The Night Time Noise: Why Tinnitus Can Be More Noticeable at Night
When I was little, I thought the noise in my ears was “night time noise”- a sound everyone’s body made when they went to sleep. As I grew a little older, I attributed the sound to crickets, until I realized during the middle of winter that there were no crickets outside. So, this night time noise must be something else. In this month’s blog, we explore the common experience of noticing tinnitus more at night.
Many individuals with tinnitus report that it is more noticeable at night, especially when it’s time to fall asleep (Manchaiah et al., 2018). For some, tinnitus is intermittent. For others, tinnitus is always there; yet, it is the perception of it that can change at night. Let’s address typical reasons why your tinnitus may seem to turn on or turn up at bed time.
Quiet Environments
As the day winds down and night draws near, we are often in quieter spaces. Simply being in a quiet environment can make tinnitus feel more noticeable and for many, it is the number one factor in reportedly worse tinnitus (Pan et al., 2015). Why is this? In a quiet space, there are fewer background sounds to mask or cover the sound of tinnitus. The sound may have been there all along but was not at the forefront of our mind and did not take priority over the other sounds we needed to hear. Without other things to listen to, it becomes easier for the brain to shift the focus to tinnitus.
Nervous System & Stress
Just as night time might be the first moment we find ourselves in a quiet room all day, it might also be the first time we have slowed down all day. Just because we know the day is done does not always mean our body receives the cue to relax. Chronic stress fuels a heightened, hyperactive response from the brain, including the autonomic nervous system (ANS). The ANS is responsible for regulating involuntary actions within the body (think heart rate, blood pressure, breathing patterns, digestion of food). It also plays the essential role of controlling our response to stress by switching between “fight or flight” mode and “rest and digest” mode. When we are stuck in fight or flight mode (a stress state), the brain effectively turns up the perceived volume of tinnitus and turns down our ability to filter it out (Patil et al, 2023).
Physical Discomfort
Perhaps, your tinnitus does not become bothersome until your head hits the pillow. Our sleeping position can exacerbate tinnitus due to changes in blood flow, disorders of the jaw (clenching or grinding teeth, TMJD), and issues of the neck, shoulders, or spine. A 2023 study found that participants with both chronic tinnitus and chronic neck pain perceived a higher impact from tinnitus, with greater psychological burden, and poorer sleep (De Meulemeester et al, 2023). If laying in bed is ever physically painful or brings tension, this can also bring the nervous system into fight or flight mode in anticipation of an uncomfortable sleep.
Managing Bothersome Tinnitus at Night
Approaches for managing tinnitus at night vary widely from low tech masking sounds to physician-prescribed sleep aids and everything in between. Below are a few lifestyle-based strategies worth exploring. Note that the focus here is to:
Decrease the perception of tinnitus in quiet,
Encourage a rest and digest state of the nervous system, and
Support comfort and decrease pain responses from the brain and body.
Background Sounds
Playing background sounds can help shift the brain’s attention away from the tinnitus while you are focusing on a quiet evening activity or falling asleep. Background sounds should be pleasant, yet not too engaging, so it can fade into the backdrop of your environment. Instrumental music and nature sounds are popular choices but you are the final authority on what exactly that sound should be. The volume should not exceed the volume of your tinnitus as this is meant to blend seamlessly, effectively masking the tinnitus without flooding the brain with additional overwhelming stimuli. This brings us to the next strategy.
Decrease Stimuli
Take note of the types of stimulation your brain interacts with in the evening hours. Our senses are sometimes overwhelmed by information, such as lights and sounds (TV, phones, tablets, smart watches, notifications, rush hour traffic, etc). Our brains can also be overloaded with tasks, such as difficult conversations, decision-making for the following day, late night work, or the gratification from social media scrolling. Be intentional about the stimuli you invite to your evening routine, wherever practical.
Create a Comfortable Sleep Routine
Build a routine that feels cozy and welcoming to help the brain shift to rest and digest well before it’s time to close your eyes. The specifics here will depend on your preferences and how you define relaxation. Self-care routines, such as a hot shower or skin care regiment, or leisure pursuits, including reading or drawing are a great place to start. Gentle movements or stretches can help decrease physical tension in the body and signal to the brain that it’s time to rest. Breathwork is, perhaps, the ultimate compliment to any sleep or rest routine. Taking slow, gentle breaths can decrease heart rate and blood pressure while enhancing the balance of oxygen and carbon dioxide. This is a simple, yet effective way to encourage a change within the body, which then communicates this change to the brain, including the parts that consciously perceive tinnitus.
Talk to a Provider
Consult an audiologist and ENT to determine if additional tests, referrals, or treatment of underlying medical conditions is advised. Addressing tinnitus from more than one angle, depending upon your unique experience, can often bring the greatest success.
For a deep dive into the studies referenced above, check out these resources:
De Meulemeester K, Meeus M, De Pauw R, Cagnie B, Keppler H, Lenoir D (2023) Suffering from chronic tinnitus, chronic neck pain, or both: Does it impact the presence of signs and symptoms of central sensitization? PLoS ONE 18(8): e0290116. https://doi.org/10.1371/journal.pone.0290116
Manchaiah, V., Beukes, E. W., Granberg, S., Durisala, N., Baguley, D. M., Allen, P. M., & Andersson, G. (2018). Problems and life effects experienced by tinnitus research study volunteers: An exploratory study using the ICF classification. Journal of the American Academy of Audiology, 29(10), 936–947. https://doi.org/10.3766/jaaa.17094
Pan, T., Tyler, R. S., Ji, H., Coelho, C., & Gogel, S. A. (2015). Differences among patients that make their tinnitus worse or better. American Journal of Audiology, 24(4), 469–476. https://doi.org/10.1044/2015_aja-15-0020
Patil, J. D., Alrashid, M. A., Eltabbakh, A., & Fredericks, S. (2023). The association between stress, emotional states, and tinnitus: A mini-review. Frontiers in Aging Neuroscience, 15, 1131979. https://doi.org/10.3389/fnagi.2023.1131979
