Intermittent tinnitus

[Bacus]

Hello,

This is my first time writing. I have had tinnitus in my left ear since February and have noticed that sleep always seems to trigger it. This can happen at any time during the night. I wake up with a shrill sound in my left ear, usually after having a dream. It is distressing, to say the least. This high-pitched sound stays with me for the rest of the day, making it a very unproductive day.

Then, for the next day or two, there will be an absence of sound. My ability to cope is severely tested by this cycle.

I have seen my family doctor and an ENT specialist. Besides prescribing Clonazepam, they seem unaware of how to help with my condition. Their medical observation is that many people have tinnitus and are not bothered by it, which is not at all reassuring in my case.

I live in a small town in southern Ontario, Canada, and finding the right type of help has been challenging.

Any help or advice would be appreciated.

Bacus

 

[Golly]

Hi Bacus:

I believe our condition is quite common. My advice is to work with your doctors (possibly see a neurologist) and come up with a course of action that works for you. Drugs like Klonopin do help; but they can be addictive, so beware. I take Mirtazapine (15mg) nightly to regulate my sleep.

There are other medications that apparently work for some people with intermittent, sleep-related tinnitus. Let me know if you'd like to hear about these.

Hang in there! Golly

PS. I lived in London, Ontario for seven years.

 

[Bacus]

Hi Golly,

Thank you for your advice. After reading about benzodiazepines, their addictive nature, and the painful withdrawal they can cause, I am genuinely frightened. I have been taking up to 1 mg of Klonopin for sleep.

I plan to talk to my doctor about switching to either Mirtazapine or Amitriptyline. Do you know about the potential side effects of these medications? Also, are they addictive?

Sorry for my ignorance—I have hardly taken any pharmaceutical medications before, and tinnitus has been a challenging experience. At this stage, I am just looking for a good night's sleep.

I have read your other posts and would appreciate any help you can offer.

Regards.

 

[Golly]

Hi Bacus:

Amitriptyline (Elavil) is an older, tricyclic antidepressant that has good sleep-inducing properties. If you are only taking it for that purpose (that is, as a sleep aid and not an antidepressant), a dose as low as 10mg is often sufficient. While non-addictive, there are side effects that you need to ask your doctor about (some less serious, like dry-mouth, and some more serious, like heart-related ones).

Mirtazapine (Remeron) is a tetracyclic antidepressant that has fewer side effects than Amitriptyline, but is also terrific for sleep (and is also non-addictive). Interestingly with Remeron, the less you take, the more tired you get! You might find that as little as 3.75mg (a quarter of the smallest dose) is enough.

Note that weight gain is a potential side effect of both these drugs.

You should also note that Amitriptyline helps some people better deal with tinnitus. I am not sure if it's volume reduction or anti-anxiety properties, or something else. But I think that this effect is observed when people take therapeutic doses (i.e. 50mg and up). The same benefits may be associated with Mirtazapine, but it is less well documented.

I'll definitely stay in touch with you. Feel free to contact me any time.

Best, Golly

 

[Bacus]

Hi Golly,

Thank you for the information. It seems Remeron is the better of the two options, although I am not too happy about the potential for weight gain.

As you may know, in Canada, it is very difficult to change doctors due to the healthcare system. My current doctor does not respond well to patient recommendations.

You mentioned that there are other sleep medications that work for intermittent tinnitus. I would love to hear about them.

I have tried Melatonin and most over-the-counter medications without success.

Thank you for your help.

Regards,
Bacus

 

[Golly]

Hi Bacus;

In my opinion, the weight gain connection is overblown. First of all, I believe only about 15% of patients experience this side-effect. Second, just as many experience increased appetite as a side-effect. I suspect that if you control your urge to over-eat (if indeed you feel it), you will be fine in this regard. I have now been on Remeron for almost four months and have not gained a pound. But as always, do your research and talk to your doctor.

I think you might want to discuss these kinds of medications with a psychiatrist who will be more familiar with these drugs and more comfortable prescribing them. Also, you should probably consult a neurologist. They often have interesting insights into tinnitus. Certainly, they are the first specialists to see (besides ENTs) to rule out known causes (treatable and otherwise).

The other medications I was alluding to are not necessarily for sleep. For example, Gabapentin (Neurontin) is often prescribed off-label to treat tinnitus. The jury is out as to whether this one works better than a placebo (it didn't for me in the low doses I took). But it is worth a shot if a doctor will work with you on this. (Gabapentin is pretty good for sleep, too.)

-Golly

 

[jazz]

I think you might want to discuss these kinds of medications with a psychiatrist who will be more familiar with these drugs and more comfortable prescribing them. Also, you should probably consult a neurologist. They often have interesting insights into tinnitus. Certainly, they are the first specialists to see (besides ENTs) to rule out known causes (treatable and otherwise).

The other medications I was alluding to are not necessarily for sleep. For example, Gabapentin (Neurontin) is often prescribed off-label to treat tinnitus. The jury is out as to whether this one works better than a placebo (it didn't for me in the low doses I took). But it is worth a shot if a doctor will work with you on this. (Gabapentin is pretty good for sleep, too.)

-Golly

Bacus,

I agree with Golly that neurologists and psychiatrists understand the brain better than ENT's, including neurootologists who specialize in the ear.

About the antiepileptic drugs like gabapentin, they do help some people. This is because tinnitus and epilepsy share a down regulation of GABA receptors. GABA is an inhibitory neurotransmitter. It works in conjunction with glutamate, an excitatory neurotransmitter. Normally, these neurotransmitters are in balance. In neurological disorders like tinnitus, this balance tips to favor glutamate. This results in an overactivity of neurons--known as glutamate excitotoxicity. Drugs like gabapentin help to restore this balance. (Of course, this is a simplification. But I believe the main points are correct.)

Regarding gabapentin, the clinical studies are not conclusive, but this is because of research issues, according to a 2011 review published in the American Journal of Audiology. (http://aja.asha.org/cgi/content/short/20/2/151) Talk to your physician about trying gabapentin or another antiepileptic drug, especially carbamazepine. And there are other drugs. Flexeril, a muscle relaxant, has recently been mentioned on TT as well as namenda. (Here's a link to the latter: https://www.ncbi.nlm.nih.gov/pubmed/23015804)

Remember that tinnitus is a symptom, not a disease, so something that works for one person may not work for another. It's important to be open minded and work closely with a doctor, trying several approaches. For many on this board, moreover, vitamins and other supplements have also helped, especially magnesium. Magnesium has several functions that makes it good against tinnitus, and its positive effects were published in 2011 in a phase II clinical trial. (https://www.ncbi.nlm.nih.gov/pubmed/22249877)

Here's an article in gabapentin and its uses:
https://en.wikipedia.org/wiki/Gabapentin

Finally, you may also find this 2009 review article of tinnitus pharmacology interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136369/

Good luck and be strong!

 

[Mr Registered User]

Here's some more uneducated info from me:

Tinnitus coming on during sleep -- could it be sinus-related? Do you have an sinus block, and/or does your ear ever feel blocked or stuffed up?
if so, perhap Google: "sinuses eustachian tube dysfunction tinnitus".

How about acid reflux? I've read that, during sleep, food particles can not only reflux up to the throat, but even up to the sinuses!

 

[Bacus]

Thank you Golly and Jazz,
I appreciate your advise and will consider your recommendations.
I wonder if it is possible to habituate intermittent tinnitus .ie a shrill brain rattling ,tinny noise.
I am considering buying the TRT book from amazon, as there is no TRT centres where I live.
Nothing but the best and good wishes .
Bacus

 

[Golly]

Hi Bacus:

There are people who swear by TRT. I am not sure how intermittency affects its efficacy, but it's worth asking around.

Indeed, habituation is probably impeded somewhat when tinnitus is intermittent. Part of the problem is the (largely false) belief that you can control the timing of the "good days." Further, there exists the temptation to live for the "good days," which should be avoided lest you effectively write off half of the life you have left to live!

I must admit that after two plus years with intermittent tinnitus, I remain acutely aware of the sensation of head-noise on "bad days." However, tinnitus no longer makes me panic. I understand that is something that I will have to live with until I find a suitable medication or treatment. Also, I know that I can have a great time with my kids regardless of what noises I hear. I believe that once you become comfortable knowing that you can still enjoy life regardless of this condition, part of the habituation (the acceptance) is made easier.

Chat with others on this board and find a path that feels right for you. It may be TRT, or you might want to experiment with medications (under a doctor's supervision) as I have done. Or, perhaps it's a sinus issue as suggested by Mr. Registered User. But you won't find out until you do your research and know your options.

Finally, take comfort in the fact that you are not alone. What's more, there is plenty of promising research being conducted as we write!

-Golly

 

[Gary Goodson]

Hello,

I noticed that this thread is a bit dated, but I still wanted to reply in the hope that it might help others. I am a 63-year-old male with sleep apnea, but otherwise, I am healthy. I have had unilateral tinnitus (left side) for four years. About once a week, or even more frequently, the tinnitus disappears for one or two days. This change always happens while I am sleeping. I never notice it changing while awake—I simply wake up to either the "noise" or the absence of "noise."

It might be old news to many of you, but it took me several years to make the connection between sleep quality and tinnitus.

I have found that regular exercise, avoiding staying up late, skipping naps, and not drinking—especially in the evening—help improve the depth of my sleep. Deeper sleep benefits the mind in many ways, and for me, and apparently for many others, it can reduce tinnitus.

I am also getting a new sleep apnea machine, and I hope that helps as well.

There are many articles documenting this. Here is one.