The Importance of REM Sleep for Tinnitus
by Barry Keate
Approximately 60% of patients with tinnitus experience disturbances of the normal sleep pattern. In one clinical study, 26 patients with tinnitus and sleep disturbance were subjected to sleep studies involving polysomnography (PSG). (1) PSG records sleep patterns such as airflow in the lungs, blood oxygen levels, brain waves using EEG, breathing and heart rate, and electrical activity of the muscles.
In 17 of the 26 patients, PSG revealed a pathological sleep analysis: 10 patients were diagnosed with obstructive sleep apnea, four with insomnia and an increase in nighttime awakenings as well as a reduction in deep sleep and REM (rapid eye movement) phases. Pathological movements of the legs were seen in three cases. In six of the nine patients with normal sleep during the study, the patients displayed a prolonged time delay before falling asleep. The authors concluded saying sleep disturbances are a factor that strongly predicts decreased tolerance to tinnitus.
Another study sought to determine the prevalence of insomnia and its impact on the quality of life among community elderly subjects (at least 65 years of age) with subjective tinnitus. In this study, 52% were found to have insomnia and it was significantly more common among those with tinnitus than those who did not have tinnitus. Results indicated that insomnia is much more common among elderly subjects with tinnitus than those without, and its presence further depreciates quality of life in these elderly individuals. (2)
A study conducted in Israel, found associations between tinnitus, insomnia and depression. Eighty military personnel with tinnitus and noise-induced hearing loss were evaluated. The self-rated severity of tinnitus was greater in subjects with higher sleep disturbance scores. Self-rated depressive symptoms were also highly correlated with sleep disturbance. (3)
As we can see from the above references, tinnitus can and often will produce sleep disturbances, reduce quality of life, and increase depression in patients with tinnitus. But what is the mechanism causing these problems?
There is a connection between insomnia and the degradation of rapid eye movement (REM) sleep that is a consequence of insomnia, especially if combined with prescription sleep medications.
There are two main stages of sleep, rapid eye movement (REM) sleep and non-rapid eye movement (NREM) sleep, which includes stages 1-4. REM sleep typically occupies 20-25% of normal sleep, about 90-120 minutes a night. It is considered the lightest stage of sleep and occurs periods of varying duration throughout the night.
Polysomnograms show brainwave patterns in REM to be similar to that recorded during wakefulness. During this stage the eyes move rapidly in different directions.
Intense dreaming occurs during REM sleep as a result of heightened brain activity, but muscle paralysis occurs simultaneously in the major voluntary muscle groups. REM is a mixture of excited brain states and muscular immobility.
The function of REM sleep is not totally understood but there are several, widely agreed upon, theories. REM sleep appears to be crucial for the consolidation of memory and learning, plays an important role in the development and maintenance of the central nervous system (CNS), preserves the function of the immune system and aids in the creative process. REM sleep is essential for the rejuvenation and neuroplasticity of the neuronal synapses, which allows the brain to learn, grow and adapt to changing stimuli.
REM sleep deprivation leads to psychological disturbances, such as anxiety, irritability, hallucinations and difficulty concentrating. (4) These conditions, in turn, lead to increased sensitivity to and decreased tolerance of tinnitus.
Unfortunately, many people with tinnitus and sleep-related disorders turn to their doctors for pharmaceutical help, either for their tinnitus or in order to get a good night’s sleep. All too often, they leave the doctor’s office with a prescription for a benzodiazepine medication.
Benzodiazepine medications present a host of problems to those who use them longer than a very short time. They become addictive very quickly so the dose has to be constantly increased. If not, they begin to produce the same symptoms they were meant to treat and eventually can make those symptoms much worse. Benzodiazepine withdrawal can be a nightmare, accomplished only over a long period of time.
A discussion of these medications used as sleeping pills is included in the book, “Tinnitus Retraining Therapy” by Drs. Pawel Jastreboff and Jonathan Hazell. In their words, “The very frequent consequence of sleep disturbance is that many tinnitus patients are taking sleeping pills. This has the negative effect of interfering with normal sleep patterns: decreasing the proportion of the rapid eye movement (REM) stage of sleep that is essential for rest. Patients might be unconscious for a longer time than without medications but will not necessarily experience more REM sleep. These drugs, commonly in the tranquilizer group, produce significant changes within the central nervous system and especially the limbic system. Although they may be helpful in the short term, when there is intense distress, they do not break the vicious cycle of tinnitus reaction. It is important to recognize the negative side effects of such drugs, the possibility of development of dependence and the fact that they will not help tinnitus in the long term”. (5)
The solution to the problem consists of finding a natural compound that will aid in sleep, not cause dependency, and increase REM sleep time. Such a compound exists in melatonin, a hormone produced in the pineal gland of humans that regulates sleep patterns and increases REM sleep.
In two randomized trials conducted in Germany, melatonin showed great promise. Fourteen patients with neuropsychiatric sleep disorders and reduced REM sleep duration (25% or more below normal) were given melatonin for a four-week trial. It was shown that melatonin was significantly more effective than placebo: patients on melatonin experienced significant increases in REM sleep percentage. There were also substantial improvements in measures of daytime dysfunction. The effects outlasted the period of melatonin administration and diminished only slowly over time (6)
In July 2013, we introduced our newest product, Arches Tinnitus Sleep Formula™ . In an accompanying Quiet Times article, “Melatonin, Sleep and Tinnitus,” we discussed the action of melatonin on tinnitus-induced insomnia.
For those having difficulty sleeping due to tinnitus or other causes, or have daytime dysfunction (anxiety, irritability and difficulty concentrating) that may reflect disturbed sleep patterns and reduced REM sleep; they may be greatly helped by Arches Tinnitus Sleep Formula™.
1 – Eysel-Gosepath K, Selivanova O. Characterization of sleep disturbance in patients with tinnitus. Laryngorhinootologie. 2005 May; 84(5):323-7.
2 – Lasisi AO, Gureje O. Prevalence of insomnia and impact on quality of life among community elderly subjects with tinnitus. Ann Otol Rhinol Laryngol. 2011 Apr;120(4):226-30.
3 – Alster J, Shemesh Z, Ornan M, Attias J. Sleep disturbance associated with chronic tinnitus. Biol Psychiatry. 1993 Jul 1-15;34(1-2):84-90.
4 – http://en/wikipedia.org/wiki/rapid_eye_movement_sleep.
5 - Tinnitus Retraining Therapy, Pawell Jastreboff and Jonathan Hazell, Cambridge University Press, 2004, p 97.
6 – Kunz D, Mahlberg R, Muller C, Tilmann A, Bes F. Melatonin in patients with reduced REM sleep duration: two randomized controlled trials. J Clin Endocrinol Metab. 2004 Jan;89(1):128-34.