Tinnitus is a condition that makes you hear a noise in your ear even though no external sound exists. Tinnitus is not a real noise: it has no external source and only the patient perceives it.
In some cases, the doctor may be able to hear this sound with a stethoscope.
The noise of tinnitus can manifest as whistling, hissing, buzzing, roaring, clicking, squealing, or whooshing. For some people, it can even evoke a familiar tune.
The volume and pitch of this noise vary. Depending on the cause, tinnitus can also be temporary or permanent.
Tinnitus is not a disease, but it often signals that a problem exists, and if the cause is not quickly identified, the situation can worsen. In some cases, tinnitus announces imminent hearing loss.
Some people with tinnitus go about their usual activities without feeling its effects, while others have difficulty concentrating or carrying out their daily activities.
A common complaint among patients with tinnitus is the inability to sleep. Most of them explain that the noise becomes unbearable as soon as they lie down, preventing them from falling asleep.
In this article, we explain why tinnitus worsens when lying down. But let's start by briefly looking at some causes of tinnitus.
Causes of Tinnitus
Here are some common causes of tinnitus.
1. Prolonged exposure to loud noises
Constant exposure to loud noises is a major cause of tinnitus. Intense noise can permanently damage the cells of the cochlea.
Recreational and occupational noises from sources such as heavy machinery, explosions, firearms, concerts, nightclubs, and chainsaws can also cause tinnitus. The effects of noise on the ear can be temporary or permanent.
The duration of tinnitus depends on the duration of exposure. In some cases, tinnitus can progress to hearing loss.
2. Ototoxic medications
These are medications whose side effects can damage the ear. They are often used to treat conditions such as heart disease, kidney disease, infections, and cancers. Some painkillers also fall into this category.
Ototoxic medications generally cause acute tinnitus, which can be temporary or permanent depending on the degree of ear damage.
Medications that can cause tinnitus include aspirin, loop diuretics, certain antibiotics, antidepressants, anti-inflammatories, and quinine-based treatments.
3. Earwax blockage
A significant accumulation of earwax in the ear can cause tinnitus. Tinnitus due to earwax blockage is often temporary and usually disappears once the earwax is removed.
4. Damage to the hair cells of the inner ear
Tinnitus can result from damage to the hair cells of the inner ear. These hair cells are responsible for sending electrical signals from the ear to the brain. This signal is then interpreted by the brain as sound.
When hair cells are damaged, they start sending random signals to the brain, causing tinnitus.
Tinnitus due to damage to the hair cells of the inner ear is permanent.
5. Other causes
Other factors can cause tinnitus: dental problems, head or neck tumors, age, high blood pressure, Meniere's disease, temporomandibular joint (TMJ) syndrome, otosclerosis, and head or neck trauma.
Why tinnitus appears when lying down
If you suffer from tinnitus, you have probably noticed that at times the noise does not bother you, and at other times it becomes unbearable.
One of these painful moments occurs when you are lying down. This is very frustrating and can affect the quality of your sleep; this is why most patients with tinnitus experience insomnia.
People whose noise worsens when sitting, lying down, or with head movements usually have pulsatile tinnitus.
Pulsatile tinnitus often manifests as a rhythmic noise, synchronized with the heartbeat. The sound most affected people perceive is actually the sound of blood flowing through their bodies.
Your tinnitus gets louder when you lie down due to pressure on nerves, blood vessels, and muscles.
Changing from a standing or sitting position to a lying position alters blood circulation in the vessels. This change can intensify tinnitus, especially when it is due to a vascular disorder.
Here are some blood vessel-related disorders that can cause tinnitus, especially when lying down.
Atherosclerosis
With age, the main blood vessels around the middle and inner ear lose their elasticity. In addition, there is an accumulation of cholesterol and other deposits in the vessels. Blood then flows through them with more force and becomes audible.
Capillary malformation
The development of abnormal connections between veins and arteries, called arteriovenous malformation (AVM), can cause tinnitus in only one ear.
Neck and head tumors
The growth of a tumor in the head or neck can also cause tinnitus. This often occurs when the tumor compresses blood vessels in the head or neck. A benign ear tumor that has appeared as a result of repeated infections can also cause tinnitus.
Turbulent blood flow
When the carotid artery or jugular vein in the neck narrows, blood flow can become irregular or turbulent. This turbulence causes tinnitus.
Hypertension
People with high blood pressure are prone to tinnitus. Increased pressure of blood flowing through the veins can promote the onset of tinnitus.
To date, there are no medical recommendations on the position to adopt for lying down or sleeping when suffering from tinnitus. You are advised to sleep in the position in which you feel most comfortable and which helps you fall asleep faster.
That said, if the noise affects only one ear, it is recommended to lie on your side, with the affected ear covered or clear, which can improve the quality of your sleep.
You can also wear headphones playing sound or music to mask the noise or create a sound distraction from tinnitus. This is called masking, and this technique can be very effective.
If you use headphones or earbuds, lie on your back so as not to put pressure on the side of your face or ear. Also make sure the volume is not too high.
Tinnitus when lying down at night
Bedtime is a dreaded time for most people with tinnitus, as the noise intensifies as soon as they lie down. It can become so intense that you are unable to sleep all night.
The main reason your tinnitus intensifies at night is the lack of auditory input. Without you even being aware of it, your ear constantly picks up sounds throughout the day. But you don't notice it because you are used to it: these noises no longer attract your brain's attention and are therefore neither interpreted nor analyzed.
These continuously picked-up background noises help to cover up the tinnitus, so you don't hear it during the day.
In the evening, however, everything becomes silent, and the absence of background noise makes tinnitus unbearable.
Furthermore, the brain itself can create noise, even in the absence of external sound. Indeed, it is accustomed to perceiving a background sound throughout the day. The silence of the night does not correspond to what it knows during the day, and it then begins to fill this void with its own sensations.
In addition to the lack of auditory input, some medications taken at bedtime can worsen tinnitus.
This is the case with aspirin, a painkiller that many take for relief before going to sleep. Aspirin is an ototoxic drug and will worsen tinnitus.
Taking aspirin in the evening, combined with a lack of auditory input, can make tinnitus formidable and lead to psychological disorders such as anxiety and depression. Drinking alcohol in the evening can have similar effects.
Conclusion
One of the best ways to manage tinnitus that worsens when lying down is to use a white noise generator in your bedroom.
This not only reduces the intensity of the tinnitus noise but also limits the brain's need to create sound to fill the void left by the absence of background noise.
For tinnitus related to a vascular problem, some medications can provide relief by dilating blood vessels and allowing more oxygen to flow to the outer and inner ear. The ears then function better. However, we advise you to consult your doctor before taking any treatment.
Does your tinnitus worsen when you lie down? How do you manage it? Share your suggestions in the comments section.
To learn more about tinnitus and other hearing disorders, discover CLARIA.
