Sleep disturbances related to tinnitus are reported by about half of those with this condition. This ringing or buzzing in the ears can vary in volume, and occur continuously or intermittently.
It is most commonly caused by prolonged exposure to loud sounds, but can also be caused by auditory infections, injuries, or as a consequence of aging.
Nighttime exacerbation of the condition is a common problem due to elevated auditory sensitivity resulting from the near-silence of the sleep environment. This leads to the perception of a heightened intensity of the tinnitus sound. An increase in the tinnitus signal means an increase of negative reactions in the autonomic and limbic systems producing a state of alertness and consequent physiologic arousal that disrupts sleep patterns.
How Sound Generators Help
The perception of auditory gain can be countered by sound enrichment of the sleep environment, restoring lateral inhibition. This weakened internal tinnitus signal helps in preventing the state of awareness that impairs sleep. Many people regularly benefit from “white noise” or recordings of nature sounds that reduce background noises.
Removing or reducing these disturbances promotes a more relaxed physiological state essential to achieving and retaining a healthy sleep state. Studies show that tinnitus is one of the auditory problems that sound generators can help to mitigate. In a study conducted with a group of 35 tinnitus sufferers using sound generation, researchers found that sleep improved significantly, as measured against the Pittsburgh Sleep Quality Index (PSQI).
Selection of the bedside sounds used was based on the personal preferences of the subject, and not on any estimate of the sound’s effectiveness. This report focused on the different sounds subjects chose, so it’s sensible to grade sleep improvements by these sounds, along with possible health issues as factors in rating the relative affect on subjects’ sleep quality.
Over 500 subjects using sound generation devices were selected at random from a starting group of 986 candidates. Each was mailed a questionnaire to be completed and returned at the end of a six-to-twelve month experience using a commercially sold sound generation device. They were asked to rate their quality of sleep experiences on a scale of 1 to 10, with 1 being no noticeable improvement and 10 being pronounced improvement.
Less than half (230) of these questionnaires were returned, or 43.7%, of which 36 were rejected due to unusual conditions such as unilateral tinnitus, or simply a failure to answer a sufficient number of questions. The resulting group of 184 subjects were all males suffering from bilateral tinnitus.
Sound Enrichment and Hearing Loss
It is reasonable to assume that sleep enrichment sounds are only effective when audible. Among the 184 subjects, 140 had hearing problems and used hearing aids to improve the auditory experience. The mean differences in right and left pure tone thresholds for the two groups showed, as expected, that those without hearing aids showed greater perception and variation.
Binaural 3- and 4-frequency averages using standard weighting on Mann-Whitney Rank-Sum tests demonstrated even more substantial differences between the hearing-impaired and non-hearing-impaired groups. Averages were higher for both test cases in non-hearing impaired subjects,
Disruptive Sleep Disorders
While there are many types of sleep disorder to be found in the general population, the five specific disorders most common in the test group were:
- Obstructive sleep apnea, where the subject may experience multiple waking episodes each night. (30%)
- COPD, or chronic obstructive pulmonary disorder – breathing problems and low oxygen content in the blood leads to sleep disruption. (11%)
- Nocturia – waking from a need to urinate, related to prostate issues such as BPH (benign prostatic hypertrophy) causing sleep interruption one or more times per night. (48%)
- Chronic pain – the majority of those suffering from moderate to severe pain experience frequent sleep disruptions. (56%)
- Restless leg syndrome – the majority of sufferers from RLS report difficulty falling or staying asleep. (3%)
Those with various other sleep disorders comprised 16% of subjects. Among the 184 subjects 36% were diagnosed with one or more sleep disorders, such as overlap syndrome, where COPD and sleep apnea occur together.
Previous studies had shown that up to 70% of tinnitus patients had been diagnosed in the past with mental health disorders, and nearly half of these with multiple conditions. Of the 184 patients in the tinnitus study, 94 had been diagnosed with at least two mental health conditions, most commonly post-traumatic stress disorder or depression.
A promising 79% of subjects indicated their sleep quality had improved, giving moderate to high numerical ratings. Statistical analysis applied to these results show a strong correlation between improvement and frequency of device user per week. More significant improvement was shown among those who used their sound devices more often.
Subjects were categorized in four groups related to mental health diagnoses:
- * No mental health issues reported (44.6%)
- * PTSD (12%)
- * Depression (12%)
- * PTSD and depression (15%)
Further segregation into groups classified according to mental health, sleep disorders, and hearing aid use proved difficult due to a lack of information in all areas for all participants. No significant difference in improvement was found between the four groups of mental health patients was found.
Only the main grouping of mental health status into diagnosed and non-diagnosed subjects showed a significant difference. More improvement was reported for those previously diagnosed for mental health issues, but that difference when compared to overall results was small (only 0.29).
The majority of users reported significant improvements in sleep quality when using bedside sound generators. A greater improvement was reported among those with prior mental health issues than among those without, though the difference was minor. This finding may be due to the lack of baseline comparisons often found among patients with mental health concerns. Common health issues, specifically sleep disorders and hearing impairment, had no particular impact on sleep quality ratings.
A marked increase in quality of sleep for those using sound generation devices more frequently is a more ambiguous conclusion: did sleep quality improve because devices were used more, or did subjects use them more often because they felt it improved sleep? This question hopefully can be answered in the future by conducting more closely monitored patient sleep studies.
The study seems to confirm reports that better quality of sleep with bedside sound generators in use among the general population also can benefit tinnitus sufferers. However, further studies are needed that employ standardized measures to establish baselines for all subjects as well as analysis of post-device usage.
About Dr Zhanneta Shapiro
Dr Zhanneta Shapiro received her Masters of Science from Brooklyn College in 2005 and completed her Doctorate of Audiology from Florida University in May 2008. Her graduate training was in various hospitals in the tri-state area and a residency period completed at Ear Nose and Throat Associates of New York. [ Learn More ]