation. This will help you fall asleep more quickly and importantly, stay asleep all night. If complete avoidance is impossible, you may consider using the night lighting mode on your smartphone (for example ‘Night Shift’ mode on Apple devices) which reduces the blue light and its subsequent interference with melatonin production.
Audiologists have long known that hearing aids can reduce your awareness of tinnitus. This is because they improve access to sound and the brain is then too busy hearing all the real noises in the environment to focus on insignificant internal sounds.
This is known as ‘masking’, where the ambient noise around you masks out or covers up the tinnitus. Hearing aids also reduce the stress and strain the brain is under trying to follow speech and can therefore reduce the impact of tinnitus by making conversations easier and more accessible. For those who don’t experience enough relief from hearing aids alone, there is also the option of a specialised tinnitus masking program which is available in most modern hearing aids.
Your audiologist can set up a special masking program which is tailored for each individual and provides a pleasant, low-level background noise that is typically very subtle and can drown out the tinnitus. The less you hear the tinnitus, the less likely your brain is going to ‘look’ for the tinnitus and with practice, it can fade off into the background where you don’t notice it. If you hear less of the tinnitus you are definitely going to sleep better.
Tinnitus is commonly worse during times of stress and therefore addressing the cause of this will allow you to relax more easily and have a good night’s sleep. Consider relaxation exercises or classes as well as deep breathing, meditation, mindfulness or aromatherapy.
There are many resources out there to help you with this including apps, podcasts, courses and videos. It may seem ineffective at first but with practice, you will reap the rewards. If you are having negative thoughts it can also be useful to write them down and ‘put them away’.
A study published in 2017 provided clear evidence that relaxation, meditation and mindfulness were all effective in the management of tinnitus. It is important not to be stressed about sleep itself as this will make it harder to relax and perpetuates the vicious cycle of poor sleep making tinnitus worse and worse tinnitus making sleep more difficult. Once you start to feel more relaxed and work at enjoying life more fully, you will sleep better as well.
Research shows that tinnitus can be triggered by muscular tension in the upper body, particularly in the neck and therefore addressing this may provide relief from the noise and a better night’s sleep. If you are known to grind your teeth (bruxism) or clench your jaw, you may have temporo-mandibular joint (TMJ) issues. Seeing a physiotherapist or dentist with a special interest in TMJ/jaw problems could be helpful. Even for those who don’t report specific pain, treating the muscles can prove to be very relaxing and therefore help you sleep better.
With practice, tinnitus doesn’t have to control your sleep and quality of life. If you work at it, you can ‘habituate’ or get used to the tinnitus and train your brain that it isn’t important and not to focus on it. It is easier to habituate to these noises once you learn more about them, and accept that they aren’t harmful so you no longer feel threatened by them.
If it’s not harmful or threatening, then it can’t hurt you! Once you do this, the tinnitus can fade into the background and restful sleep can return. It is very important to know that something can be done and you don’t just have to ‘live with it’.
If you have any questions or would like to schedule a tinnitus consultation with one of our friendly and experienced audiologists and tinnitus specialists, contact your local Attune Hearing clinic today. They will be able to perform a comprehensive hearing test and tinnitus assessment to provide you with a tailored treatment and management plan to help you take control of your tinnitus.
Until then, use the strategies discussed here to improve your quality of sleep and start breaking the vicious tinnitus cycle. Once you do this, your quality of life is sure to improve. Good luck and sleep well!