Sleep Architecture Disrupted in Tinnitus Sufferers

[jazz]

Everyone knows how important sleep is to people with tinnitus. Sleep strategies, medications, and supplements--all these topics engender frequent discussion on TT and for good reason: getting a good night's sleep is the most important single factor that affects tinnitus intensity for many people. Below is a sleep study comparing people with tinnitus to people without. The results are not surprising: sleep architecture is disrupted in people with tinnitus. This study is an excellent beginning in understanding the relationship between sleep and tinnitus. Hopefully, more sleep studies will follow--including one that looks at people with active tinnitus and those who have habituated. It would be useful to know if habituation turns off some of those neural networks that affect not only sleep, but also general cognitive functioning.

Here's the abstract:

Ear Hear. 2013 Jul-Aug;34(4):503-7. doi: 10.1097/AUD.0b013e31827bc436.

Sleep architecture variation in chronic tinnitus patients.

Attanasio G, Russo FY, Roukos R, Covelli E, Cartocci G, Saponara M.

Source
Department of Sensory Organs, Sapienza University of Rome, Rome, Italy. giuseppe.attanasio@uniroma1.it

Abstract
OBJECTIVES:
The aim of the study was to evaluate the sleep architecture and its possible alterations in chronic tinnitus patients, and investigate any possible correlation between sleep architecture modifications and tinnitus perception, adaptation, and the degree of discomfort in these patients.

DESIGN:
In a prospective, case-control, nonrandomized study, 18 patients affected by chronic tinnitus were compared with a homogeneous control group consisting of 15 healthy subjects. The experimental group was enrolled at the Tinnitus ambulatory at Policlinico Umberto I Department of Sensory Organs, and the control group was composed of voluntary subjects. A full overnight polysomnography was performed on both groups. Tinnitus patients answered two questionnaires: the tinnitus handicap inventory (THI) and a questionnaire concerning their subjective sleep quality, tinnitus intensity before bedtime, tinnitus intensity at remembered nocturnal wake-up periods, and tinnitus intensity at morning wake-up. Controls completed only the sleep quality questionnaire.

RESULTS:
All tinnitus patients had a statistically significant alteration in sleep stages. Average percentage of stage 1 + stage 2 was 85.4% ± 6.3, whereas, in the control group, the average percentage of stage 1 + stage 2 was 54.9 ± 11.2 (p < 0.001). Stages 3 and 4 and rapid eye movement (REM) sleep was lacking in all tinnitus patients with an average percentage of 6.4 ± 4.9 of REM sleep, and 6.4 ± 4.9 of stages 3 + 4. The control group showed an average percentage of 21.5 ± 3.6 of REM sleep and 21.5 ± 3.6 of stages 3 + 4 (p < 0.001). No correlation was found between the decrease of REM and the increase of the THI score in the tinnitus group (r = 0.04). However, a mild correlation was found between the increase of light sleep (stage 1 + stage 2) and the THI score reported by the tinnitus group. Therefore, patients with light sleep report a higher THI score (r = 0.4).

CONCLUSIONS:
The significant alteration of sleep parameters assessed in tinnitus patients underlines the necessity to consider an adequate therapy that could improve patients' sleep quality and also opens avenues for further investigations.

 

[just1morething]

I added Remeron(mirtazapine) to my arsenal for improved sleep. I took 15mg along with Zolpidem 10mg & had a dramatic improvement in my tinnitus today. Yesterday my T was a loud piercing ringing that I could barely stand.
I think quality REM sleep = much lower tinnitus the following day IMHO. (not eliminating it totally of course)

I changed to mirtazapine from Nortriptyline because of bad dry mouth of the latter. I also heard good things about the med from Golly,Karl, & others. I will update if it continues to work well. I am still looking into proton pump inhibitors affecting tinnitus as well. I seem to have loud hissing today and may be noise activated--frustrating.

-just1morething

 

[Markku]

I added Remeron(mirtazapine) to my arsenal for improved sleep. I took 15mg along with Zolpidem 10mg & had a dramatic improvement in my tinnitus today. Yesterday my T was a loud piercing ringing that I could barely stand.
I think quality REM sleep = much lower tinnitus the following day IMHO. (not eliminating it of course)

I changed to mirtazapine from Nortriptyline because of bad dry mouth of the latter. I also heard good things about the med from Golly,Karl, etc.. I will update if it continues to work well.

-just1morething

Have you thought about dropping Zolpidem and only using Remeron? Do you take Zolpidem every night? Doesn't it build up tolerance?

Just thinking aloud here, as many find sleep relief solely with Remeron, with no need to use other drugs.

 

[just1morething]

Have you thought about dropping Zolpidem and only using Remeron? Do you take Zolpidem every night? Doesn't it build up tolerance?

Just thinking aloud here, as many find sleep relief solely with Remeron, with no need to use other drugs.

Yes, I might go that route eventually, but am probably addicted to Zolpidem for now. I did not sleep well last night ( was up till 2:30 am) so I don't know if bad day today is partially cause of that, or just noise activated tinnitus from operating combine.

I did use Remeron 30mg last night, but it did not make me sleepy for some reason. The previous night I slept great with only 15mg. Sometimes helps to take a shower at night to get your body relaxed before going to bed.

I am not a happy camper with my current loud hissing sound in my head.

 

[meeruf]

@Markku

I used Zolpidem the first eight weeks of tinnitus. It builds up tolerance very fast. In the beginning I was totally wasted when I took them. It even "cured" my tinnitus. That effect stopped after about four weeks. After eight weeks the "buzz" I got from them stopped too.

 

[spleen]

Since I got my tinnitus, I never had difficulties to sleep, even with 2 times tinnitus aggravations during the past 2 years, and I never took medication. However, I have the impression to be more tired than usual every day since I got the tinnitus, maybe because tinnitus affects the quality of sleep, I don´t know.

Are you guys getting night medication to actually begin to sleep or to have a better quality sleep (more regenerative sleep) or something else ? Is it the norm not to be able to sleep because of tinnitus ?

 

[meeruf]

Since I got my tinnitus, I never had difficulties to sleep, even with 2 times tinnitus aggravations during the past 2 years, and I never took medication. However, I have the impression to be more tired than usual every day since I got the tinnitus, maybe because tinnitus affects the quality of sleep, I don´t know.

Are you guys getting night medication to actually begin to sleep or to have a better quality sleep (more regenerative sleep) or something else ? Is it the norm not to be able to sleep because of tinnitus ?

I take it just to get to sleep. When I'm sleeping, not even a bomb can wake me up.

 

[Riikka]

I envy you meeruf for being such a good sleeper. I'm that kind of person that is awakened in the early hours by any kind of sound. And once I'm awake at night, it's much harder for me to fall asleep again. In the evening I'm usually that tired that I fall asleep despite of the tinnitus. I have always been a light sleeper, but I have been wondering if I have become an even lighter sleeper because of the tinnitus.

I use Remeron and it helps me fall asleep. Unfortunately it doesn't keep me from waking up during the night.

 

[Cher69]

Sounds just like me riikka - I wish I could sleep all night I waken often and can find it takes me an hour or more to go back to sleep. I have had all nighters with zero sleep but that is when anxiety rockets.

I've just been given a new AD to take at night that helps sleep so far it's helped me get through a tough sleepless couple of months. I just can't amagine ever being able to sleep without some tablet to help !

I've had zoplicone and been very careful how I take them to prevent dependency and addiction I feel much more positive on the AD than zoplicone.

If I can sleep well ad without fear of failure I can deal with this T !

 

[LadyDi]

I hear you, Cher. I had sleep problems about nine years before I got tinnitus but now they are even worse. It s getting harder to fall asleep even with meds. Used to just be the night waking. I usually feel tired during the day, I am sure in part due to low quality sleep.

Had my first party at my house last night since my tinnitus an it Just exhausted me, with my ears roaring the whole time. I was totally wiped out when I crawled into bed...and still couldn't fall asleep until 3 am. I feel so helpless, my mom is visiting and it's hard for me to be cheery and social. Today was the first time I cried in awhile.

 

[Lulubug69]

I have found a sleep remedy that has proven to be very effective for me. It's not habit forming. I use a combo of two herbs. Passionflower extract is like valium. I use only half of the recommended dose and also something called Rhodiola Recharge. It is a combo of herbs that help with adrenals. It was recommended to me by a woman's health nurse practitioner, for stress and trouble sleeping and anxiety. She told me it would be fine for me to take now that I am experiencing T. These are something I use at night...every night. No drugged feeling when I wake. I love this stuff. I can wake in the night, and get right back to sleep. I've recommended it to all of my girlfriends as we are always stressed. This can be taken by men too. Just wanted to share, if just one other person finds it works for them, it's worth mentioning.

 

[LadyDi]

Thanks Lulu. I am trying out anything that sounds helpful and safe, so will give this a whirl.

 

[Frédéric]

Polysomnographic Findings in Patients With Chronic Tinnitus
Liane Sousa Teixeira, Carlos Augusto Costa Oliveira, Ronaldo Campos Granjeiro, Carine Petry, Adra Brasil Leitão Travaglia, Fayez Bahmad, Jr
Hospital de Base do Distrito Federal, Brasília, Brazil
Universidade de Brasilia, Brasília, Brazil

Corresponding Author: Liane Sousa Teixeira, SQN 305 Bloco C, Residencial Henrique Dias, Brasilia, DF 70737030, Brazil. Email: liane_st21@hotmail.com
First Published October 8, 2018 Research Article
https://doi.org/10.1177/0003489418805766

Abstract
Objectives:
Tinnitus is an auditory sensation in the absence of any external stimulus. It has a negative impact on quality of life and interferes with concentration, sleep, social activities, and even emotional stability. The aim of this study was to compare sleep architecture in patients with and without chronic subjective tinnitus.

Methods:
This was an observational, noninterventional, and prospective study. The sample consisted of 50 individuals of both sexes aged 20 to 60 years. Twenty-five patients with tinnitus constituted the study group, and for comparison, a control group consisting of 25 patients without reported tinnitus was formed. The patients underwent polysomnography and were administered the Epworth Sleepiness Scale, Tinnitus Handicap Inventory, and visual analog scales.

Results:
The group with tinnitus had higher mean values in sleep stages 1 and 2, and lower mean values in stage 3 and in rapid eye movement (REM) sleep, compared with the control group, and this difference was significant only for REM sleep (P = .031). This demonstrates that patients with tinnitus remained longer in shallow sleep and spent less time in deep sleep (stage 3) and REM sleep.

Conclusions:
This study shows that patients with tinnitus have significant alterations in REM sleep latency as well as the REM sleep phase.

Keywords: sleep, Tinnitus Handicap Inventory, Epworth Sleepiness Scale, obstructive sleep apnea syndrome, tinnitus, otology, otolaryngology

Source: http://journals.sagepub.com/doi/abs/10.1177/0003489418805766?journalCode=aora

 

[Frédéric]

Clinical research on sleep quality in patients with tinnitus].

Objective:To understand the sleep quality of patients with tinnitus, and to investigate the correlationship between tinnitus and sleep and analyze the influencing factors.

Method:The patients with tinnitus as the main complaint used as the experimental group were 263 cases. One hundred and seventy respondents with no tinnitus complaint were selected as the control group. They were assessed by general information survey, Pittsburgh Sleep Quality Index, the Hamilton Anxiety Scale, the Hamilton Depression Scale, pure tone audiometry and acoustic immittance measurement.

Result:There were 122 cases（46.4%） with sleep disorders in the experimental group and 49 cases（28.8%） with sleep disorders in the control group, and the difference was statistically significant（P=0.000）; The anxiety and depression were the influencing factors of sleep quality in patients with tinnitus, it was found that gender had influence on sleep latency and the course of disease and hyperlipidemia had influence on sleep disorders.

Conclusion:Tinnitus patients were prone to sleep disorders, and the accompanying anxiety and depression were the important factors affecting sleep quality.

Source: https://www.ncbi.nlm.nih.gov/pubmed/31623044

 

[Frédéric]

Association of sleep terror, walking or talking and tinnitus

Background/purpose
Sleep disturbances are associated with chronic tinnitus in humans. However, whether parasomnias are associated with chronic tinnitus is unclear. This study aims to investigate this issue.

Methods
Clinical data for 2907 subjects who had visited the Sleep Center of a community hospital in Taiwan during November 2011 to June 2017 were collected retrospectively. The association of chronic tinnitus with sleep terror, sleep walking, and sleep talking was analyzed using Pearson's Chi-Square test and multivariate logistic regression.

Results
The cohort age ranged from 7 to 91 years old, with a mean age of 49.8 years (standard deviation, 14.3 years). The cohort included 1937 patients without and 970 patients with chronic tinnitus. The percentage of patients who experienced sleep terror was significantly higher among those with tinnitus than those without (p < 0.001). The percentage of patients reporting sleep walking was slightly higher in subjects with tinnitus than in those without, with borderline significance (p = 0.063). The percentage of patients experiencing sleep talking did not differ significantly between the groups. Multivariate logistic regression also showed that sleep terror but not sleep walking was significantly associated with tinnitus after adjusting for age, sex, hearing loss, and insomnia. After adjusting for other factors, subgroup analysis by age showed that sleep terror was significantly positively associated with chronic tinnitus in patients aged 20–44 years but not in those aged 7–19 or >45 years.

Conclusion
Sleep terror is positively associated with chronic tinnitus, especially in young adults.

Full article: https://www.sciencedirect.com/science/article/pii/S0929664620301066

 

[Frédéric]

Prevalence of sleep impairment in patients with tinnitus: a systematic review and single-arm meta-analysis

 

[Frédéric]

The important information is this:

A U-shaped relationship between sleep duration and tinnitus incidence: analysis of 13,871 participants from NHANES

 

[Nes]

Does tinnitus itself affect REM sleep, or is it tinnitus-related anxiety that prevents a good night's sleep?

To add my two cents, ever since developing tinnitus, I've started waking up multiple times per night. I used to be a heavy sleeper despite having anxiety before acquiring tinnitus. Even when my tinnitus is low, I still wake up, but on those nights, I don't hear it and can fall back asleep quickly.

For me, Melatonin and occasionally Clonazepam (0.25 mg every three or four days during bad periods) have been a godsend. I still wake up, but at least falling asleep is no longer an issue, and the quality of my sleep improves significantly.

 

[PeterPan]

In small doses, Remeron increases sleep duration. Prolonged sleep deprivation, especially a lack of REM and stage 3 sleep, is harmful to long term health.

But I wonder, does using Remeron actually address the long term health risks? It might improve sleep duration, but does it truly counteract the long term effects of sleep deprivation? For example, does it actually increase REM and stage 3 sleep?

I'm tempted to try Remeron, but I have a general aversion to medication. If a study showed that Remeron contributed to the long term health of tinnitus sufferers, that would make the decision easier.

 

[Scruffiey]

In small doses, Remeron increases sleep duration. Prolonged sleep deprivation, especially a lack of REM and stage 3 sleep, is harmful to long term health.

But I wonder, does using Remeron actually address the long term health risks? It might improve sleep duration, but does it truly counteract the long term effects of sleep deprivation? For example, does it actually increase REM and stage 3 sleep?

I'm tempted to try Remeron, but I have a general aversion to medication. If a study showed that Remeron contributed to the long term health of tinnitus sufferers, that would make the decision easier.

There's no way medicated sleep is going to be as good for you as natural sleep, so it is a judgment call. Long term use of an antidepressant may not be great for you, but long term sleep deprivation is not great either.

Unless you can adjust over time through therapy, exercise, or other methods and manage to get eight hours of natural sleep with your tinnitus, you will probably have to choose between more sleep with lower quality or less sleep but completely natural.

If medication is the only way you can fall asleep, then there is no real question. You will have to take it.

However, if you can adjust your schedule, one long sleep period may not be necessary. Research suggests that humans historically had multiple sleep and wake cycles, sleeping for three hours, waking for an hour to read or relax, then sleeping again. If your issue is more about sleep duration rather than falling asleep, a siesta like approach might be beneficial.

 

[Eloy79]

The Brain, Tinnitus, and Sleep: An Unexpected Relationship

Studies have shown that tinnitus is a phantom perception, meaning that the brain "creates" a sound that does not exist in the environment. Most people only experience phantom perceptions when they are asleep, such as in dreams or hypnagogic hallucinations. However, people with tinnitus experience them while fully awake.

In addition, tinnitus is linked to abnormal hyperactivity in certain brain regions, especially those responsible for hearing. And this is where sleep comes into play: when we sleep, brain activity changes radically, allowing some areas to "reset" and others to be temporarily suppressed.

A key finding suggests that during deep sleep, the brain can naturally "turn off" tinnitus. This would explain why many people with tinnitus experience temporary relief upon awakening or why some manage to sleep despite the constant noise in their ears.

Deep Sleep: A Natural Solution for Tinnitus?

Our sleep goes through several phases, but one of the most important is slow-wave sleep, also known as deep sleep. In this stage, the brain generates synchronized electrical impulses that seem to "silence" certain unwanted neural activities.

Recent research indicates that in people with tinnitus, some areas of the brain remain hyperactive even during sleep, which can cause insomnia or frequent awakenings. However, there is also evidence that when deep sleep is intense enough, tinnitus can be temporarily suppressed.

This discovery opens the door to new strategies to treat tinnitus by modulating sleep. Techniques such as controlled sleep deprivation, nocturnal habit therapy, or even certain specific sounds could help induce deeper and more effective rest, reducing the perception of tinnitus.

Reference: sciencealert.com

 

[DimLeb]

A key finding suggests that during deep sleep, the brain can naturally "turn off" tinnitus.

In other news, during deep sleep, the brain can naturally turn off vision and smell as well. LOL. Basically, we're not aware of much when we sleep!