Why Melatonin for Tinnitus Works

As a tinnitus specialist, I routinely recommend melatonin tinnitus therapy for my patients. Here, I outline my reasons for endorsing this natural supplement for tinnitus:

• How does sleep affect tinnitus?
• How does melatonin help sleep?
• Melatonin’s Functions in the Brain
• Migraine, Melatonin, and Chronic Tinnitus
• Review of Melatonin Tinnitus Clinical Trials
• How much melatonin should you take for tinnitus?
• Tips on How to Sleep with Tinnitus
• What are Melatonin’s Side Effects?
• The Limitations of Melatonin for Tinnitus Relief

Introduction to Melatonin for Tinnitus

Melatonin, a hormone produced by the pineal gland in the brain, plays a crucial role in regulating the sleep-wake cycle. Beyond its well-known function as a sleep aid, recent studies have explored the potential benefits of melatonin therapy for ringing ears. 

As my patients know, I strongly stress the importance of sleep optimization for tinnitus relief.  For this reason alone, melatonin is a good supplement to include in the treatment of tinnitus, especially in cases where tinnitus patients have insomnia (difficulty going to sleep). 

However, as we learn more about the neurological benefits of melatonin, it’s becoming clear that using melatonin to treat tinnitus may have benefits far beyond its impact on restoring sleep. Here, I cover what you need to know about melatonin for tinnitus.

How does sleep affect tinnitus?

Improved sleep quality is crucial for tinnitus relief due to its profound impact on various physiological and psychological aspects of overall health. Here are key reasons why adequate and restful sleep and tinnitus relief go hand-in-hand:

Sleep Parameter	Description
Stress Reduction	Quality sleep helps regulate stress hormones, such as cortisol. Elevated stress levels are associated with increased tinnitus perception and annoyance.
Neurotransmitter Balance	Sleep influences the balance of neurotransmitters in the brain, including serotonin and dopamine. Imbalances in these neurotransmitters are linked to mood disorders and can contribute to tinnitus distress.
Cognitive Function	Adequate sleep enhances cognitive function, including attention and memory. Improved cognitive abilities can contribute to better coping strategies for dealing with tinnitus, reducing its cognitive impact.
Immune System Support	Sleep is essential for a well-functioning immune system. Tinnitus may be linked to inflammation, and a robust immune response can help manage inflammatory processes in the body, potentially mitigating tinnitus symptoms.
Emotional Health	Sleep plays a critical role in emotional regulation. Lack of sleep can lead to irritability, mood swings, and heightened emotional responses.
Hormonal Balance	Sleep influences hormone regulation, including melatonin. Disruptions in melatonin production can impact sleep quality and may be associated with tinnitus severity.
Overall Health	Chronic sleep deprivation is linked to various health issues, including cardiovascular problems and metabolic disturbances. Addressing these broader health concerns contributes to tinnitus recovery.

Tinnitus patients are particularly susceptible to the effects of poor sleep. This is because sleep disturbance can activate a migraine-like process in the brain, making the tinnitus intensity worse. When indicated, we always screen our patients for sleep disorders.

Many tinnitus patients suffer from dysfunctional sleep wake cycles (called circadian rhythm disorder) or insomnia. These sleep problems tend to amplify their ringing loudness and intensity. For this reason, melatonin supplementation is a powerful complementary therapy in the treatment of tinnitus.

How does melatonin help sleep?

Melatonin plays a crucial role in regulating the sleep-wake cycle, also known as the circadian rhythm (the brain’s 24 hour clock system). Melatonin hormone helps synchronize various physiological functions in the sleep-wake cycle, acting as a “biological clock” that signals the body when it’s time to wind down and prepare for sleep.

Plasma melatonin hormone produced by the pineal gland reaches its peak plasma levels at night. This is because it’s production is inhibited by light. The peak wavelength that suppresses melatonin production is 480 nanometers, which happens to be the blue light spectrum. That’s why blue light from screens can cause insomnia at night; it suppresses the effects of melatonin.

At night, melatonin prompts physiological changes, such as a drop in body temperature and an increased propensity for sleep. Conversely, exposure to light, especially natural sunlight or artificial blue light, inhibits melatonin production, signaling wakefulness and alertness.

Given the importance of good sleep for tinnitus patients, melatonin tinnitus therapy makes good sense.

Melatonin’s Functions in the Brain

Beyond its critical role in regulating sleep, melatonin has numerous important functions in the brain and central nervous system. These additional features amplify the potential effectiveness of melatonin on tinnitus treatment. Here are some of the benefits that melatonin has on the brain and inner ear:

Melatonin Function	Description
Neurotransmitter Modulation	Melatonin can influence the release of neurotransmitters, such as dopamine, serotonin, and GABA, which are essential for communication between brain cells. This can also support neural plasticity.
Antioxidant Properties	Acting as a potent antioxidant, melatonin can protect against oxidative stress, reducing the risk of cellular damage. Its antioxidant properties can also boost inner ear immunity and protect against drug mediated ototoxicity.
Neuroprotection	Melatonin has a protective effect on neurons by scavenging free radicals and reducing inflammation, which may contribute to the prevention of neurodegenerative conditions.
Mitochondrial Support	Melatonin has been shown to support mitochondrial function, enhancing energy production within neurons and promoting cellular resilience.

It’s important to emphasize that melatonin protects against noise induced hearing loss. Further, it helps prevent hearing loss from ototoxic drugs like aminoglycoside antibiotics.

Summing up, melatonin has powerful effects beyond helping with sleep or insomnia. By exerting antioxidant. anti-inflammatory, and neuroprotective effects, melatonin serves as an excellent complementary treatment for auditory system health.

Migraine, Melatonin, and Chronic Tinnitus

Research from my academic clinic in the past 5 years has shown that tinnitus is amplified by a migraine-like process in the brain. This can happen even if you never have a headache. In many people, the sole symptom of this migraine reaction is loud tinnitus.

Studies have shown that people with migraine headaches have a statistically significant decrease in melatonin levels compared to healthy people. Further, melatonin supplementation in migraine patients has been shown to be effective as an adjuvant therapy. Finally, melatonin has been shown in clinical trials to decrease calcitonin gene related peptide (CGRP), a key inflammatory mediator that drives the migraine process in the brain [1].

Given that melatonin has been successfully used as a complementary therapy for migraine management, we’ve used it effectively for tinnitus as part of a comprehensive tinnitus management program. For all of these reasons, melatonin as a supplement for tinnitus relief shows great potential. 

Review of Melatonin Tinnitus Clinical Trials

Clinical trials exploring the relationship between melatonin and tinnitus have shown promising results. In the pioneering trial by Rosenberg et al., melatonin’s efficacy for tinnitus was assessed through a randomized, double-blinded, placebo-controlled study. The study found that individuals with elevated tinnitus handicap inventory (THI) scores or sleep difficulties experienced improvement with melatonin [2]. Note that randomized, double-blind, placebo-controlled studies produce the highest quality medical evidence we have. 

In another notable study, Abtahi and team compared melatonin to sertraline (Zoloft). In this study, 3mg melatonin (3 mg nightly for 3 months) led to a significant reduction in THI scores compared to sertraline. Notably, melatonin showed effectiveness with minimal side effects [3]. 

These are extremely positive results. We are currently working on further high-quality clinical trials to validate these findings conclusively, considering melatonin’s recognized efficacy in improving sleep and overall quality of life for individuals with tinnitus.

How much melatonin should you take for tinnitus?

Melatonin dosages can vary, and it’s advisable to start with lower doses (typically 1-3 mg) to assess individual tolerance and effectiveness. Most insomnia clinical trials for use a 3 mg dose of melatonin, a standard adult dose. Older adults should start at lower doses. There doesn’t appear to be an issues with extended use.

What is the best form of melatonin to use? It can be confusing because there are multiple different formulations of melatonin, from standard pills, to gummies, to sublingual strips and drops. In addition, some melatonin products are marketed as fast-acting or quick-release formulas. 

In my view, the most important thing is to get a high quality formulation of melatonin (for instance from Fullscript). This is because there is wide variation in the actual dosage in many low-quality manufacturers that do not do quality control testing. As long as you have a high quality product, the effects will be consistent and you’ll figure out with experience when the best time is for you to take your melatonin. 

High Dose Melatonin for Tinnitus

There is no data on the utility of high dose melatonin for tinnitus (i.e. doses higher than the pineal gland normally produces). However, a 2020 meta-analysis (summary of multiple studies) of high dose melatonin reported that there were increased reports of drowsiness, headache and dizziness [4].

I recommend avoiding high dose melatonin for ear ringing relief. This is because sleeping too much can worsen tinnitus just as much as not enough sleep.

How to Take Melatonin for Ear Ringing at Night

Melatonin should be taken around 30-60 minutes before bedtime. When used for tinnitus, melatonin therapy should be combined with other non-invasive interventions that can help foster better sleep. These are sometimes called “sleep hygiene” techniques and they can help with insomnia related to tinnitus.

Tips on How To Sleep with Tinnitus

Sleep disturbances are extremely common for people who suffer from tinnitus. It’s important to follow simple guidelines that will help optimize your ability to sleep (this is called “sleep hygiene”). These guidelines should be used in parallel with melatonin tinnitus therapy for best results. Here are some tips on how to sleep with ringing ears:

Recommendation	Description
Consistent Sleep Routine	Establish a regular bedtime routine for better sleep quality.
Blue Light Reduction	Minimize exposure to blue light before bedtime, especially from screens. Blue light actually blocks melatonin release.
Sleep Environment Optimization	Create a sleep environment to enhance rest that is cool, dark, and comfortable.
White Noise or Sound Generators	Use white noise or sound generators to help mask tinnitus sounds while you are falling asleep.
Mindfulness Techniques	Practice mindfulness exercises like progressive relaxation and deep breathing as you prepare to go to sleep.
Stimulant Avoidance	Steer clear of stimulants in the evening for a calmer bedtime experience.
Hydration Timing	Refrain from drinking water three hours before bedtime for uninterrupted sleep.
Avoid Email/Social Media	In the 1-2 hours before going to sleep, don’t look at your email or social media. Excitement/stress caused by reading or seeing something on email/social media will cause suppression of sleep.

What are Melatonin’s Side Effects?

Melatonin for tinnitus is generally considered safe for short-term use, but some individuals may experience side effects. Common side effects of melatonin may include the following:

Melatonin Side Effect	Notes
Daytime Sleepiness	Some individuals (older adults in particular) may feel drowsy during the day, especially if melatonin is taken in larger doses. If this happens, reduce the dose.
Headache	Melatonin use has been associated with headaches in some cases. This can occur if you sleep too much.
Dizziness	A feeling of lightheadedness or dizziness has been reported by a small number of individuals. This will happen if you take melatonin and don’t go to bed and continue walking around the house.
Nausea	Melatonin supplementation may uncommonly cause nausea or stomach discomfort in some users.
Irritability	Mood changes, including irritability, have been reported in rare instances.
Vivid Dreams or Nightmares	Some people may experience vivid dreams or nightmares when taking melatonin.
Sleep Disruptions	Paradoxically, melatonin can affect sleep patterns negatively in rare individuals, leading to difficulty falling asleep or staying asleep.

If you get any side effects, try going to a lower dose before completely giving up on melatonin. You should not take melatonin if you have untreated sleep apnea, as this can make your apnea worse. Some advise against taking melatonin if you’re pregnant or suffer from depression. Also, combining melatonin with blood-thinning medications or anticonvulsants may pose risks.

Limitations of Melatonin for Tinnitus Relief

Despite all of the promising benefits of melatonin tinnitus therapy covered here, I want to stress that in most cases, a comprehensive treatment approach is needed in order to achieve long-lasting tinnitus relief. 

Natural remedies for tinnitus should always be viewed as complementary to other important therapies, like sound therapy, cognitive behavioral therapy, dietary changes, and in some cases, pharmaceutical therapy. Melatonin alone may not improve tinnitus enough in most cases.

Ultimately, the issue with chronic tinnitus is the migraine reaction in the brain and the neural network changes it causes. For lasting tinnitus relief, treatments must include therapies that address the migraine reaction and help the brain to rewire (neural plasticity). This requires an integrative medicine treatment strategy, and melatonin tinnitus therapy is only a part of it.

Conclusion: Melatonin is Natural Help for Tinnitus

Melatonin tinnitus therapy is an important treatment tool, especially for those seeking a natural approach. While individual responses may vary, melatonin’s multifaceted benefits on sleep, neural function, and overall well-being make it a compelling option in the holistic management of tinnitus. 

However, as with any supplement for tinnitus, beware of expecting a quick fix. Melatonin tinnitus therapy is an important intervention, but it must be combined with other structured therapies that address the fundamental neural mechanisms that cause and perpetuate tinnitus.

Melatonin Tinnitus Therapy References

[1] Zduńska A, Cegielska J, Domitrz I. The Pathogenetic Role of Melatonin in Migraine and Its Theoretic Implications for Pharmacotherapy: A Brief Overview of the Research. Nutrients. 2022 Aug 15;14(16):3335.

[2] Rosenberg SI, Silverstein H, Rowan PT & Olds MJ Effect of Melatonin on Tinnitus. The Laryngoscope 108, 305–310 (1998).

[3] Abtahi S, Hashemi S, Mahmoodi M & Nilforoush M Comparison of melatonin and sertraline therapies on tinnitus: A randomized clinical trial. Int J Prev Med 8, 61 (2017).

[4] Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D’Rozario AL, Comas M, Raisin I, Saini B, Gordon CJ, McKinnon AC, Naismith SL, Marshall NS, Grunstein RR, Hoyos CM. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. J Pineal Res. 2022 Mar;72(2):e12782.