Sleep and Tinnitus

Getting past the tinnitus and into Dreamland

By Barry Keate
Barry Keate, has lived with tinnitus over 40 years and has published 150+ research articles on numerous aspects of tinnitus. He is an expert on the condition and a well-known advocate for those with tinnitus.

Getting a good night’s sleep is extremely important for people with tinnitus. Unless we sleep well we become drained, our energy reserves are depleted, nerves are frayed and tinnitus becomes potentially much worse. We all must do whatever we can to ensure we sleep well so we have the energy and good spirits to deal with the noise.

I remember when I was in the worst throes of my tinnitus and the problems I had. I could get to sleep fairly easily but would wake up in the middle of the night. My tinnitus was very loud. At that time of night our defenses are low and we are more vulnerable to what disturbs us. I would wake up and not be able to go to sleep again. Thoughts would go through my head like “How can I keep this up for the rest of my life?” I even had anxiety attacks in the middle of the night. Adrenaline would shoot into my system and I’d sit bolt upright in bed, heart pumping loudly, ears screaming and anxiety coursing through me.

Fortunately, my tinnitus is now under control, much quieter, and I sleep well. When I do wake up, it’s not because of the noise and I usually drop off again quickly. But over the years I have learned a lot about how to get to sleep and stay asleep despite the sound. I would like to discuss some of the ways I learned to do this. I’ll also discuss ways that I did not use but have proven effective for other people.

Regular, vigorous exercise is necessary for everyone but especially for those people plagued with tinnitus. Exercise increases circulation, helps rid the body of toxins, and feeds nutrients to the brain and auditory passage. It is a tremendous stress reliever, helping us cope with stress and be more relaxed. Exercise releases endorphins which increase pain thresholds and produce feelings of wellness. Regular exercise aids greatly in getting a good night’s sleep. We should exercise a minimum of three times weekly for at least 20 minutes after our heart rate begins to increase. It is important not to exercise within three hours of bedtime but late afternoon or early evening is fine.

There are a number of relaxation techniques that are also valuable tools in sleeping well. The American Tinnitus Association (ATA) has long advocated both biofeedback and hypnotherapy for those with tinnitus. A more detailed discussion of these and the description of a good relaxation technique is found in our Information Center article “Stress and Tinnitus.”

Tinnitus Masking
Tinnitus masking and tinnitus instruments are two ways to mask the annoying sound of tinnitus. A tinnitus masker is a device that usually fits within the ear canal and emits a sound designed to take a person’s mind off tinnitus. A tinnitus instrument is a combination hearing aid and tinnitus masker. It amplifies outside sound and produces a distraction from the internal sound of tinnitus. Tinnitus instruments are the most effective at masking tinnitus. They also have the advantage that at night the hearing aid can be turned off and the masker left on, allowing the person to go to sleep.

A more detailed explanation of hearing Aids, tinnitus maskers and tinnitus instruments can be found in our Information Center article “Tinnitus Masking .”

Many people simply leave a radio or TV on or a fan blowing to distract their attention. This can be very effective for some but I have heard reports of less than amused spouses who objected to the extra sound.

It has been shown many times that the best masking sounds for tinnitus are the sounds of running, splashing or falling water. This was the groundbreaking discovery that led Dr. Jack Vernon on his quest to develop tinnitus masking techniques. There are many sound generating devices on the market today and they can be found in most department stores. They are like a bedside clock radio in size and they can generate a range of sounds, chosen by the person using it. Most of these will include the sounds of bubbling brooks, rainfall or crashing surf. They are quite inexpensive and can be a great help in getting to sleep.

There is a long list of natural sleep aids that can be very helpful in taking us to the slumber zone. Black Cohosh eases pain and is relaxing. This was used by Native Americans to ease menstrual cramps and is useful in relieving pain from neuralgia.

Chamomile promotes a feeling of well-being. It’s good for the digestion, is relaxing and generally soothing and relaxing. A cup of chamomile tea before bedtime is an excellent way to encourage sleep.

Gotu Kola is an Asian herb that has a calming effect and improves circulation. It is very good for the nervous system.

Valerian Root is probably the best known herbal remedy for sleeplessness. It eases both nervous and muscle tension. It’s great for combating stress and relieving insomnia. Valerian tea is a natural sedative. High doses could cause paralysis and a weakened heartbeat, but used as the package suggests, it is a very beneficial aid to sleep. It is known as the valium of the nineteenth century.

One of my favorites and one I use on a fairly regular basis is melatonin. This is a hormone that is produced in the pineal gland and is a part of serotonin metabolism. It is responsible for regulating mood and sleep patterns, is a powerful antioxidant and has been shown to be helpful for some people with tinnitus.

A clinical study conducted at the Ear Research Foundation in Sarasota, FL, tested 3 mg melatonin on tinnitus patients for one month. They found that those people who did not have trouble sleeping were not greatly benefited by the melatonin. However, of the people who had difficulty sleeping, 47% reported an overall improvement in their tinnitus.

I find that if I take a 3 mg quick-release melatonin, I wake up at around 3 AM feeling pretty good but it’s difficult to get back to sleep. I use a time-release formula and it keeps me asleep all night long. Time-release melatonin can be hard to find in many stores. I purchase mine from the Life Extension Foundation at Search for “timed-release melatonin” or only the quick-release products will show up.

Many people will have good results from 3 mg melatonin. For others, it may not be enough and they will need to take 6 mg. This should not be harmful. If you take too much, the worst that happens is you wake up feeling groggy. In this case reduce the amount the next evening. It takes several days usage before melatonin becomes fully effective.

Because melatonin suppresses corticosteroid activity, those who are taking corticosteroids for anti-inflammatory or immune suppressive purposes (e.g., transplant patients) should exercise caution with melatonin supplementation. Melatonin could interfere with fertility. It is also contraindicated during pregnancy and lactation.

Tryptophan is also very helpful for getting to sleep. Tryptophan metabolizes into melatonin and serotonin. It has been taken off the market by the FDA but is prevalent in many foods including turkey and milk. The tryptophan in milk is released when it is heated. In my bad times, when sleep was very difficult, I would wake up with horrible thoughts and couldn’t fall back asleep. I found if I warmed up a glass of milk, not too hot, just warm to take the chill off, it would knock me out for the rest of the night. Read the complete story on Tryptophan, Serotonin, Melatonin and Tinnitus at our Information Center.

GABA (Gamma Amino Butyric Acid) is a calming neurotransmitter. It is helpful for getting to sleep and for many people it helps lower tinnitus sounds. It is a natural brain tranquilizer. There are many neurotransmitters at work in the brain. Two main categories are excitatory and inhibitory neurotransmitters. Glutamate is an excitatory neurotransmitter and is the main villain in those with cochlear-synaptic tinnitus. This is the type characterized by hearing loss. GABA is an inhibitory neurotransmitter and works to neutralize the overabundance of glutamate. A dosage of 500 to 1,000 mg of GABA before bed helps reduce mental tension and aids in sleeping. It is very inexpensive and can be found in most health food stores. It can produce sluggishness and should be treated as a tranquilizer. Please be very careful driving or operating equipment when using GABA.

I am not a big fan of prescription medications and try to stay away from them as much as possible. However, sleeping well is of the utmost importance to those of us with tinnitus. If none of the above suggestions are helpful in getting to sleep, it may be necessary to resort to prescription meds.

There are two main categories of prescription meds used to help people sleep. The first is the benzodiazepine group which consists of drugs likeValium, Xanax and Klonopin. The second is the non-benzodiazepine hypnotics which includes Ambien and Lunesta.

Valium, Xanax and Klonopin are benzodiazepine drugs that many doctors prescribe for tinnitus. They are addicting to varying degrees and cannot be used continuously for a long period of time. They are helpful in reducing tinnitus symptoms and aid in sleeping. Valium is the most addicting of these and is not used often for this reason. Xanax is very popular and is prescribed often for tinnitus. However, the ATA report on medications that cause tinnitus lists Xanax as causing it in 6.6% of cases. For this reason I am not a fan of Xanax.

A slower acting and somewhat less addicting medication is Klonopin. It takes longer to become dependent on Klonopin and it does not cause tinnitus. A small dose of Klonopin before bed can be very effective.

The non-benzodiazepine hypnotics Ambien and Lunesta are frequently prescribed as sleeping aids. These medicines are very effective in aiding sleep. These medications are not addicting in the sense of being narcotic but people can become psychologically dependent on them. This means if they are used over a long period people are uncomfortable when they discontinue. This is called rebound insomnia and will often disappear after several days.

Ambien and Lunesta work by activating the GABA receptors in the brain. This is essentially the same thing as taking GABA supplements. Rather than adding GABA, Ambien and Lunesta make the existing GABA more available, therefore more effective. Adding GABA makes it more effective also. Think of GABA as the natural Ambien.

Of course, the best way to reduce the sleepless aggravation of tinnitus is to reduce the tinnitus sound itself. The ingredients used in Arches Tinnitus Formulas have been shown in numerous clinical trials to reduce tinnitus sound for most people who use them according to recommended dosage and for the prescribed period of time.

You may want to try different approaches to getting a good night’s sleep. One or more of these should be effective in helping you drop off. Once a tinnitus sufferer begins to sleep well again, tinnitus typically improves. Remember if you choose to use nutraceuticals or pharmaceuticals make sure you read thoroughly all cautionary notes and use only as indicated. Relaxation techniques like biofeedback and self-hypnosis are the safest and have no side effects. I hope you find something here that can work for you and I’ll look you up in Dreamland.