Sleep and Tinnitus
About half of all people with tinnitus report that it disturbs their sleep. This may mean that the tinnitus makes it hard for them to drop off to sleep, prevents them from returning to sleep when they wake in the night, or wakes them before they are ready to get up.
Different people need different amounts of sleep. Some people need at least eight hours, others can get by on only three or four. As you grow older, you are likely to experience less deep sleep, more light sleep, and more awakenings during the night.
Lack of physical activity may contribute to poor sleep patterns, so increasing physical activity can lead to improvement.
Everyone has a ‘natural sleepiness cycle’. Sleepiness tends to increase every 60 to 90 minutes or so. As you find yourself getting sleepy, you may decide “I’ll just finish this . . .” but by the
time you finish your task, the sleepiness has passed – you’ve got your ‘second wind’. If you go to bed during the wave of sleepiness you’ll fall asleep more quickly.
Lying in bed just resting is also relaxing – you don’t have to be asleep. Lying in bed peacefully is much more restorative than lying in bed worrying.
Sleep can be disturbed by sounds, physical discomfort, travel across time-zones, or worry.
Everyone has a bad night now and then but generally recovers with a night of good sleep.
States and stages of sleep on a typical night
Normally, sleep begins with Stage 1 of NREM (non-rapid eye movement) sleep, which feels almost like meditating. A few minutes later, in Stage 2, the awareness of place is gone. Sleep becomes deeper and more restful during Stages 3 and 4. During these four NREM stages, the body slows down. Heart and breathing rates and body temperature all slowly decrease. Then sleep drifts back through Stages 3 and 4. This total NREM period is normally 80-100 minutes. Suddenly, REM (rapid eye movement), a different kind of sleep, begins. The eyes move back and forth in this stage. The heart and breathing rates increase and become erratic. There are vivid dreams during REM sleep
This NREM/REM cycle recurs approximately every 90 minutes throughout the night. It is also normal to wake briefly, several times during the night.
The effects of tinnitus on sleep
Tinnitus can affect your sleep in different ways.
First, the incessant noise of the tinnitus can be an annoying distraction when you are seeking peace and quiet, thus preventing you from dropping off to sleep.
Second, worrying about the tinnitus, listening to it actively and wondering about it may also increase your physical and mental tension and make it hard to relax enough for sleep to overcome you. Tinnitus typically sounds louder when there are fewer external sounds present – the night and early morning are quiet so your tinnitus may seem to be amplified.
Some people also find their tinnitus very noticeable in the morning, perhaps because the slight ear blockage present on awakening dulls their hearing and increases their attention to internal sounds.
Managing sleep difficulties
Treatment for sleep difficulties associated with tinnitus consists of:
Sleep Education: learning about normal sleep patterns and the normal sleep/wake cycle.
Sleep Hygiene: only using your bed for sleeping – avoid reading, watching TV, using electronic devices or eating in bed.
Establish an Optimal Sleep Pattern: go to bed at around the same time each night but if you do not fall asleep within about 30 minutes of turning out the light, get up and do something else until the next wave of sleepiness arrives.
Sleep Restriction: avoid daytime naps and going to bed before 10.00pm. Avoid trying to ‘make up’ for lost sleep by sleeping in or going to bed very early.
Relaxation: stress, anxiety and worry related to the tinnitus and/or to other events can disturb your sleep. There are specific and effective techniques that can reduce or eliminate anxiety and body tension. As a result, your mind is able to stop ‘racing’, your muscles can relax, and you can drift into restful sleep. Enrol in a relaxation course near home or try guided relaxation practice using a recording - from music stores, bookstores or over the Internet.
Rehearsal/planning: list activities for the next day to ‘put them out of your mind’, avoid eating spicy foods or performing any energetic exercise in the hour or two before you go to bed, wind down with a relaxing activity, e.g. have a warm bath.
Use of External Sounds: it is important to avoid silence so that your ear has something ‘real’ to listen to. This will help to distract you from the tinnitus. Opening the window or turning on a fan provides subtle sound. Bedside sound generators of various kinds, including smartphone applications, can deliver non-meaningful sounds via a standard speaker, an earphone or ear-bud, or a special speaker under the pillow.
“Sleep Better Without Drugs” Dr David Morawetz
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