Why does tinnitus get worse at night?

Author: EarPros Team

What is nighttime tinnitus?

For many people worldwide, nighttime's quietude often brings the unwelcome presence of tinnitus. This condition manifests as a constant ringing, buzzing, or hissing in the ears, turning peaceful pre-sleep moments into a cacophony of sound, leaving those affected longing for quiet.

The absence of daytime noise during the evening hours tends to make tinnitus more pronounced, as there's nothing to disguise it. Sleep disturbances and shifts in circadian rhythms, together with changes in blood circulation and neural activity, can influence hearing sensitivity and the severity of tinnitus. Moreover, psychological aspects frequently exacerbate the awareness of tinnitus at night, making its presence even more pronounced

Nocturnal tinnitus symptoms

An estimated 15-20% of people experience tinnitus, as reported by the American Tinnitus Association. The condition's nocturnal form is particularly common, with a significant number of sufferers noticing a spike in their symptoms amidst the quiet of the night:

  • Persistent ringing or buzzing sounds in the ears
  • Increased perception of tinnitus in quiet environments
  • Difficulty falling asleep due to intrusive tinnitus noise
  • Frequent waking from sleep
  • Heightened stress or anxiety
  • Daytime fatigue as a result of disrupted sleep patterns
  • Concentration difficulties stemming from lack of restful sleep
  • Overall impact on quality of life and well-being
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What causes ringing in the ears at night?

There are several factors contributing to the heightened perception of tinnitus at night:

  • Ambient Noise: Less background noise at night means tinnitus sounds become more noticeable.
  • Hearing Thresholds: Elevated nighttime hearing thresholds make tinnitus stand out as other sounds fade.
  • Fatigue and Stress: Day's end fatigue and stress can make tinnitus seem louder by hindering our brain's filtering ability.
  • Sleep and Circadian Rhythms: Nighttime changes in blood flow and neural activity can intensify tinnitus perception as we transition to sleep.
  • Silence's Role: In silence, the brain may amplify internal sounds like tinnitus in the absence of external auditory input.
  • Psychological Factors: Attention and emotional states at night can increase the conscious awareness and distress of tinnitus.

Can tinnitus cause sleep apnea?

Tinnitus, while not a direct cause of sleep apnea, can contribute to a pattern of sleep disturbances that may lead to secondary issues like sleep apnea. For some individuals, the persistent ringing or buzzing sounds of tinnitus can make it challenging to fall and stay asleep, which can exacerbate sleep-related disorders. 

In cases where sleep apnea is identified as secondary to tinnitus, it implies that the disrupted sleep patterns caused by tinnitus may be a contributing factor to the development or worsening of sleep apnea. Therefore, effectively managing tinnitus may have a beneficial effect on improving the symptoms of sleep apnea, emphasizing the need for a holistic treatment approach to these interconnected conditions.

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How to stop tinnitus and ringing in ear at night

A variety of management strategies and treatments are available to mitigate nocturnal tinnitus. This section examines a spectrum of approaches, from medical interventions to lifestyle adjustments:

Medications

Some medications may help reduce tinnitus, particularly if related to anxiety or depression:

  • Antidepressants have shown promise in alleviating nocturnal tinnitus symptoms by also addressing depression.
  • Antianxiety drugs can help reduce ear ringing at night and related stress, though they require cautious use due to addiction risks.
  • Intratympanic Injections, steroids or lidocaine injections into the ear may provide short-term relief for severe nighttime tinnitus cases, though their long-term effectiveness varies.

Sound therapy

Sound therapy provides an external noise to distract from tinnitus:

  • White Noise Machines: These devices mask tinnitus with consistent sounds like static, aiding sleep.
  • Tinnitus Notch Therapy: Filters out tinnitus frequencies, helping the brain ignore the ringing.

Cognitive behavioral and retraining therapy

Cognitive Behavioral Therapy (CBT) teaches patients to change their perception and reaction to tinnitus, improving their quality of life.

Tinnitus Retraining Therapy (TRT) uses sound therapy and counseling to make tinnitus less noticeable.

Lifestyle and physical activities

  • Diet and Nutrition: Adjusting one's diet can affect tinnitus, although most evidence is anecdotal.
  • Foods to Avoid: Limiting caffeine, alcohol, and salty foods may help alleviate tinnitus symptoms.
  • Beneficial Nutrients: Certain nutrients like magnesium, zinc, and B vitamins may support ear health and manage tinnitus, especially with magnesium for those deficient.
  • Exercise and Physical Activity: Regular exercise improves blood flow and reduces stress, which may help ease tinnitus.
  • Exercise Benefits: Cardio activities improve circulation, which is beneficial for ear health and can reduce tinnitus severity.
  • Exercise Recommendation: Aerobic exercises such as walking, cycling, and swimming are beneficial, while intense exercises should be moderated to avoid raising blood pressure and aggravating tinnitus.

Stress management techniques and tinnitus relief

Managing stress is essential due to its potential to worsen tinnitus:

  • Mindfulness and Meditation: Practices like mindfulness and meditation aid in relaxation and diverting attention from tinnitus, with studies noting sustained relief.
  • Relaxation Techniques: Activities (accompanied by white, pink, or brown noises) including deep breathing, muscle relaxation exercises, and yoga are effective in mitigating stress and, consequently, tinnitus symptoms.

Alternative and complementary therapies

  • Acupuncture effectiveness for tinnitus relief is variable and not consistently supported by research.
  • Herbal supplements are commonly used for tinnitus, evidence of their efficacy is limited, and professional advice is recommended due to interaction risks.
  • Biofeedback and neurofeedback techniques help patients learn to influence their body's responses, potentially aiding in tinnitus stress management.
  • Hypnotherapy may provide relief through deep relaxation and modifying the subconscious experience of tinnitus.
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Tinnitus hearing aids maskers

Hearing aids may benefit those with concurrent hearing loss by amplifying external sounds and thus diminishing the prominence of tinnitus. Masking devices can be worn to provide a low-level sound that masks the tinnitus.

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How to sleep with tinnitus?

A pragmatic checklist offering concrete steps to mitigate tinnitus during nighttime, fostering improved sleep and alleviation:

  • Develop a serene bedtime ritual to cue your body for sleep.
  • Utilize sound-masking apparatuses, like white noise generators, to create a tranquil auditory backdrop.
  • Optimize your sleep setting for tranquility – consider blackout drapes, a cozy mattress, and a temperate room climate.
  • Steer clear of stimulants such as caffeine and nicotine in the hours leading up to sleep.
  • Engage in relaxation practices like mindful breathing, progressive muscle relaxation, or meditation to lessen stress and anxiety.
  • Maintain a tinnitus log to identify triggers and discern patterns in your tinnitus experiences.
  • Discuss with a medical professional regarding sleep aids that do not aggravate tinnitus symptoms.

Ringing in the ears at night FAQs

What's the meaning of ringing in left ear at night

While some cultural beliefs assign spiritual meanings to ringing in the left ear at night, medically this symptom is recognized as unilateral tinnitus. It often becomes more noticeable during the quiet of the night as external noises diminish and we prepare for rest. This condition can be caused by various factors, including noise-induced hearing loss, stress, or earwax buildup.

For those experiencing this disruptive ringing, it's important to consult with healthcare professionals to identify the cause and explore effective treatments such as sound therapy or relaxation techniques.

When should I be worried about tinnitus at night?

While occasional, temporary nightitme tinnitus might not be cause for concern, you should consult a healthcare provider if you experience tinnitus that is persistent, worsening, or impacting your quality of life.

You should also seek medical attention if nocturnal tinnitus begins suddenly without an apparent cause, is accompanied by hearing loss or dizziness, or if it's affecting your mental health, like causing anxiety or depression.

Is ringing in one ear at night serious?

Ringing in one ear at night, also known as unilateral tinnitus, can sometimes be more serious than tinnitus in both ears.

It's particularly important to seek medical evaluation if the ringing is only in one ear as it could indicate underlying health issues such as ear infections, earwax blockages, or more rare conditions like Meniere's disease or acoustic neuroma.

Can sleeping pills make tinnitus worse?

Yes. Sleeping pills, particularly those that belong to the class of medications known as benzodiazepines, may have the potential to worsen tinnitus in some individuals. While they are prescribed to aid with sleep, these medications can affect the central nervous system and potentially alter auditory processing. For some, this alteration may exacerbate the perception of tinnitus.

Additionally, the use of sleeping pills can lead to a decrease in sleep quality and changes in sleep architecture, which might indirectly heighten the awareness of tinnitus. It is important to consult with healthcare professionals before starting or stopping any medication, as a tailored approach to managing both sleep and tinnitus can be crucial to improving overall well-being.

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