Losing sleep over tinnitus?

Do you notice that your tinnitus sounds different when you wake up from sleep? It might be louder than usual, or maybe even quieter than usual. If so, grab a nice cup of tea and find yourself a comfy chair, I’ve got some recent research for you to read.

Neuroscientist Robin Guillard has looked at night-time sleeping and day-time napping and their effect on tinnitus.

In both research studies, he and his teams worked with patients who found that their tinnitus changed significantly when they woke up, whether from overnight sleep or a nap. This included patients whose tinnitus was quieter after they woke up, as well as people whose tinnitus was louder.

What they found out
In the first study1Guillard R, Korczowski L, Léger D, Congedo M, Londero A. REM Sleep Impairment May Underlie Sleep-Driven Modulations of Tinnitus in Sleep Intermittent Tinnitus Subjects: A Controlled Study. Int J Environ Res Public Health. 2023 Apr 14;20(8):5509. doi: 10.3390/ijerph20085509. PMID: 37107791; PMCID: PMC10138791. the researchers compared two group of tinnitus patients. Both groups had matching age, gender, self-reported hearing loss and tinnitus impact on their quality of life. The only difference was that those people in group one experienced a change in the volume levels of their tinnitus when they woke up from sleeping (whether overnight or naps), and the participants in group two didn’t.

Overnight sleep and tinnitus
The research found some potential reasons why group one might experience these changes to their tinnitus loudness after overnight sleep. Polysomnography2All participants in both research studies underwent polysomnography assessment which monitored their brain waves, oxygen level in their blood, heart rate and breathing while they were asleep. testing showed that there was no difference between the quantity of sleep nor the occurrence of sleep apnoea between the two groups. There was also little difference in how long it took participants from either group to fall asleep or wake up.

However, there was a difference between the quality of sleep experienced by the groups. Participants in group one (those who experienced a change in tinnitus on waking up) had more light sleep, less deep sleep and less REM stage sleep than the participants in group two.

According to earlier research3Ohayon, M.M.; Carskadon, M.A.; Guilleminault, C.; Vitiello, M.V. Meta-Analysis of Quantitative Sleep Parameters From Childhood to Old Age in Healthy Individuals: Developing Normative Sleep Values Across the Human Lifespan. Sleep 2004, 27, 1255–1273. a healthy person of around 50 years old would expect REM sleep to form 20% of their total sleep time. Yet participants in group one had 15.9% of REM sleep. Could this deterioration in both deep sleep and REM sleep create the change in tinnitus volume?

Let’s look at the science of sleep
During the average night, our sleep is made up of 4-6 sleep cycles averaging about 90 minutes each. Each sleep cycle has four stages as follows:

During light sleep our bodies experience a drop in temperature, our muscles relax, and our breathing and heart rates slow. Our brain activity slows too, with short bursts of activity that help us resist being disturbed by external stimuli, such as noises or lights.

The deep sleep stage is critical for allowing our mind and body to recover from the day and wake up refreshed. Muscles and tissues are repaired, and the immune system is strengthened. There is also evidence that deep sleep contributes to insightful thinking, creativity, and memory4https://www.sleepfoundation.org/stages-of-sleep accessed 31.1.24

REM sleep is named after the Rapid Eye Movements underneath our eyelids that characterise this sleep stage. It’s the stage that is known for giving us vivid and intense dreams. But, more importantly, it’s believed to be essential to cognitive functions like memory, learning, and creativity5https://www.sleepfoundation.org/stages-of-sleep accessed 31.1.24

When we don’t get enough deep sleep or REM sleep we might see an impact on our thinking ability, our emotions and our physical health.

Naps and tinnitus

Have you ever woken up from a day-time nap and thought “wow, is my tinnitus worse or is it a trick of my mind?” If you have, chances are it’s real.

In the study above the researchers noted that participants in the first group not only noticed changes in their tinnitus when they woke up in the morning, but also when they woke up from a nap. There was, however, an important difference. Although their tinnitus might be louder or quieter when they woke up after overnight sleeping, it was always louder after a nap.

In a second research project6Robin Guillard, Vincent Philippe, Adam Hessas, Brice Faraut, Damien Léger, Alain Londero, 0883 Understanding how naps may modulate tinnitus, Sleep, Volume 46, Issue Supplement_1, May 2023, Pages A388–A389, https://doi.org/10.1093/sleep/zsad077.0883, Robin Guillard and another team of researchers studied 37 people who said that their tinnitus changed significantly when they woke up from naps taken during the day.
The participants in the study were asked to attempt to nap six times over 2 days. Not everyone was able to nap every time on demand (I know I wouldn’t be able to!) but the researchers still had 197 naps to analyse.

Their research confirmed that naps did alter tinnitus loudness. The first nap of the day caused the most significant increase, followed by the second nap of the day and then the third. They also found that the longer the nap, the greater the increase in tinnitus volume.

You might remember that in the first study there was a question whether poorer REM sleep in group one might be linked to the change in tinnitus they experienced on waking up. What’s interesting is that in this study, naps also resulted in a change in tinnitus – an increase – and yet it is unusual to experience REM sleep during naps (unless they’re long). So maybe it’s not the reduction in REM sleep that’s having an impact on the tinnitus. Maybe that’s simply coincidental? Clearly, there’s a lot more research to be done on sleep and tinnitus.

I have interpreted this research to make it accessible to people with tinnitus. Any errors in this article are my own.