Sleep Care

Tinnitus and Sleep

If you’ve ever experienced a mild ringing or buzzing sound in your ears, you’re not alone: about one third of all adults have the symptoms of tinnitus at some point in their lives. Usually, the sound will last for a period of time and fade away, or come and go in short intervals. For about 10%-15% of adults, however, the duration is longer and requires a medical evaluation. In extreme circumstances—such as when it lasts for more than two years—tinnitus can be considered permanent. It occurs most commonly in people over forty, and tends to affect more men than women.   The causes of tinnitus can vary widely Tinnitus is not a disease, but rather a symptom of some underlying cause. The reasons for a person developing tinnitus can vary widely. Common causes include natural aging, working around loud noises, and a buildup of earwax developing in the ear. Some medications—such as large doses of aspirin—are capable of causing tinnitus. Ruptures of the eardrum, blows to the head, drinking an excessive amount of alcohol or caffeinated beverages, and repeated exercise with the neck in a stretched or strained position—such as when bicycle riding—can also lead to its development. While there may be a variety of triggers for tinnitus to occur, studies have found that it typically takes more than one trigger occurring simultaneously for it to develop. Stress can also be a significant factor as well: about 75% of new cases of tinnitus have some component of emotional stress as a main factor, compared to cases where a more biological explanation was the underlying cause. Tinnitus and sleep Although it is common for people with chronic tinnitus to have sleep problems, the exact relationship between tinnitus and sleep is unknown. A Brazilian series of studies done in 2005 evaluated tinnitus and bruxism (teeth grinding while asleep), finding that the frequency of tinnitus was greater in subjects with sleep bruxism and chronic facial pain (as compared to a normal control group). Participants in other studies have reported that tinnitus is louder when first awakening, which may suggest that bruxism can increase the severity of tinnitus due to jaw and neck contractions during sleep. Insomnia is another sleep problem prevalent in people with chronic tinnitus—although the effect of tinnitus on insomnia may be minimal. According to a 2007 study, subjects with tinnitus and insomnia reported they took longer to fall asleep than those with only insomnia when answering questions about their sleep while being evaluated in a lab. However, no differences were observed for measures of self-reported daytime tiredness, depression, or ability to performed sustained-attention tasks the following day. Varied causes, varied treatments Fortunately, since there are a variety of causes for tinnitus, there are several different courses of treatment for it as well. These generally fall into two categories: treatments designed to reduce the intensity of tinnitus, and treatments designed to lessen the psychological irritation caused by the constant noise. Medications can be useful in reducing tinnitus, although research into this has been challenging due to a strong placebo effect in trials and the subjective nature of results (i.e., patients are reporting their experience of whether or not the tinnitus is still present; there is no way to objectively verify this outside of those self-reports). Several drugs capable of improving sleep—such as amitriptyline and clonazepam—have been shown to be more beneficial than placebo. A 2006 study done on the effects of melatonin on tinnitus and sleep found an association between the amount of improvement in sleep and tinnitus, with melatonin’s impact on sleep being greatest among subjects with the worst sleep quality. For some, the use of sound therapy can provide adequate resolution to their tinnitus symptoms. Typically, this is done through use of a noise machine or music set to the lowest level that provides relief. When using this approach, it is important for the sound to be introduced bilaterally to the ears to avoid the perceived location of the tinnitus moving from one ear to the other. For example, if using a music player in the bedroom to resolve tinnitus problems during sleep, make sure it is placed at a central location, such as the middle of a dresser

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across from the foot of the bed—do not place the music player on a nightstand to the side of the bed, as this would cause the sound to reach each ear differently. Since tinnitus can be very psychologically irritating, cognitive therapy can be beneficial to replace negative ways of thinking about tinnitus with positive ones, especially for patients whose tinnitus is permanent and irreversible. Behavioral therapy focusing on positive imagery, attention control, and relaxation training can also be useful. For those whose tinnitus is caused primarily by neck and jaw strain, massaging and stretching the neck and jaw muscles regularly has been associated with a significant improvement in symptoms.

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