Have you ever tried to fall asleep at night, but all you can hear is ringing in your ears? Is your tinnitus keeping you awake until the wee hours of the morning? You deserve deep restful sleep without tinnitus getting in the way. In this article, we will highlight five effective strategies that can help you get a good night’s rest, even with tinnitus. We will also talk about creative solutions for using calming noises without disturbing a partner or anyone nearby.
What Is Tinnitus?
Tinnitus, or constant ringing in the ears, is a symptom experienced by as many as 15% of adults. While many people with tinnitus do not find symptoms disturbing, a small percentage considers their symptoms bothersome in their daily life–especially at night, when it is quiet.
Tinnitus can have a number of underlying causes, but in most instances, it is a benign condition stemming from changes that naturally occur inside the inner ear, called the cochlea, and the way those changes are interpreted by the auditory nervous system.
The cochlea has tiny hair cells which transmit sound information to the brain via the auditory nerve. These cells are lost continuously throughout our lives as a result of the aging process, exposure to noise, toxic substances, medications, etc., which can lead to the development of tinnitus.
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
"Treble Health helped me reduce my tinnitus by about 80%, and now I can live my life again!"
– Steve D.
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The prevalent theory regarding generation of tinnitus is that it is a perception of a phantom sound by the auditory cortex, similar to phantom pain. It is called a phantom sound because it is thought to be triggered by the brain reacting to the absence of stimulation of the areas inside the cochlea that have lost hair cells. This is why most adults with tinnitus also have hearing loss.
Dr. Thompson shares tips on how to sleep with tinnitus
Although many individuals who experience tinnitus are not bothered by it, a small percentage of individuals with tinnitus can develop negative reactions to phantom sounds and experience disruptions to their circadian rhythm.
These negative reactions typically develop from fear and uncertainty around tinnitus, as there may be a fear that tinnitus is a sign of a more serious medical condition. They may also be told by their doctor that they have to learn to live with it, rather than recommending tinnitus management, causing tinnitus patients to feel hopeless and leading to further sleep issues, creating a vicious cycle of stress and increased tinnitus symptoms.
Untreated tinnitus can have a significant impact on sleep. Tinnitus or ringing in the ears usually sounds like a high-pitched noise. Patients also describe it as buzzing, whooshing, or roaring. No matter what it sounds like, it can make peace and quiet seem impossible. There are two things we know really well about tinnitus. First, being stressed, worried, or having concerns about your tinnitus can make it louder. Second, tinnitus always sounds louder in a quiet environment and to find relief often means introducing background noise, be it ambient music or white noise.
Effective tinnitus management treatments are available. For example, one such technique is called Tinnitus Retraining Therapy (TRT). Tinnitus retraining therapy helps patients with tinnitus remove their negative reactions to tinnitus and use sound therapy to habituate (get used to) to tinnitus. Sometimes this therapy is described as tinnitus masking, though this description is not completely accurate. Instead, this particular intervention can help manage stress by utilizing ambient noise (think soft music, or white or brown noise) and mental health intervention.
Tinnitus Sound Therapy
The idea behind sound therapy (aka: sound masking) is that the perception of tinnitus varies depending on presence versus absence of background noise. When in a quiet room, tinnitus is very noticeable. However, when background noise is present, tinnitus is either not noticeable at all or much less pronounced. For example, many report not hearing their tinnitus when watching tv or when a fan or an air conditioner is on. This is because our brains perceive the world around us through contrasts and comparisons. A quiet room has a greater contrast for tinnitus symptoms to arise than a noisy room, making it more noticeable. We will hear the loudest sound, rather than the smallest, and tinnitus is usually significantly lower than a typical background noise.
Many people with tinnitus tend to notice it more at night because it is typically quiet at night. Day time, for most people, is filled with sound, and night is associated with quiet.
Difficulty Sleeping And Insomnia
Around 10% of people with tinnitus report having difficulty sleeping and they often state that falling asleep is one of their most significant daily challenges. As a result, sleep deprivation is a common side effect of this condition. To make matters worse, sleep deprivation can intensify the symptoms of tinnitus. Insomnia is a sleep disorder that is characterized by difficulty falling asleep and or staying asleep. People with insomnia have one or more symptoms such as difficulty falling asleep, waking up often during the night, and having trouble going back to sleep.
A 2022 study found that half of tinnitus patients have an associated sleep disorder. These patients reported suffering from high anxiety and stress levels due to not sleeping well and also because of the ringing in their ears. Another study determined that it may be the tinnitus suffers’ subjective perception of their sleep quality is effected by tinnitus rather than their actual sleep. Luckily, research also shows that when patients completed tinnitus therapy and used sound in their environment or in their ears, their sleep improved significantly.
Five Techniques To Fall Asleep (And Stay Asleep) More Easily
The first three techniques are healthy sleep habits and the last two are methods that use sound masking. These can help improve sleep and reduce stress. If you are in search of better sleep with tinnitus, try some of these techniques.
1. Relax before bed time
Try spending at least 20 to 30 minutes in the evening doing something that relaxes you before you try to fall asleep. This can be reading, lighting a candle, taking a bath, playing relaxing music or whatever else that helps you wind down.
2. Limit screen time and blue light exposure
Limit your screen time specifically on a computer, a phone, or a TV. Blue light on those devices is known to interfere with healthy sleep. Turn them off or avoid blue light as much as possible. It is especially important to avoid content such as action movies, news, and other forms of loud, exciting, or distressing media that grabs your attention. Limit the light in your bedroom and use blackout curtains to cover other light sources when you are trying to fall asleep. Sleep masks can also be considered.
3. Relax using deep breathing, meditation, or stretching
Relax using deep belly breaths while you are lying on the floor or on your bed, and slowly breathing and relaxing your body. Practice breathing techniques and meditation, as their effect will improve as you get better. There are a number of excellent apps available currently that could help you improve your breathing techniques and meditation habits. Stretching also works very well to help relax before going to sleep. You can practice a guided meditation or try some guided sleep audios or apps.
4. Sound therapy to help fall asleep while lying in bed
Sound therapy can help in two ways. First, the sound can mask the ringing in your ears. Second, the sound can calm and relax you. You can use things like a white noise machine, a fan, or a recorded sound of the ocean. These can help to mask or drown out the noise of your tinnitus and enable you to have a relaxing sleep for the whole night. Apps are also available that provide many sound choices to help mask symptoms.
Many people find nature sounds helpful. It is important to keep in mind that the sounds you choose must not be annoying or bothersome. It is best to use neutral noise that does not evoke either positive or negative emotions.
Be sure to select a volume that is not louder than the tinnitus itself. It is important to reduce the contrast between the tinnitus and background, while still hearing tinnitus. This contrast allows the brain to habituate to symptoms to limit poor sleep. It is not possible to habituate to something inaudible, so you should not try to drown out the sound of tinnitus altogether.
5. The sound pillow
The Original Sound Pillow is a small speaker inside a pillow and it allows the individual to sleep while listening to calming sounds of the ocean, nature noise, white noise, and other kinds of relaxing tones to help you fall asleep easier and faster. It’s very easy to use. You just need to plug in your cell phone to an aux cord that is inside of a soft pillow. You can then hear calming noise through your pillow without bothering anyone else in the room.
I Wake Up In The Middle Of The Night Because Of Tinnitus–Help!
Some tinnitus patients report waking up in the middle of the night because of their tinnitus symptoms. Typically, when people wake in the middle of the night for any reason, the sounds associated with tinnitus are particularly loud because the rest of the home is still or quiet. If you are waking up because of tinnitus, or waking up for another reason entirely and experiencing distress as a result of experiencing a spike in tinnitus volume, it can be helpful to use the methods laid out above and practice good sleep hygiene.
Additionally, if using sound therapy, it is important to leave the noise on for the entire night. When asleep, we naturally go through cycles of deep sleep and light sleep. Waking up during the night is not abnormal, although most of us do not remember having woken up because we typically fall right back asleep. Tinnitus suffers, however, may stay awake as they become aware of their tinnitus. Therefore, having the background noise on throughout the night will ensure that the sound of tinnitus does not prevent you from falling back asleep easily.
Can Melatonin Help Me Sleep With Tinnitus?
Many people use melatonin to help them fall asleep at night. This may be helpful for a short period, but is not recommended long term. Always consult with your medical doctor before taking any medication, even an over the counter intervention, to help you sleep.
What You Can Do: A Quick Summary
Follow some or all of the five healthy sleep habits recommended above for one month and monitor your progress. Let us know what works best for you. If it works well, keep at it! Additional techniques to try, if the items listed above, such wearing a sleep mask, and avoiding products that emit blue light, do not help include:
- Turning on a fan. You may already have a fan at home, so this may not even require an additional investment. You can also purchase a bedside noisemaker to approximate the noise of a fan. This will help you fall asleep faster and maintain the deep sleep so vital for human health.
- Using our sleep index questionnaire. We have a sleep index questionnaire for free on our website Treble Health. You can fill out this questionnaire to understand how significant your sleep problem is.
If the techniques we have identified are do not for you, consider reaching out to one of our audiologists for further information on tinnitus treatment options.