Ringing Ears And Sleepless Nights: The Tinnitus And Sleep Apnea Connection

The relationship between tinnitus and sleep disturbances, especially sleep apnea, is an area of increasing focus in medical research. Tinnitus, characterized by a persistent ringing, buzzing, or hissing sound in the ears, often disrupts individuals’ sleep cycles, leading to frequent awakenings throughout the night and a subsequent lack of restful sleep. 

In fact, approximately 60% of those with tinnitus report experiencing such sleep disturbances. This unsettling statistic mirrors the experiences of many individuals living with sleep apnea. This disorder manifests in intermittent cessation of breath during sleep, who similarly report frequent nocturnal awakenings and a groggy feeling the following day.

This article aims to explore these connections, shedding light on the interplay between tinnitus and sleep apnea, and how this understanding can pave the way for more effective treatment strategies.

What Is Tinnitus?

Tinnitus is a condition where individuals perceive sound, such as ringing, buzzing, or hissing, without any external source. It’s not a disease, but rather a symptom of underlying issues like hearing loss, ear injury, or circulatory system disorders.

There are two types: subjective and objective. Subjective tinnitus, the more common form, is only heard by the individual and can be due to damage in the auditory nerves or brain’s sound processing areas. Others can hear objective tinnitus, too, and it often results from blood vessel problems, muscle contractions, or inner ear bone conditions.

Despite its cause or type, tinnitus can significantly impact quality of life, causing sleep disturbances, concentration problems, and increased stress and anxiety. Hence, its understanding and treatment are vital in audiology and related medical disciplines.

What Is Sleep Apnea?

Sleep apnea is a prevalent sleep disorder where an individual’s breathing periodically stops or significantly reduces during sleep. This condition manifests in three primary forms. 

Obstructive sleep apnea (OSA), the most common variant, occurs when the throat muscles overly relax during sleep, leading to a blockage that disrupts airflow into the lungs. On the other hand, central sleep apnea (CSA) is characterized by a disconnect in communication between the brain and the muscles that control breathing—the brain fails to send the necessary signals, resulting in temporary cessation of breathing. 

There is also treatment-emergent central sleep apnea, also known as complex sleep apnea. This form typically arises when a person initially diagnosed with OSA transitions to CSA following therapeutic intervention for OSA. 

What Are the Symptoms Of Sleep Apnea?

There are several symptoms of sleep apnea, ranging from mild to severe. Symptoms of the different forms of sleep apnea overlap, so you cannot differentiate between the two by symptoms alone. If you notice any of these potential symptoms, contact a sleep specialist or your primary care provider as soon as possible.

• Loud snoring
• Gasping for air while sleeping
• Waking up with a dry mouth
• Reported periods that you stop breathing as heard by your sleep partner
• Headaches in the morning
• Feeling groggy after a full night’s sleep
• Irritability
• Daytime sleepiness
• Inattention and difficulty concentrating
• Difficulty staying asleep

What Causes Sleep Apnea

Sleep apnea is caused by distinct mechanisms depending on the specific type. Obstructive sleep apnea (OSA) is caused by the relaxation of throat muscles, narrowing or closing the airway during sleep. This often leads to brief awakenings, triggered by the brain to reopen the airway. Despite being unremembered, these interruptions can occur up to thirty times an hour, disrupting the sleep cycle and leading to poor sleep quality.

On the other hand, central sleep apnea (CSA) arises when the brain fails to send signals to the breathing muscles, causing periods of breathlessness. This can result in waking up short of breath or difficulty falling or staying asleep. Both types of sleep apnea disrupt sleep and can lead to potential health issues if left untreated.

What Are the Risk Factors for Sleep Apnea?

There are several potential risk factors for developing sleep apnea. Having any one or more of these risk factors can influence the onset of this condition.

• Being overweight
• Having a thicker neck
• Having narrow airways
• Gender – sleep apnea is generally more common in males
• Old age
• Having a family history of sleep apnea
• Frequent use of alcohol, sedatives, or tranquilizers
• Smoking
• Nasal congestion
• Stroke
• Medical conditions (Congestive heart failure, high blood pressure, type 2 diabetes, polycystic ovary syndrome, hormonal disorders, prior stroke, and chronic lung diseases)

How Are Tinnitus and Sleep Apnea Connected?

The connection between tinnitus and sleep apnea is an intriguing subject of ongoing medical research, with several studies revealing a significant correlation between the two conditions. 

One such study discovered that obstructive sleep apnea (OSA) triggered more cases of tinnitus than hearing loss, and patients experiencing excessive daytime sleepiness, a common symptom of OSA, exhibited a higher risk of tinnitus. This research suggested that high-frequency snoring sounds, often associated with OSA, could contribute to the development of tinnitus.

Moreover, some researchers propose that tinnitus and sleep apnea may share a common neurological foundation. They hypothesize that both conditions could adversely affect the same brain regions responsible for facilitating restful sleep, thus explaining their frequent co-occurrence.

Together, these findings underscore the potential interplay between tinnitus and sleep apnea, paving the way for more integrated and effective therapeutic strategies.

Treating Tinnitus and Sleep Apnea

Treating tinnitus and sleep apnea requires a multi-faceted approach. Studies suggest that addressing sleep disturbances can improve tinnitus management, with sleep studies helping to tailor effective sleep disorder therapy into tinnitus treatment plans.

Tinnitus treatments may include hearing aids, ear-level sound generators, Tinnitus Retraining Therapy (TRT), Cognitive Behavioral Therapy (CBT), and sound therapy. For sleep apnea, mild cases can benefit from lifestyle changes like losing weight or quitting smoking. In contrast, severe cases may require devices like continuous positive airway pressure (CPAP) machines or oral appliances, or even surgical interventions.

The treatment plan may also encompass addressing associated medical conditions, medication adjustments, supplemental oxygen, or the use of an adaptive servo-ventilation device. The aim is to provide a comprehensive approach that addresses both conditions, enhancing patient well-being.

Seeking Out Professional Help For Treatment

If you’re experiencing symptoms such as persistent ringing in the ears, interrupted breathing during sleep, or excessive daytime sleepiness, it’s important to discuss these with your primary care doctor or a sleep medicine specialist. A sleep medicine specialist can be a physician of neurology, sleep psychology, otolaryngology (otherwise known as ENT), or other physicians that complete a sleep medicine fellowship after obtaining a medical degree. You can find certified sleep medicine doctors through resources like the American Board of Sleep Medicine’s directory.

For concerns primarily related to tinnitus, consultation with an ENT and an audiologist is recommended. These professionals can provide a comprehensive evaluation and develop a personalized treatment plan to manage your symptoms.

Remember, early intervention can significantly improve your quality of life and prevent potential health complications.