Can Tinnitus Cause Insomnia? (Science Says...Yes!)

Long story short, there’s actually quite a bit of research showing that people who suffer from tinnitus often have sleeping issues as well.

A survey of 174 tinnitus patients found that about 25% of them had chronic sleep issues. The more severe their tinnitus symptoms were, the more likely they were to have difficulty sleeping (1).

If you’d like to know why tinnitus can cause insomnia symptoms, and how it’s usually treated, read the rest of this short post.

The Link Between Stress and Both Insomnia and Tinnitus

One of the biggest risk factors of insomnia is stress.

Stress makes it difficult to get to sleep, that much is obvious.

When researchers have looked at patients with both insomnia and tinnitus, they found that (2)

…objectively showed that patients with insomnia have an increased emotional distress associated with their tinnitus.

In other words, when tinnitus causes people a large amount of stress, it makes sense that it leads to sleep issues.

Furthermore, both tinnitus and insomnia are linked to similar stress-related conditions including depression and anxiety disorders.

To make things worse, there’s some research that suggests that this loop conditions your brain to associate tinnitus with stress, which can cause chronic stress and insomnia issues (3).

SummaryStress caused by tinnitus is the main reason that it leads to insomnia. It’s also possible for the stress that comes as a result of insomnia to make tinnitus symptoms worse (and so on in a vicious cycle until chronic insomnia develops).

How Tinnitus Affects Sleep Quality

Sleep problems come in many different forms.

When it comes to tinnitus, it typically makes falling asleep the most difficult part, rather than issues like waking up early.

Researchers have found that both primary insomnia and distressing tinnitus are results of physiological hyperarousal (4).

Hyperarousal is essentially another way to say that your body and mind are on “high alert,” and is a common symptom of stress-related disorders.

While there’s research to confirm it, it’s pretty obvious that being in a state of hyperarousal makes it more difficult to fall asleep (i.e. delayed sleep onset).

In addition, it can result in lighter sleep, increasing the difficulty of maintaining sleep leading to waking up during the night and inconsistent sleep-wake cycles.

The Effect of Age on Tinnitus and Insomnia

One risk factor of insomnia is age. The older you are, the more likely you are to develop sleep issues.

At the same, studies also show that tinnitus is more common as age increases (7). In addition, tinnitus severity is linked to the age that it develops (more severe in older patients).

In more practical terms, if tinnitus and insomnia aren’t fixed or improved significantly, they typically only get worse over time as you age.

How Comorbid Tinnitus and Insomnia is Treated

The semi-good news is that since tinnitus and insomnia are often both caused by an underlying amount of stress, they can be treated at the same time for many patients.

Evidence currently supports that stress-relieving therapies have a positive influence on both sleep quality and tinnitus-related distress (4).

The primary therapy used for this is cognitive behavioral therapy (CBT) to learn how to manage stressful thoughts better. Research shows that it is highly effective (5).

Similarly, neurofeedback is an approach that has successfully been used to treat insomnia and tinnitus (6).

Cognitive Behavioral Therapy for Treating Tinnitus

Currently, the most effective and leading treatment for insomnia is cognitive behavioral therapy (CBT).

CBT involves reframing how you interpret thoughts, and is often helpful for a wide variety of stress-related disorders.

Since stress plays a big role in long term tinnitus and the sleep problems it can cause, some researchers have studied and found that CBT can be effective in patients with both insomnia and tinnitus (5).

In a German study with 95 patients who had chronic tinnitus (with an average age of 49.3 years), multiple treatment methods were tested:

• Group 1 - White noise generators (to drown out ringing)
• Group 2 - Hearing aids
• Group 3 - CBT for 3 months
• Control group - No action taken

There was no significant difference between any of the experimental groups, but the results overall were promising.

In the CBT group:

64.5% of our patients improved significantly after the initial group therapy. In contrast, the patients of the waiting list control group showed no significant improvement.

The chart below shows the mean values of the tinnitus questionnaire total score in the CBT group (a higher score indicates worse symptoms).

While the biggest improvement occurred at the 3 month follow up (the middle bar), there were still further improvements seen at the 6 month follow up.

So even after the 3 month treatment period, the takeaways from the treatment continued to persist and even improve.

Neurofeedback for Treating Tinnitus

No one treatment works for everyone, so it’s always good to find alternatives.

A neurofeedback protocol uses software to alter brain wave activity in certain areas to combat over or underactivity (8).

Research has shown that people with tinnitus often have overactivity in delta frequency brain waves, and underactivity in alpha frequencies (6).

The graph below effectively shows how a neurofeedback was able to normalize delta frequency brain waves over a period of 6 months in tinnitus patients.

There’s a clear immediate benefit after the session, but also an upwards trend over time, showing that this can be a long-term solution.

At the 1 month follow up, patients had significant improvements in:

• Intensity of tinnitus symptoms
• Annoyance levels from tinnitus noises
• Effect on life
• Overall problems

SummaryWhen a patient has both tinnitus and insomnia (or even lesser sleep issues), a physician will typically prescribe some sort of stress-relieving therapy like CBT.

Consequences of Insomnia From Tinnitus

There are several serious side effects of insomnia by itself, including:

• Higher stress
• Chronic fatigue
• Daytime sleepiness
• Skin problems
• Lower sex drive
• Weight gain
• Weaker immune system
• Heart problems

And much more.

Adding tinnitus on top of that increases the likelihood and severity of any side effects. The potential hearing loss from tinnitus can lead to additional stress, and we've already covered how stress impacts sleep.

Finally, tinnitus is also linked to sleep apnea, which can further worsen sleep.

Summary: Tinnitus and Insomnia

Sleep disorders like insomnia are common among tinnitus sufferers.

Most of the sleep problems from tinnitus are based on the stress that the annoyance of tinnitus causes. More severe tinnitus (ringing frequency and severity) corresponds to poor sleep.

These issues may or may not resolve by themselves, but in most cases benefit from professional medical evaluation and treatment.

Both CBT and neurofeedback protocols are currently the most promising treatments in people with tinnitus and sleep problems.

References

1. Tinnitus and insomnia
2. The Effect of Insomnia on Tinnitus
3. Phantom auditory perception (tinnitus): mechanisms of generation and perception
4. Tinnitus and insomnia: Is hyperarousal the common denominator?
5. Evaluation of the tinnitus retraining therapy as combined with a cognitive behavioral group therapy
6. Neurofeedback for subjective tinnitus patients
7. Does tinnitus distress depend on age of onset?
8. Neurofeedback: A Comprehensive Review on System Design, Methodology and Clinical Applications