Tinnitus often interferes with sleep. What can you do to sleep better with tinnitus?
Tinnitus is very common, affecting around 15% of adults, with around 1-2% of people having it bad enough that it severely affects quality of life. In its severe forms, tinnitus can be associated with depression, anxiety and insomnia. In my practice I see a number of people who find it hard to sleep because of tinnitus. Unfortunately, there is no cure for tinnitus, so treatments focus on lessening the awareness of tinnitus and its impact on quality of life, rather than a cure.
What is tinnitus?
Tinnitus is the perception of sound in the head without an external source of noise being present. Some people describe it as a ringing in the ears, others describe it as a static noise, ringing, buzzing, roaring, whistling or hissing. It may be intermittent or may occur continuously sometimes being stronger than at other times.
It’s not really known why tinnitus occurs, but it can occur more often in people who have had prolonged noise exposure and head or neck injuries
How is tinnitus treated?
Treatment for tinnitus is aimed at controlling underlying disorders and suppression the symptoms and perception of tinnitus. As such, the primary goal of treatment has been improvement in quality of life rather than curing the condition. This can be achieved through a variety of regimens, but none are completely effective.
Medications aren’t really effective in managing tinnitus. There are no medications approved by the Food and Drug Administration (USA) or European Medicines Agency (EMEA) for the treatment of tinnitus as no medication has been proven to be effective. Despite this there are a number of medications that are trialled to help reduce the symptoms of tinnitus, such as antidepressants (e.g. amitriptyline), benzodiazepines (e.g. diazepam or clonazepam) and anti-histamines.
Non-drug treatments, in contrast to medications, have been shown to have some effect in reducing the symptoms of tinnitus. Some of the non-drug treatments studied include:
- Tinnitus retraining therapy (TRT) – aims to reach a stage where people are unaware of tinnitus unless they consciously focus on it. This is achieved by a combination of counselling, together with low-level noise generated by wearable noise generators or environmental sounds. Improvements have been reported in up to 80% of people, but research studies are not of high quality, and treatment takes 1-2 years before effects are seen.
- Masking – uses devices such as noise generators to produce low-levels sounds such as white noise to reduce the perception of tinnitus. Some people report this to be an effective technique, but a meta-analysis failed to show conclusive evidence that masking is effective.
- Biofeedback – is a relaxation technique that teaches people to control certain autonomic body functions. The goal is to help people manage tinnitus-related distress by changing their reaction to it.
- Cognitive behavioural therapy (CBT) – aims to motivate people to learn to alter their psychological response to tinnitus by identifying and reinforcing coping strategies, distraction skills and relaxation techniques. Several studies and a meta-analysis have shown benefit compared to control patients in reducing tinnitus-related distress, but no benefit on the loudness of the tinnitus.
- Mindfulness – incorporates mediation and yoga to help people face, explore and alleviate suffering by relating to present experiences. A number of small studies, such as this one, have shown mindfulness training reduces tinnitus symptoms as well as improving quality of life.
- Surgery – such as microvascular decompression (MVD) of the 8th cranial nerve has been used. In 43 cases of tinnitus described in this study, 60% of people had a positive outcome, particularly those who had had symptoms for less that 5 years.
What can be done to sleep better with tinnitus?
When people have symptoms of tinnitus and disturbed sleep or insomnia, I will often use a combined approach bringing together a number of the above strategies.
- CBT and mindfulness – have been shown to be effective both as treatments for tinnitus and insomnia. For each of these conditions, these psychologically-based treatments are effective at reducing the impact of symptoms and distress symptoms cause.
- Masking – or use of white noise / background noise during sleep has been shown to improve sleep (discussed in more depth in this post) as well as reduce symptoms of tinnitus. A study conducted in 2006 in 39 people with tinnitus, showed that using a sound generator during sleep improved sleep quality. The most popular sounds were ‘brook’ and ‘birds’.White noise is thought to work by creating a background screen of noise, so that even if other noises occur in the environment or internally such as with tinnitus, those noises are masked or screened out by the white noise.
- Medication – alone is not an effective treatment for tinnitus, but can be helpful to address sleep disturbance associated with tinnitus. If people have ongoing trouble with sleep and tinnitus despite using CBT, mindfulness and masking, I will look at adding a sedative medication such as one of the benzodiazepines (e.g. clonazepam) or anti-depressants (e.g. amitriptyline).
Related posts & links:
- Can white noise help with sleep?
- Tinnitus Association of Victoria
- Tinnitus and sleep disturbance – British Tinnitus Association
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