Sleeping with Tinnitus: Critical Insights

It's critical that you learn how to sleep with tinnitus. Around 54% of people with tinnitus suffer from some kind of sleep disturbance. Moreover, the relationship between tinnitus and sleep is bidirectional—poor sleep amplifies tinnitus distress, and louder tinnitus disrupts sleep. Here I cover:

• Why does tinnitus get worse at night?
• Can lack of sleep cause tinnitus?
• Tinnitus and Insomnia
• Tinnitus and Sleep Apnea
• Behavioral Treatments for Sleeping with Tinnitus
• Is there an optimal tinnitus sleeping position?
• Products for Sleeping with Tinnitus
• How to Sleep with Tinnitus: Medical Interventions

Understanding Sleep and Tinnitus

Sleep disturbances are significantly associated with tinnitus severity. This is because poor sleep can increase neural excitability, disrupt auditory processing, and amplify tinnitus distress.

Research indicates that tinnitus insomnia is driven by cognitive and behavioral processes similar to primary insomnia, including heightened anxiety, negative sleep-related thoughts, and maladaptive coping behaviors.

There is also a strong correlation between tinnitus and sleep apnea, with disrupted breathing patterns further exacerbating sleep fragmentation, autonomic dysregulation, and overall tinnitus distress.

For these reasons, sleep optimization should be a central concern for all tinnitus treatment programs. This guide explores the complex relationship between tinnitus and sleep, the neurological consequences of sleep deprivation, and practical strategies for improving sleep despite tinnitus.

Why does tinnitus get worse at night?

It’s common for tinnitus to feel louder at night, and this is a normal neurological response. Several key factors contribute to this perception:

• A Quiet Environment – During the day, hearing ambient sounds—like traffic, conversations, or background music—help mask tinnitus. At night, when background noise fades, the brain perceives tinnitus as louder due to the contrast enhancement effect. This is a well-documented auditory phenomenon where the brain amplifies a sound when it lacks competing input.
• Lack of Distractions – Throughout the day, cognitive load is high—your brain is engaged in tasks, conversations, and external stimuli. At night, with fewer distractions, the attention centers in the brain (such as the prefrontal cortex and salience network) become more fixated on the ringing or buzzing, making it feel more intrusive.
• Stress System Activation – If stress or anxiety accumulates throughout the day, the nervous system remains in a heightened state of alertness, preventing the body from transitioning into a relaxed, sleep-ready state. This can increase thalamocortical dysrhythmia, a neural pattern linked to both tinnitus and insomnia, further reinforcing the cycle.

This combination of auditory contrast enhancement, attentional focus, and nervous system activation leads to increased frustration and difficulty sleeping, fueling a cycle of tinnitus sleep anxiety.

Understanding that nighttime tinnitus isn’t actually louder but only perceived as such can help shift focus toward strategies that reduce its impact.

Mental Health, Tinnitus, and Sleep

Tinnitus and sleep disturbances can significantly impact mental health. Tinnitus patients often report poor sleep quality, insomnia, and other sleep-related issues, which can exacerbate the distress caused by bothersome ear ringing or buzzing.

When the brain is deprived of sleep, it struggles to regulate stress, emotional responses, and sensory processing. This can lead to heightened brain stimulation, making tinnitus feel louder and more intrusive. Additionally, sleep loss disrupts auditory processing and increases brain excitability, further aggravating tinnitus perception.

The mental health consequences of persistent sleep disturbances are substantial. Research shows that tinnitus sufferers with chronic insomnia are at higher risk of depression, anxiety, and emotional distress, often experiencing a reduced quality of life. Insufficient sleep also weakens the brain’s ability to filter and habituate to tinnitus, making it feel even more overwhelming.

How Sleep Deprivation Worsens Tinnitus and Mental Health:

Sleep Related Factor	Effect on Tinnitus
Increased Neural Excitability	Poor sleep overstimulates the brain’s auditory pathways, making tinnitus seem louder.
Impaired Stress Regulation	Sleep deprivation weakens the brain’s ability to manage stress, leading to heightened anxiety and emotional distress.
Disrupted Auditory Processing	A tired brain struggles to filter tinnitus, causing it to dominate awareness.
Greater Sensory Overload	Sleep loss reduces the brain’s ability to adapt to constant stimuli, making tinnitus feel more intrusive.
Elevated Risk of Depression and Anxiety	Studies link chronic tinnitus-related insomnia to a higher prevalence of mood disorders.
Reduced Coping Ability	Poor sleep weakens resilience, making tinnitus distress harder to manage.

Prioritizing sleep is not just about improving rest—it’s an essential step in stabilizing mood, reducing stress, and preventing the cycle of sleep deprivation and worsening tinnitus symptoms. By addressing both sleep quality and mental health, individuals with tinnitus can achieve better overall well-being and regain control over their symptoms.

Can lack of sleep cause tinnitus?

The glymphatic system is the brain’s built-in waste clearance mechanism, responsible for flushing out inflammatory waste products. This process occurs primarily during deep sleep, when cerebrospinal fluid flows through brain tissues to remove toxins. When sleep is disrupted, the glymphatic system functions inefficiently, leading to toxin accumulation and increased brain inflammation.

Chronic sleep deprivation triggers widespread inflammation in the brain, which has been linked to several neurological conditions, including chronic migraines and certain forms of dementia. In tinnitus sufferers, neuroinflammation can make symptoms more intrusive, similar to how migraines worsen with poor sleep. Sleep deprivation worsens hyperactivity in the hearing part of the brain, increasing tinnitus intensity and making it harder to ignore.

How Poor Sleep Increases Brain Inflammation and Worsens Tinnitus:

• Glymphatic Dysfunction – Lack of deep sleep impairs brain detoxification, allowing inflammatory waste to build up.
• Increased Neural Irritability – Sleep loss raises excitability in hearing pathways of the brain, intensifying tinnitus perception.
• Higher Risk of Neurological Disorders – Poor sleep is associated with cognitive decline, migraines, and hypersensitivity to sound (hyperacusis).
• Tinnitus and Migraine Link – Both tinnitus and migraine share an inflammatory basis, and sleep deprivation exacerbates symptoms in similar ways.
• Stress-Induced Inflammation – Chronic stress, worsened by poor sleep, contributes to neuroinflammation and tinnitus distress.

By prioritizing sleep and reducing neuroinflammation, tinnitus sufferers can lower the intensity of their symptoms, improve cognitive function, and enhance overall brain health.

How to Sleep with Tinnitus and Insomnia

Insomnia secondary to tinnitus is a major concern, where distress from tinnitus fuels poor sleep, increased stress, and heightened tinnitus perception. This creates a self-reinforcing cycle that makes both sleep and tinnitus worse. Many individuals with tinnitus-related insomnia become hypervigilant, constantly monitoring their symptoms, which leads to increased emotional arousal at night. Treating tinnitus is crucial to alleviate these sleep issues and improve overall health.

How Tinnitus Insomnia Develops:

• Hyperarousal Before Sleep – Anxiety about tinnitus prevents relaxation, making it difficult to fall asleep.
• Symptom Monitoring – Over-focusing on tinnitus increases distress and delays sleep onset.
• Frequent Night Wakings – Sleep is fragmented, leading to reduced sleep quality and more daytime fatigue.
• Emotional Impact – Insomnia worsens anxiety and depression, further intensifying tinnitus distress.
• Cognitive Distortions – Negative thoughts about sleep loss (e.g., “I’ll never get enough rest”) perpetuate the cycle of insomnia.

How to Sleep with Tinnitus Using CBT

Cognitive behavioral therapy for Insomnia (CBT-I) is a structured, evidence-based approach that helps retrain the brain to manage sleep anxiety and maladaptive sleep behaviors. Many clinical practice guidelines consider CBT-I to be a gold standard treatment for insomnia.

Key Techniques in CBT-I to Fall Asleep with Tinnitus:

Technique	Explanation
Sleep Restriction Therapy	Reduces time spent awake in bed, helping to consolidate sleep.
Cognitive Restructuring	Challenges negative sleep-related thoughts (e.g., “If I don’t sleep well, my tinnitus will be unbearable”).
Stimulus Control Therapy	Strengthens the connection between bed and sleep by limiting wakeful activities in bed.
Relaxation Exercises	Includes mindfulness, deep breathing, and progressive muscle relaxation to lower nighttime hyperarousal.
Guided Sleep Hygiene	Establishes healthy bedtime routines and environmental adjustments to improve sleep consistency.

CBT-I vs. Sleeping Pills

CBT-I is the gold-standard treatment for tinnitus-related insomnia, with a success rate of 70–80% in improving sleep. It effectively targets dysfunctional sleep behaviors and negative thought patterns, leading to a good night's sleep.

In contrast, sleep medications offer short-term relief but often come with side effects, tolerance issues, and potential withdrawal effects, which may worsen tinnitus. While they can be useful in acute situations, they do not resolve the underlying sleep disturbances that perpetuate tinnitus-related insomnia.

Breaking the Cycle of Tinnitus Insomnia

By addressing both sleep anxiety and unhelpful behaviors, CBT-I helps people with tinnitus-related insomnia regain control over their sleep patterns. Research shows that individuals who undergo CBT-I experience quality sleep, reduced tinnitus distress, and overall improved mental well-being.

Tinnitus and Sleep Apnea

Tinnitus and obstructive sleep apnea (OSA) are often interconnected, with research showing that individuals with severe sleep apnea have a higher prevalence of tinnitus.

OSA involves repeated episodes of blocked breathing during sleep, leading to decreased brain oxygen, sleep disruption, and brain hyperactivity—all of which can worsen tinnitus perception. The combination of poor sleep quality and intermittent drops in oxygen can contribute to  brain inflammation, a fight or flight response, and increased tinnitus-related distress.

Since both conditions feed into each other, treating OSA can often improve tinnitus symptoms. Effective interventions include:

• Weight Loss – Reducing excess weight can alleviate pressure on the airway and improve both OSA and tinnitus severity.
• CPAP (Continuous Positive Airway Pressure) – The gold standard for keeping airways open and improving sleep continuity.
• Mandibular Advancement Devices – Oral appliances that reposition the lower jaw to prevent airway collapse in patients with mild OSA.
• Sleep Surgery – Procedures like uvulopalatopharyngoplasty (UPPP) or Inspire therapy may help in severe cases where other treatments fail.

Behavioral Treatments for Sleeping with Tinnitus

Improving sleep quality with tinnitus requires a structured approach that incorporates behavioral changes and sleep hygiene strategies. Sleep disturbances are often worsened by poor habits that disrupt the body’s natural sleep-wake cycle, so making intentional adjustments can help regulate sleep patterns and reduce nighttime tinnitus distress.

The key is to create a sleep-friendly routine that promotes relaxation, reduces hyperarousal, and supports the brain’s ability to habituate to tinnitus.

Essential Sleep Hygiene Strategies for Sleeping with Tinnitus

Sleep Hygiene Strategy	Explanation
Consistent Sleep Schedule	Going to bed and waking up at the same time every day (even on weekends) helps regulate the circadian rhythm.
Screen Time Management	Avoid blue light from screens at least an hour before bedtime to prevent disruption of melatonin production.
Caffeine and Alcohol Reduction	Avoiding stimulants (caffeine, nicotine) in the afternoon and limiting alcohol intake can improve sleep quality.
Optimized Sleep Environment	A cool, dark, and quiet room with blackout curtains in the bedroom can help you to fall asleep.
Relaxation Techniques Before Bed	Practices like deep breathing, guided meditation, progressive muscle relaxation, or a warm bath can reduce nighttime arousal and stress. Relaxing music can help too.
Circadian Rhythm Regulation	Exposure to natural sunlight in the morning and minimizing artificial light at night helps keep the body’s internal clock aligned.
Nap Management	Long or late-afternoon naps may be the underlying cause of insomnia and should be avoided.

By consistently implementing these behavioral changes, individuals with tinnitus can improve their ability to fall and stay asleep while reducing the negative impact of tinnitus on their nightly rest.

Is there an optimal tinnitus sleeping position?

The way you sleep can significantly impact tinnitus perception and overall sleep quality. Since tinnitus can be influenced by somatic factors—such as neck tension, jaw dysfunction, or poor posture—choosing a position that minimizes strain on these areas is crucial. Poor head and neck support can worsen somatic tinnitus, particularly in individuals with TMJ disorder or cervical spine issues.

Sleeping with Somatic Tinnitus:

• Neck Position Matters: Keeping the neck in a neutral position can reduce muscle tension that may make somatic tinnitus worse. A cervical-support pillow can help maintain alignment.
• Jaw Alignment is Key: Sleeping in a position that prevents excessive jaw clenching or misalignment (especially for those with TMJ disorder) can help reduce pain which can aggravate tinnitus.
• Avoid Sleeping on Your Stomach: This position can strain the neck and worsen somatic tinnitus symptoms.
• If Sleep Bruxism is Suspected: A custom nightguard can help reduce jaw tension and prevent bruxism-related somatic tinnitus.

Experiment with different sleep positions, optimize pillow support, and incorporate sound-masking strategies to find what works best for your tinnitus and sleep comfort.

Side Sleeping with Tinnitus: Benefits and Challenges

• Pro: Supports glymphatic drainage, the brain’s waste-clearance system, which may help reduce neuroinflammation linked to tinnitus.
• Con: The ear on the pillow gets blocked, reducing external sound input and making internal tinnitus seem louder.
• Solution: Using sleep headbands or sound pillows can provide external sound stimulation, preventing the increased perception of tinnitus.

Products for Sleeping with Tinnitus

Using the right tools can create a sleep-friendly environment and help mask tinnitus, promoting more restful nights. From sound-based solutions to environmental enhancements, these products can make a significant difference:

Sound-Based Solutions: Masking tinnitus with gentle sounds can provide much-needed relief and create a soothing auditory backdrop for sleep:

• White Noise Machines: A sound machine that plays white noise or pink noise.
• Bedside Noise Generators: Include timer options and various nature sounds or gentle music.
• Sound Pillows: Built-in speakers provide soothing sounds directly to your ears, ideal for those who prefer side sleeping.
• Headbands with Speakers: Perfect for side sleepers, sleep headbands allow you to listen to masking sounds comfortably without disturbing your partner.

Environmental Enhancements: Creating a calming sleep environment is just as important as masking tinnitus:

• Air Purifiers: Improve air quality while offering subtle white noise to mask tinnitus.
• Aromatherapy: Essential oils like lavender, chamomile, or bergamot can help promote relaxation and sleep readiness.
• Sleep masks: A sleep mask can create a dark environment, which helps signal to your body that it's time to sleep by promoting the production of melatonin.

Light Management: Light exposure plays a crucial role in regulating your sleep-wake cycle:

• Green Light Therapy: Gentle green light at night can support melatonin production without disrupting the body’s 24 hour clock (circadian system).
• Blue-Light-Blocking Glasses: Prevent evening screen exposure from delaying sleep onset.
• Morning Blue Light Generators: Boost natural wakefulness and help reset your body’s internal clock. You can get the same effect by spending some time outdoors in the morning sun.

By integrating these tools into your bedtime routine, you can minimize tinnitus-related distress, improve sleep quality, and create a more relaxing nighttime environment. Combining sound therapy, environmental adjustments, and light management can make your nights more restful and your tinnitus more manageable.

How to Sleep with Tinnitus: Medical Interventions

When lifestyle and behavioral strategies fall short, medical interventions can play a key role in managing tinnitus-related sleep disturbances. These approaches address both sleep quality and underlying conditions that may aggravate tinnitus.

Melatonin and Natural Sleep Aids

• Melatonin: A natural hormone that regulates the sleep-wake cycle, melatonin has shown promise in improving sleep quality for tinnitus sufferers who have difficulty falling asleep.
• Herbal Remedies: Chamomile, valerian root, and passionflower teas or supplements can promote relaxation and improve readiness for sleep.
• Magnesium and Glycine: These supplements support nervous system balance and help calm nighttime hyperactivity that can worsen tinnitus, making it easier to fall asleep.

Prescription Sleep Medications

• Sedatives or Hypnotics: Your doctor may suggest medications like zolpidem (Ambien) or eszopiclone (Lunesta) for short-term relief to promoting sleep onset. However, they carry risks of dependency and side effects, making them unsuitable for long-term use.
• Low-Dose Antidepressants: These can improve sleep quality and reduce anxiety without the same dependency risks as traditional sleeping pills. This strategy is used with great success by the NeuroMed team.
• Hormone Replacement Therapy (HRT): HRT can be effective for managing sleep disorders associated with menopause, especially when sleep disruptions are linked to vasomotor symptoms such as hot flashes.

Sleep Coaching

• Sleep Coaching: Sleep coaching provides personalized strategies to improve sleep hygiene, manage stress, and address tinnitus-related challenges. By integrating CBT-I principles with one-on-one guidance, sleep coaching offers tailored advice, progress tracking, and accountability to help individuals create sustainable routines and overcome tinnitus-related sleep disruptions. This is a key component of NeuroMed’s tinnitus treatment program.

Diagnostic Sleep Testing

Persistent sleep issues may signal an underlying condition. Sleep testing can identify problems such as:

• Sleep Apnea: Obstructive sleep apnea (OSA) can disrupt sleep and worsen tinnitus. Treatments like CPAP (Continuous Positive Airway Pressure) or mandibular advancement devices may significantly improve sleep quality.
• Circadian Rhythm Disorders: Misaligned internal clocks can exacerbate sleep issues. Adjustments through light therapy or melatonin timing can help reset the sleep-wake cycle.
• Other Sleep Disorders: Conditions like restless legs syndrome or periodic limb movement disorder can be identified and treated, improving overall sleep quality.

By integrating these medical interventions with sound behavioral strategies, individuals can achieve better sleep and reduce tinnitus-related distress. The NeuroMed team can help develop a personalized plan tailored to your specific needs.

Tinnitus Rehabilitation Programs and Sleep Optimization

At NeuroMed, sleep optimization is a cornerstone of a broader, multimodal tinnitus rehabilitation approach. Addressing the complex nature of tinnitus often requires integrating various therapies and interventions to target the condition from multiple angles. A comprehensive strategy includes:

• Pharmaceutical Therapy: When appropriate, medications may help reduce tinnitus-related neurotransmitter imbalances associated with insomnia, disrupted sleep, atypical migraine, and loud tinnitus.
• Nutraceuticals: High-quality vitamins and supplements can support neurological health, reduce inflammation, and improve sleep.
• Lifestyle Medicine: Interventions like stress management, regular physical activity, anti-inflammatory diets, and mindfulness practices can significantly impact overall well-being and tinnitus perception.
• CBT for Tinnitus: Cognitive Behavioral Therapy helps individuals reframe negative thoughts about tinnitus, promoting habituation and reducing distress.
• Sound Therapy: Using both generic and customized sound therapy can desensitize the hearing system and provide relief.
• Mindfulness and Relaxation: Practices like meditation, progressive muscle relaxation, and deep breathing exercises help lower autonomic nervous system hyperactivity, improving both tinnitus and sleep.
• Nutritional therapy: Avoiding caffeine, alcohol, and other trigger foods can reduce nervous system overstimulation and improve sleep quality. Moving towards an anti-neuroinflammatory diet can help overall brain health. The NeuroMed tinnitus treatment program includes visits with a nutrition coach who will help guide you through this process.

A multimodal approach acknowledges that tinnitus is not just an auditory issue—it’s deeply tied to brain networks, stress, lifestyle, and sleep. By using these therapies together, people can address the root causes of their distress and achieve meaningful relief. Non-medical interventions like tinnitus retraining therapy cannot help when sleep disorders are unaddressed.

A rehabilitation model of care is the most effective way to implement multimodal therapy, providing structured guidance, ongoing support, and expert oversight to ensure lasting progress. With a dedicated care team, personalized treatment plans, and continuous reinforcement, individuals can navigate the complexities of tinnitus recovery with confidence, maximizing their chances of meaningful relief.

Conclusion: Sleeping with tinnitus is possible!

Tinnitus can make sleep difficult, but with the right approach, restful nights are possible. By addressing the root causes of tinnitus-related sleep disturbances through proven behavioral and medical strategies, you can break the cycle of sleep deprivation and distress. At NeuroMed, we are experts at treating tinnitus.

You don’t have to face this alone—personalized support is key. The rehabilitation model for tinnitus is showing remarkable success in helping people regain control of their sleep, their tinnitus, and their well-being.

Contact us today to see if NeuroMed’s tinnitus rehabilitation program is the right fit for you.