“Over the years, I've found that tinnitus is one of the most difficult and frustrating problems for my patients. Patients want a pill to take, or at least an immediate and reassuring answer, which is often difficult, if not impossible. Once the obvious causes have been ruled out, the best place to start is to manage the sleep environment and mask the noise with white noise, among other techniques described in this article.” - Drew Sutton, MD, board-certified ENT
Tinnitus is an auditory disorder in which a person hears a sound that does not come from their immediate environment and that others do not perceive. The sound heard is most often a hiss, hum, or buzz.
It can accompany age-related hearing loss, lasting inner ear damage, illness, and even be a side effect of certain medications. Tinnitus can be permanent or come and go, in a rare form called pulsatile tinnitus. It can also affect both ears or just one, like hearing loss, which can be symmetrical or asymmetrical.
Overall, people with tinnitus lead normal lives, with little impact on their daily lives, apart from the discomfort caused by the noise. However, one problem often arises: bedtime. With nothing else to focus on, it's easy to fixate on the tinnitus, which prevents a full night's sleep.
Most forms of tinnitus are currently incurable; affected individuals must therefore manage their symptoms using various solutions. Future treatments may emerge, but for now, symptom management remains the best available relief. Here's an overview of concrete strategies to help you fall asleep and stay asleep.
Tinnitus therapy
Many people with tinnitus perceive the noise but experience it negatively: they find it nagging, annoying, irritating. Being alone with one's tinnitus can generate negative emotions and spoil the day. For those who are genuinely bothered by their tinnitus, therapy can help.
Tinnitus therapies primarily aim to change one's perception of it, since the tinnitus itself cannot be eliminated. Cognitive Behavioral Therapy (CBT) is the most commonly used. During CBT, a therapist reviews with you the negative, often automatic, reaction that your tinnitus triggers.
You are then better equipped to live with your tinnitus, without an automatic negative reaction. When CBT is successful, affected individuals simply notice their tinnitus.
Sleep sounds
One of the main difficulties when you have tinnitus and are trying to fall asleep is that there is little to no noise at night. There may be slight ambient noises, like air conditioning or a fan, but generally, the loudest sound a person with tinnitus hears is the ringing in their ear.
To cover the sound of tinnitus, you can play white noise at bedtime. Depending on the nature of your tinnitus, music or nature sounds may also work. Due to their pitch, some types of tinnitus are difficult to mask; fortunately, there are many sleep soundtracks at different frequencies, which facilitate this masking.
In addition to covering your tinnitus, these sleep sounds also mask outside noises that may wake you up during the night.
Only go to bed when you are tired
Going to bed without being tired is the best way to have trouble falling asleep. Lying there with your eyes closed, perfectly awake, allows your mind to wander — and, in the case of tinnitus, the sound is precisely what an awake mind will latch onto.
Sometimes you may need a short nap to get a boost. But the best solution is to go to bed when you are exhausted.
Waiting until you're exhausted increases your chances of falling into a restful sleep, rather than lying awake staring at the inside of your eyelids and getting annoyed by the ringing in your ears.
Adopt good sleep hygiene
Sleep hygiene refers to how you control the parameters that influence your sleep. Good sleep hygiene consists of creating an optimal sleep environment by limiting external distractions that may wake you up, while following schedules conducive to quality sleep.
Here's a more detailed look at three aspects of sleep hygiene you can improve to sleep better. These strategies make it easier to fall and stay asleep, a valuable help for people with tinnitus.
Regular sleep schedules
The first aspect of sleep hygiene concerns your schedule. Regularity is essential, as it trains your body's 24-hour internal clock to recognize and anticipate when to sleep and when to wake up.
To fully benefit from a well-regulated circadian rhythm, you need to set a schedule and stick to it.
Many people choose to sleep in on weekends; while this extra rest can be exactly what you need, it can also disrupt the delicate balance of your sleep-wake cycle. By keeping your schedule as regular as possible, you make it easier for your body to fall asleep, get quality sleep, and feel refreshed upon waking.
Routines
A common sleep problem is the lack of a bedtime and wake-up routine. However, both of these routines are essential for getting the rest you need.
The bedtime routine should aim to relax the body and prepare it for sleep. Dimming bright lights, avoiding screens for half an hour before bed, and engaging in a calming activity like reading help quiet a restless mind and make it easier to fall asleep.
The wake-up routine is just as important as the bedtime routine for feeling rested and refreshed the next day. When it's time to wake up, make an effort to get out of bed and move around. Getting active and getting a good dose of natural light is a great way to start the day.
With a regular routine, your body will gradually associate certain actions with going to sleep or waking up. The more it learns and anticipates this routine, the easier it becomes to fall asleep and get quality sleep, as your body will naturally begin to slow down before bedtime.
The sleep environment
The next aspect of sleep hygiene is creating a sleep-conducive environment. The most difficult thing when you have tinnitus is falling asleep; if you are constantly woken up by your surroundings, the situation becomes even more complicated.
As convenient as they are, your TV, smartphone, or tablet can harm the quality of your sleep. Notifications and bright screens at night disrupt sleep and make living with tinnitus even more difficult.
Beyond reducing screens in the bedroom, limiting other external stimuli — intermittent noises, lights — helps create an ideal environment for sleeping. It's not always possible to prevent light and noise from entering your bedroom, but you can use tools like earplugs and a sleep mask to cut yourself off from stimuli that may wake you up and complicate sleep with tinnitus.
Conclusion
In summary, tinnitus can make getting a restful night's sleep difficult, but there are excellent strategies to manage it effectively and ensure you get the rest you deserve.
Approaches like CBT and listening to white noise help reduce the impact of tinnitus when falling asleep. Going to bed when you're tired and adopting good sleep hygiene helps people with tinnitus by improving their overall sleep quality.
Sources:
Rebooting the brain helps stop the ring of tinnitus in rats | NIH
A systematic review and meta-analysis of randomized controlled trials of cognitive–behavioral therapy for tinnitus distress | Science Direct
The Role of Sleep Hygiene in Promoting Public Health: A Review of Empirical Evidence | NCBI
