Is ringing in your ears keeping you awake at night? If so, you’re not alone. Many people with tinnitus complain that the intrusive sounds make it difficult to fall asleep. They often wake up the next morning feeling groggy and sleep-deprived too. Tinnitus can definitely make getting a good night’s sleep a challenge, but it’s likely that tinnitus is only the tip of the iceberg when it comes to your sleep disturbances.
Tinnitus is a good indicator that you may have an undiagnosed sleep disorder, including a connection between tinnitus and sleep apnea.
Research indicates that often, if you have one, you likely have the other. Both conditions also contribute to poor sleep quality and additional health problems, so how can you treat both conditions and get the restful sleep you need?
What is Tinnitus?
Tinnitus isn’t caused by any external sound, and others typically can’t hear it if you’re experiencing it. The main symptom is the distinctive ringing in your ears, but tinnitus can create other phantom noises in your ears, including clicking, humming, whistling, and buzzing.
One form of tinnitus, pulsatile tinnitus, is related to poor circulation and blood flow. This creates a sound that resembles a heartbeat inside of the ear.
There are two main types of tinnitus. Subjective tinnitus, the most common type, is tinnitus only you can hear. Objective tinnitus can be heard by the person experiencing it and can sometimes be detected by others.
Tinnitus symptoms can occur periodically, or they can be present all the time including at night which contributes to sleep disturbance and can often lead to a sleep problem. In some cases, the sounds can be so loud or obtrusive that they interfere with your ability to concentrate or hear other sounds.
What Causes Tinnitus?
Tinnitus can be caused by a few different factors. Some common causes include hearing loss, an ear infection or blockage in the ear canal, or a head or neck injury. Other causes of tinnitus include:
- Meniere’s Disease— an inner ear disorder caused by abnormal fluid pressure
- A Temporomandibular joint, or TMJ disorder
- Certain medications, such as some antibiotics, diuretics, and nonsteroidal anti-inflammatory drugs (NSAIDs)
- Abnormal ear bone growth
- Eustachian tube dysfunction— where the tube connecting your upper throat to your middle ear is always expanded, which can cause discomfort
Certain factors can put you at higher risk of tinnitus as well, including exposure to loud noises, age, and use of alcohol and tobacco. Health conditions like obesity, diabetes, high blood pressure, heart problems, or head injuries can increase your risk also.
Sleep Apnea Comorbidities: Diabetes and Hypertension
If you’re reading this article, then you’re hopefully familiar with obstructive sleep apnea (OSA) and why it’s so dangerous to your health. This includes how OSA contributes to health conditions that are closely tied to tinnitus.
If sleep apnea is a contributing factor to the conditions mentioned below, treating it may have an additional benefit of reducing your tinnitus symptoms.
Here’s a brief description of OSA and its connection to other diseases also linked to tinnitus:
- Obstructive sleep apnea occurs when your airway is partially or completely blocked, making it difficult for you to breathe at night. Its most common symptoms are loud snoring, gasping or choking during the night, or daytime fatigue.
- Sleep apnea sufferers may stop breathing anywhere between 5 or even more than 30 times in a single hour. When you stop breathing during sleep, your body and your brain become oxygen-deprived.
- Sleep apnea is connected to many health issues including heart disease, diabetes, high blood pressure, and anxiety. If you have obstructive sleep apnea, you’re more likely to have these conditions because OSA contributes to or worsens them. It’s also difficult to adequately treat them unless the apnea is addressed first.
Several of the conditions that sleep apnea contributes to or worsens also happen to be conditions that according to research worsens tinnitus too. For example, if you have diabetes or hypertension (high blood pressure), these two conditions are linked to tinnitus as well.
Getting a sleep test and determining if sleep apnea is a contributing factor to these conditions, can lead to treatment that indirectly supports your tinnitus treatment.
If you have diabetes, it’s important to note that the fragmented sleep and breathing interruptions tied to sleep apnea impair glucose tolerance and decrease your sensitivity to insulin. Sleep apnea also contributes to cortisol, a stress hormone that gets in the way of cells using insulin. This worsens and makes it more difficult to treat diabetes.
Untreated sleep apnea is also a major factor cause of high blood pressure and hypertension. This is because a decrease in oxygen while sleeping forces your heart to work harder to circulate oxygenated blood through your body. This extra pressure in your arteries spikes your blood pressure even higher.
Hypopneas (pauses in breath at night) also spike norepinephrine (adrenaline) in your body. Norepinephrine is the most powerful way to spike blood pressure in the body.
It’s important to point out these two conditions specifically because they could be playing a major role in your tinnitus and the ringing in your ears as detailed below.
High Blood Pressure and Tinnitus
There’s also a connection between high blood pressure, or hypertension, with tinnitus— Nearly 45 percent of people with tinnitus also have hypertension, and people with hypertension are more likely to experience hearing loss.
High blood pressure can affect the blood vessels in your ears, which can cause tinnitus or hearing loss. If your tinnitus noises include pumping, pulsing, or beating sounds, then it’s possible that your symptoms are related to high blood pressure.
Diabetes and Tinnitus
There is a direct link between diabetes and tinnitus— in fact, between 84 and 92 percent of people with diabetes also have tinnitus. People with more severe diabetes are at an even higher risk of tinnitus and hearing loss.
More research is needed to find how exactly diabetes causes tinnitus, but one theory is that insulin resistance can prevent that oxygen and glucose from reaching your ears, which makes it harder for them to work as they should. However, it is possible for people with type 2 diabetes and tinnitus to reduce their symptoms with a consistent, healthy diet.
In one study published by The International Tinnitus Journal, 80 tinnitus patients with type 2 diabetes were instructed to follow a specific diet aiming to regulate their insulin levels. Those who consistently adhered to the diet were five times more likely to see a reduction in their tinnitus symptoms than those who did not follow the diet. After two years, 15 percent of patients who followed the proper diet even eliminated their tinnitus symptoms entirely.
If you have tinnitus and diabetes, it’s vital to keep your symptoms under control with a healthy lifestyle. But if you’re having a hard time sleeping, then there you may have another underlying condition that requires additional treatment.
Tinnitus and Hearing Loss
According to numerous reports, approximately 90 percent of people with tinnitus also have hearing loss. If you’ve lost hearing in only one ear, your hearing loss is in that ear. If your hearing loss is related to difficulties hearing high frequencies, your tinnitus is often a high-pitched ringing or hissing.
A hearing aid may help mask some of the phantom noises in the higher frequency range if you’re experiencing high frequency hearing loss by restoring your hearing in that range. This can help muffle the tinnitus sounds and provide some level of comfort and relief.
How Hearing Loss and Sleep Apnea Are Connected
Tinnitus is not only associated with hearing loss, but as expected with sleep disturbance as well. The relationship may even be cyclical— Up to 71 percent of tinnitus patients report sleep problems, and sleep deprivation may be a cause of chronic tinnitus.
Chronic tinnitus sufferers may also be at higher risk for obstructive sleep apnea (OSA).
Can Sleep Apnea Cause Hearing Loss?
No, but sleep apnea may make you more likely to experience hearing loss. The link between sleep apnea and hearing loss has only recently been observed, but addressing this connection can go a long way in treating both disorders.
In one study, researchers at Albany Medical College found a 30 percent higher risk for hearing loss in those with sleep apnea. 33 percent of participants reported hearing impairment, and 10 percent reported sleep apnea. Among the participants with hearing impairment, just over 11 percent of them also had sleep apnea.
Researchers believe the connection between hearing loss and sleep apnea is the reduced oxygen levels associated with the latter. Reduced oxygen levels may damage cochlear cells— the cells in your ears— over time, which can result in hearing loss and disorders like tinnitus.
Research also found that sleep apnea can worsen how you already feel about your hearing problems. So if you’re not getting the sleep you need, your tinnitus is more annoying and difficult to tolerate. Being more annoyed by your tinnitus symptoms also makes it harder to fall and stay asleep.
Charles E. Bishop, associate professor at the University of Mississippi Medical Center, Jackson, and audiologist in their Department of Otolaryngology and Communicative Sciences, notes that many who have tinnitus don’t seek treatment, but most who do also have sleep apnea.
Thankfully, treating sleep apnea can not only treat the effects of tinnitus and hearing loss, but also other underlying conditions like diabetes and high blood pressure.
How CPAP Can Help Treat Tinnitus Symptoms
There’s a reason why a CPAP machine, or continuous positive airway pressure, is the most popular apnea treatment for OSA: It’s effective not only for treating sleep apnea, but in treating any underlying conditions exacerbated by the apnea.
CPAP unblocks your airways by using a constant stream of air to hold your airway open and support it so you can breathe freely as you sleep. This allows your brain and body to receive the oxygen it needs to function.
In patients with diabetes, CPAP treatment lowers 24-hour glucose levels, improves glucose response, and reduces morning spikes in blood pressure. CPAP also helps increase artery size and reduce hypertension in people with high blood pressure.
So how exactly does CPAP treat tinnitus?
In the previous section, we mention how tinnitus and sleep apnea are connected because reduced oxygen levels during apnea can damage the cells in your ears and cause hearing loss. CPAP therapy can help reduce your tinnitus symptoms by improving oxygen levels in your blood, and reducing the pressure in your ears. This can prevent further cell damage that can harm your hearing.
Health conditions including high blood pressure and heart disease increase your risk of tinnitus and hearing loss. CPAP is also highly effective in treating or preventing cardiovascular problems such as high blood pressure or heart disease. In treating these, you can also address any potential hearing loss or ear disorders.
While CPAP can be an effective treatment for tinnitus, there is no definitive cure for the disorder. However, treating one underlying condition could go a long way in treating any others.
When to Consult an Expert
While tinnitus isn’t a sure sign of a sleep disorder, there is a clear connection between tinnitus and sleep apnea. Treating your symptoms can go a long way in helping you get a good night’s sleep, but if you’re still struggling to sleep at night outside of your tinnitus, you may have an underlying sleep disorder.
If you think you’re experiencing sleep disordered breathing or symptoms of OSA, check out our sleep apnea quiz. This quiz isn’t meant to diagnose sleep apnea, but it can help you figure your symptoms out and take steps towards potential treatment options.
Once you have an idea of what your symptoms are, a sleep expert can help you evaluate your symptoms and find the best treatment options for you.
The connection between tinnitus and sleep apnea can make getting a good night’s sleep difficult, especially if you have both conditions— but it doesn’t have to be that way. Contact us at the Sleep Centers of Middle Tennessee today so you can get back to the deep and restful sleep you need.
“Tinnitus.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 4 Feb. 2021, www.mayoclinic.org/diseases-conditions/tinnitus/symptoms-causes/syc-20350156.
Lavinsky L;Oliveira MW;Bassanesi HJ;D’Avila C;Lavinsky M; “Hyperinsulinemia and Tinnitus: A Historical Cohort.” The International Tinnitus Journal, U.S. National Library of Medicine, pubmed.ncbi.nlm.nih.gov/15379344/. Volkers, Nancy, et al. “Sleep-and Hearing-Interrupted.” The ASHA Leader, 12 Oct. 2018, leader.pubs.asha.org/doi/full/10.1044/leader.ftr2.23022018.56.