Intermittent Tinnitus and Taking Clonazepam to Prevent a Loud Tinnitus Day?

Hi all -- I've posted on here before a few times, but I've never really introduced myself. I developed tinnitus suddenly last fall, five days after my COVID-19 vax. I can't be sure that's what caused it, but it's my best guess. No obvious hearing loss, just tinnitus in both ears, left much worse than right. I also have a bit of reactivity or hyperacusis (not sure of the exact definitions for those) and lots of sleep disruption.

The weird thing is that most of my tinnitus is intermittent, and really regular: two quiet days (can only hear a faint noise in a quiet room if I look for it) followed by a really loud day (left ear, more of a hiss than a ring). It's been on this schedule from the start. If I get really stressed or tired, I might skip one of the quiet days, but I've never had two loud days in a row, nor, until recently, more than two consecutive quiet days.

About four months in, I was desperate for sleep. My doctor prescribed some low-dose Remeron (Mirtazapine), which has worked like a charm for me - I sleep great now. She also threw in a prescription for Clonazepam, for occasional use. I tried it on a loud day -- it really did little to knock down the volume of my tinnitus; not really worth the risk of taking it. But I also tried taking it (small dose, 0.25 mg) the night before my loud day, and low and behold, the tinnitus never started the next day. And it stayed gone for the next two days, too. Five days of peace in a row! I didn't take Clonazepam last night, and so of course, my loud tinnitus is back today, right on schedule.

So here's my question: how often can I take Clonazepam before I start to develop a tolerance for it? I think every third day might be risky, but what do you think about every six days? The half life seems to be somewhere between 40-60 hours, so it takes a long time to leave one's system. Given the many stories about the hazards of Clonazepam use, I'd rather err on the side of caution. Maybe I should just save it for days when having super loud tinnitus would really suck (days of concerts, holidays, etc...)

Any advice and perspectives are appreciated. Also, if anyone has any idea what the physiological cause of this sort of cyclical tinnitus is, please share. It's so strange.

 

I've seen others report a delayed effect between taking Clonazepam and a reduction in tinnitus, so I'm not surprised you had better results by taking it the night before.

0.25 mg every 6 days doesn't sound like it would be a problem. 0.5 mg doses are not uncommon and are sometimes taken more frequently per past Tinnitus Talk threads.

I allow myself to take Lorazepam 0.5 mg every third day at this point, although I have been averaging less than that. It's about half as potent as Clonazepam per milligram and has a much shorter half-life. I'm not sure if it affects tinnitus, since my tinnitus is so variable anyway, but it helps a little with anxiety.

 

A few have this cyclical aspect to their tinnitus, see this thread.

 

I take between 0.5 mg and 0.75 mg of Clonazepam on Wednesdays and Saturdays, giving me two days of near normality. Two issues with this: my reactive tinnitus comes back with a vengeance the days after, and I also get rebound depression when off Clonazepam, where I'm seriously down in the dumps the day or two after. It's a tough one with Clonazepam having a 60-hour half-life. I guess I'm pushing it to the max and may be putting myself into slight interdose withdrawal.

I'm in a pickle with angle grinder reactive tinnitus and dysacusis beeps. There are genuinely some evenings where I just can't take it anymore and need the relief Clonazepam provides but then await the rebound depression. Swings and roundabouts until something better comes along, my situation miraculously improves (9 months since worsening) or Dr. Shore's device comes out this century and I'm hopping on the first jet to California to have a crack at it...

 

Thanks -- somehow I missed that thread... I probably just searched for the word "intermittent" in the titles.

How is your tinnitus now? Has it changed in the intervening months?

Thanks for your reply -- my doctor blithely suggested Clonazepam (with 4 refills!), but I don't think she's thinking about the possibility of developing tolerance, etc... The idea of making my tinnitus worse in the long run is my biggest fear.

It sounds like your reactive tinnitus is actually worse after the Clonazepam wears off (not just that it bothers you more because you had a good day the day before.) This is the conundrum of using Clonazepam... buying a "good" day at the expense of the days after. Wish there were an equally effective drug with fewer drawbacks.

As for Susan Shore's device, I also have a definite somatic component to my tinnitus. I'll be on that plane, too, first change I get!

 

For a healthy male, the half life is closer to 24-30 hours.

 

How many milligrams are you taking of Mirtazapine? Does it make your tinnitus seem louder before you fall asleep? Do you feel groggy when you wake up?

 

I have been taking a quarter of a Klonopin tablet every day for the past 3 months. My doctor prescribed 10 tablets to be taken every 30 days. I have gone without taking it for 5 days and felt no difference. However, I did notice that my hissing tone decreased about 3 weeks ago. This happened a few days after I had a Swedish massage, but I'm unsure if it was related. The hissing tone used to start at night as soon as I fell asleep and carried on all day until the evening, then it would settle down, and the next day would be a good day. I repeated this pattern for several years; I hope it stays.

 

Thanks, and good to know (though I'm female) -- I'd be happy if it left my system a little sooner.

The first time I took Mirtazapine, I took half a 7.5 mg pill (so 3.75 mg), slept like a log for 8 hours and awoke to total silence. It was amazing, though I was a bit groggy. Now (about a month later), I'm taking 2/3 of a pill (so about 5 mg) and still sleeping well, but not like a log. I wake up sometimes during the night, but it's pretty easy to fall back asleep. I don't usually feel groggy in the morning, and it doesn't seem to have any effect on my tinnitus, bad or good. I'll stay on it as long as it seems to be helping, but I've heard that the sleep-inducing effect can wear off after a while. I might have to up my dose.

Wow, thanks for replying -- this is just like me, but I have two good days after my bad day. The hissing resets while I sleep; if I wake up with it, I'll have it until I go to sleep at night, then wake up the next day without it.

So glad to hear Klonopin is helping you and that you don't seem to have problems with tolerance -- maybe I'll be a little less hesitant about taking it. Are your tablets 0.5 mg?

 

What on earth is a quarter of a tablet? They come in 0.5 mg, 1 mg, and 2 mg tablets.

 

Are you still cycling between Clonazepam and Valium? Weren’t you doing 3 days of Clonazepam before switching.

I’m still debating whether to just take it everyday as my situation hasn’t improved. I feel worse if anything.

 

A 0.5 mg pill cut in four pieces.

 

There is no real pattern. I take 2-3 mg Diazepam several days a week, and low dose Gabapentin (300-600 mg) every day. I use Clonazepam twice a week to once a week, however usually with Gabapentin and Deanxit.

 

Gabapentin at night or during the day, or split? I was taking it right before my hyperacusis onset (concert) and at the time it was prescribed for anxiety. Now it is prescribed for my hyperacusis, lol. I can't tell if I love or hate Gabapentin.

Is the Deanxit to help with coping or does it have some underlying impact on tinnitus or hyperacusis? I see it's a TCA and I imagine it has to be taken every day?

I am considering trying Clomipramine again for my hyperacusis and trying to put up with the side effects this time for a bit longer.

 

I take Gabapentin 2-3 times per day. I take Deanxit with Clonazepam as per Dr. De Ridder. It's to 'break up the tinnitus network' as single medications only do so much. There are a bunch of different neurotransmitters. Most important part of Deanxit is Flupentixol.

 

Is this regime making life bearable for you, as in being able to work etc.? I noticed in one of your posts that you’ve shifted your attention to trying to just accept the condition; is the ultimately aim to get off all of the medication?

 

Would you recommend Dr. De Ridder? I spoke to Dr. Boedts Thursday morning very early my time in the US and he tended to think that my light sensitivity and floaters that came along with my right ear hyperacusis after a night club outing warranted an appointment with Dr. De Ridder.

Dr. Boedts had some really interesting insights on hyperacusis and ear pain being muscular in origin and told me to check back in with him in a few months as he's experimenting more with Lidocaine and Botox in his hyperacusis patient population. But he and I didn't actually discuss tinnitus and I feel like the fact that my tinnitus is 24/7 means that a Silverstein surgery might really not do much for me and it may be time to consider taking time away from work and paying out of pocket to be seen by Dr. De Ridder.

Just curious to get your early impressions. All good if the 'jury is still out' and you're still tweaking the right treatment for you.

 

Yes, I take a dosage of 0.5 mg and cut it into four pieces. I usually experience two good days consecutively. Do you suffer from ETD? It's surprising that our tinnitus symptoms are essentially the same. It's rare to find someone with similar symptoms.

 

Mine ranges from moderate to severe to very severe. I will use the medication until a better combination of treatments become available. Acceptance has to be a part, until that time.

I've just made and taken a little cocktail. I should remind people I don't use Ethanol.

• 0.75 mg Clonazepam
• 100 mg Gabapentin
• 1 Prochlorperazine
• 1 Paracetamol
• 8 mg Betahistine

I last used a cocktail on Sunday. Since then I've taken 300-500 mg Gabapentin a day and a couple of days added 2 mg Diazepam with one of the Gabapentin. So you can see it's all low dose and as needed with no particular routine. This is probably a better way than daily stable doses for tinnitus/hyperacusis as it lowers dependence on any one medication. The only regular medications are 30 mg Mirtazapine and low doses of Gabapentin. I would rather this than a single daily medicine or upping the Mirtazapine to 45 or 60 mg. It's a long climb down from there.

Sometimes I switch Prochlorperazine for Deanxit as they both modulate dopamine.

Not really, only if you need a prescription.

 

Do you take Gabapentin before bed for sleep? If yes, how effective is it?

 

I don't know anything about ETD (Eustachian Tube Dysfunction?). When my tinnitus started, I had muffled hearing in one ear and horrible headaches. I thought it was a sinus infection, but no one could see any signs of inflammation or fluid in my ears. None of the ENTs I went to suggested ETD as a possibility, but then, they didn't really have any idea why I had tinnitus, either. My best guess is that it was an inflammatory/autoimmune reaction from the COVID-19 booster I had gotten five days previous. Is there any reason why ETD would be so cyclical? Or reset during sleep? I find this whole thing quite mysterious. It is unusual to find someone with symptoms similar to mine; I think @Joe Cuber also has a similar pattern.

 

I don't take Gabapentin specifically for sleep. I take Mirtazapine for that and depression.

 

I think these cycles with tinnitus are not uncommon. I have been on a cycle between a single tone ringing and a hissing tinnitus for 2 years, but it's not set. It can change overnight or during the day, but it seems to be in the 1 to 3 day time range, plus there's a period of transition I catch it in at times where it's changing cycle and not clearly one or the other. And often, the hissing gets more broken up and crickety. It's never "quiet" for me, though. The squealing single tone ringing is the worst for me lately and causes more anxiety.

 

Interesting.

Mine definitely resets when I sleep; what I have when I wake up is what I have for the whole day. If it's the hiss, it will get louder in late afternoon/early evening and reach a roar around dinner time. It starts to back off around the time I go to sleep; when I wake up in the morning, it's gone for two more days. Lather, rinse, repeat. I'm sure there's some physiological cause for this... wish I knew what it was.

 

My doctor prescribed Seroquel for my sleep issues, but I haven't tried it yet. What are your thoughts on it?

Do you ever hear a hissing sound when you're sleeping?

 

Yes, sometimes it's so loud it wakes me up, often after only 90 minutes of sleep -- about the time it takes for one sleep cycle. And hence the Mirtazapine. I hope Seroquel works for you.

 

I haven't tried the Seroquel yet, and I'm still taking 3-4 mg of Mirtazapine. I'm wondering if 6 mg of Seroquel would put me to sleep, @Nick47?

I wish we could figure out how to turn two good days into five. It makes no sense that you could have complete silence for a couple of days and then all of a sudden hissing.

 

You describe exactly what I have. For me, it's pretty much a 3-day cycle that has repeated since it started a year ago and hasn't changed. On the first day, it is a pretty loud electrical hissing (snake pit) with a very fast oscillation. It's like I can literally hear the hyperactive neurons jumping around every millisecond. Only the shower can mask the horrible noise. My hyperacusis is also at its strongest on day one (cars braking). On the afternoon of the second day, I always notice that the noise gets weaker. When I wake up on the third day, the noise disappears shortly after I get up, so I have a quiet day when I can hardly hear it. The hyperacusis is also much weaker then. On the fourth day, the cycle starts all over again. This makes the suffering even more pointless and brutal for me because although the brain still seems to have the ability to keep my head quiet, it simply can't or won't do it permanently. An eternal alternation of despair and hope, pure existence and real living.

 

I have no idea on 3-4 mg of Mirtazapine. The lowest dose is 15 mg, so the break-in half is 7.5 mg. How do you get 3-4 mg?

Seroquel is not something prescribed for sleep in the UK as it's an antipsychotic.

 

Seroquel is prescribed off-label for sleep at 25 mg or less. I was told it is a strong sedative.

I use a pill cutter to get 3-4 mg of Mirtazapine. So far, the low dose has been effective for me, I am sleeping 7-8 hours.