Mark Williams, Chief Audiologist at The Tinnitus and Hearing Clinic discusses recent research
Sleep quality affects tinnitus
It has long been reported that tinnitus awareness can be influenced by a variety of body, mood and environmental factors. Emotional states of anger or anxiety can negatively impact awareness levels. Making an executive effort to monitor or evaluate the tinnitus signal can also serve to induce the perception to be prioritised into consciousness. It is well established that jaw and neck pain can serve to increase activity levels within the central auditory system and cause more artefact noise to percolate up into consciousness. However, sleep quality is, in my experience, the most prolifically reported modulating factor that patients outline as being significant in causing the salience of their tinnitus perception to change in an obvious fashion.
Poor quality sleep, that is not restorative, can start to have a temporary detrimental effect with regards to an individual’s emotional state and executive functioning. If tinnitus is the cause of disturbed sleep this can serve to increase the emotional relevance of the perception and induce the threat evaluating centres of the neurology to home in on the signal and increase its salience. This can cause a cyclical effect whereby the tinnitus causes sleep disturbance along with anxiety which then, in turn, serves to increase tinnitus awareness. Clinically this cycle needs to be broken to enable a more regular sleeping routine and functional experience. Fortunately, there are a variety of interventions that can be applied to achieve this goal with cognitive therapy, relaxation exercises, sound enrichment and certain soporific medications all having a potential role to play in the rehabilitation of the patient.
Recent study
A recent and interesting study (Guillard et al 2024) examined the effect of sleeping for short periods of time (i.e. napping) on the intrusiveness of tinnitus. The study analysed the impact of napping in 37 participants with chronic tinnitus with a total of 197 short-term sleeping events being analysed via audiological and electrical brain function evaluation methods. Each nap event at any time of the day was shown to elicit an overall significant, short term, decrease in the ability of the participants tinnitus to be effectively masked with external noise. The tinnitus maskability was shown to improve in the periods between each napping event revealing that this increase in salience was a temporary phenomenon.
Why would a nap make tinnitus worse?
So why does napping potentially affect tinnitus in an exacerbatory way and what could this mean from a clinical perspective? It is possible that sleep posture and snoring have a role to play in influencing the activity levels within the central auditory system. If certain neck muscles are strained, by suboptimal sleeping arrangements, or if jaw musculature is over worked (e.g. via bruxism or grinding of the teeth) then this activity can be transferred to the auditory system due to presence of a physiological junction box (Cochlea Nucleus) within the brain stem where the nerve that innovates neck/jaw muscles interacts with the auditory system. Another, less well-established hypothesis, posits that the hearing system is regulated by an internal volume control that is influenced by the time of day or from individuals feeling fatigued. It is, therefore, possible that the auditory system’s activity level increases in preparation for sleep in order to scan for signs of danger or predation and thus serve to prevent someone from falling asleep in an inappropriate environment. From a clinical perspective the findings of this study underline the importance of patients engaging in a regular and reliable sleep regime and that cat napping should ideally be avoided if an individual experiences a strong negative emotional response to their tinnitus perception. Fortunately, there is much that can be done in order to improve the reliability of sleep depth and duration which can serve to deprioritise the psychological relevance of the symptom in order to stimulate the habituation process.
Three things to try
- Try to sleep at night and avoid napping if possible
- If you do nap, try to avoid bad posture where your neck is strained
- Do your relaxation exercises before/after a nap
Ref:
Guillard, R., Phillipe, V., Hessas, A., et al. (2024). Why does tinnitus vary with naps? A polysomnographic prospective study exploring the somatosensory hypothesis. Hearing Research. doi:10.1016/j.heares.2024.109152.
