How to Sleep Better with Tinnitus
"My tinnitus is keeping me awake!"—I hear this often from my clients. As a hearing loss coach, I work with people experiencing a wide range of hearing and balance conditions, from sudden hearing loss to vestibular disorders. Tinnitus is one of the most common complaints among my clients, particularly when it comes to sleep.
For some, the challenge is falling asleep; in the quiet of the bedroom, their tinnitus jumps to the forefront of their attention without other sounds to mask it. Others have no trouble drifting off but wake up during the night, only to focus on their tinnitus, making it difficult to fall back asleep. The next day, exhaustion from poor sleep can make their tinnitus feel even louder, more intrusive, and harder to manage.
As someone who also has tinnitus, I remember those sleepless nights all too well. So, what can be done? How can you achieve a good night’s sleep despite tinnitus?
To better understand this, I researched the topic and spoke with tinnitus specialists to explore the connection between tinnitus and sleep—most importantly, how to improve sleep quality for those affected. Here’s what I discovered.
Understanding the Link Between Tinnitus and Sleep Disturbances
Tinnitus is a common condition where people hear sounds—such as ringing, buzzing, or hissing—in their ears or head without an external source. It occurs due to changes in brain activity and is often triggered by factors like loud noise exposure, ear damage, or hearing loss.
Tinnitus affects people's sleep in different ways—while some can sleep just fine, others struggle significantly. According to Tinnitus UK, approximately one in seven adults in the UK experience tinnitus, and many also struggle with sleep issues. In fact, it is estimated that 25% to 77% of individuals with tinnitus experience sleep disturbances, including insomnia, difficulty falling asleep, frequent nighttime awakenings, restless sleep, and reduced REM (rapid eye movement) sleep—the stage when the brain is most active.
The Emotional and Cognitive Factors in Tinnitus-Related Sleep Disruption
The connection between tinnitus and sleep issues is complex: tinnitus-related distress can make it difficult to fall asleep, while poor sleep can amplify the perception of tinnitus—creating a cycle that makes it even harder to fall asleep.
Experts point out that emotional factors—like stress, anxiety, and depression—often play a more significant role in sleep disruption than the loudness of tinnitus itself. Research by audiologist and tinnitus expert Dr. Hashir Aazh and his team supports this idea, showing that the link between tinnitus and insomnia depends more on how much a person is bothered or upset by the sound, rather than how loud it is.
Dr. Hashir Aazh - Tinnitus expert
Dr. Aazh explains, “Research at Hashir International Institute in collaboration with the University of Helsinki and the University of Cambridge has shown that the relationship between tinnitus loudness and severity of insomnia is indirect. This relationship is fully mediated by how much the individual gets annoyed by their tinnitus and the level of any underlying depression that they might be experiencing. In other words, a loud tinnitus which doesn’t cause any annoyance and depressive symptoms is likely to cause less sleep disturbances compared to a quieter tinnitus that causes annoyance and depression.”
His findings align with a broader body of research suggesting that the way a person perceives and reacts to tinnitus is more influential than its actual volume.
As Dr. Aazh adds, “There are several studies conducted in Europe and North America which reported that the loudness of tinnitus is not the main factor that contributes to how much the person gets annoyed by the tinnitus. According to cognitive theory, emotional responses such as anxiety, depression, and frustration stem from negative thought patterns—such as ‘tinnitus will ruin my life’—and maladaptive beliefs like ‘I am a failure.’”
How Tinnitus-Related Distress Affects Sleep—an Example
Let’s set the scene: After a busy day filled with background noise, you finally get into bed, exhausted and ready for a good night’s rest. But as soon as the room goes quiet, you hear it—your tinnitus seems louder now that there’s no other sound to mask it, making it harder to relax and fall asleep.
As you focus on the ringing, your mind might start racing with thoughts like, 'I’ll never fall asleep because of this noise!' This anxiety triggers your body's stress response, leading to a faster heart rate and even more racing thoughts—making the tinnitus feel even more overwhelming.
This heightened stress response, combined with the worry and anxiety, makes falling asleep even more difficult—creating a vicious cycle. Lack of rest increases the brain’s sensitivity to stress, which, over time, can amplify the perception of tinnitus, fueling even more negative thoughts and anxiety.
Tinnitus and Sleep Disruptions in the Brain
In addition to the vicious cycle and the role of emotional factors in sleep disruption in people with tinnitus, research suggests that tinnitus may also be linked to hyperactivity in certain brain regions involved in wakefulness. This overactivity can make it harder to transition into deep sleep or stay asleep. This phenomenon, sometimes called 'local wakefulness' or hyperarousal in the brain, means that tinnitus itself could be waking you up.
So, what can we do to improve sleep despite tinnitus?
Tips for a Good Night’s Sleep
To manage tinnitus and improve sleep, it's important to address both emotional and cognitive factors, such as stress and negative thought patterns. Practising good sleep hygiene can also enhance sleep quality and reduce tinnitus-related disruptions.
Here are 14 strategies to help you fall asleep more easily and stay asleep for longer. These include general sleep hygiene tips—focusing on your environment and behaviours—as well as specific approaches recommended by experts for managing tinnitus at bedtime.
Create a Bedtime Routine
Setting up a consistent bedtime routine is key to getting better sleep. Activities like reading, avoiding screens, taking a warm bath, or practising relaxation techniques (which we’ll explore shortly) signal to your body that it’s time to wind down, helping you fall asleep faster and sleep more soundly. Managing stress is also important since anxiety can make tinnitus worse. Incorporating stress-busting activities into your routine can make a big difference. Also, avoid eating late and exercising too close to bedtime. Being consistent with these habits can help relax your nervous system and reduce tinnitus symptoms, leading to a better night's sleep.
2. Optimize Your Sleeping Environment
Optimize your sleep environment by using your bedroom exclusively for sleep and relaxation. Avoid distractions like TV or work in bed, as they stimulate your mind and keep you awake. Turn off the lights when you get into bed and let sleep come naturally—don’t force it.
Make sure your mattress and pillows are comfortable, and consider using calming scents like lavender. Keep your room as dark as possible—use a sleep mask or blackout curtains to block out ambient light.
Turning down your thermostat can also help you fall asleep, as cooler temperatures promote rest. Studies suggest that the ideal room temperature for sleep is between 16-18°C (60-65°F). The key is not to feel cold in bed, so be sure to wear socks and pyjamas if you tend to get chilly.
3. Turn Off Your Screens
The human body has an internal day/night cycle known as the circadian rhythm. During the day, sunlight triggers the release of daytime hormones, while at night, the absence of sunlight prompts the brain to produce melatonin, signalling that it’s time to sleep. However, the blue light emitted by phones, TVs, computers, and other screens mimics sunlight, disrupting melatonin production and making it harder to sleep. As a result, activities like watching TV, using your phone, or working on your computer can worsen sleep issues. To promote better sleep, aim to turn off all backlit screens at least 1 hour before bedtime.
4. Clear Your Mind
Try to set aside at least an hour to unwind before bed. A busy mind can make it harder to sleep, and racing thoughts can keep you awake—tinnitus only adds to the struggle. To calm your mind, try writing down your thoughts before bed. Jotting down everything on your mind, including to-do lists and any negative or intrusive thoughts about tinnitus, helps release them. Spending 15–20 minutes each evening writing down your worries and possible solutions can ease anxiety and make it easier to fall asleep.
5. Practise Relaxation Techniques
Relaxation techniques like mindfulness and meditation can help calm the mind, reduce stress, and make it easier to sleep with tinnitus. Mindfulness helps you focus on the present moment, shifting attention away from the tinnitus sound, while meditation—especially deep breathing or guided practices—relaxes both the mind and body. Practising these techniques during the day reduces stress, and using shorter versions at night can help prepare you for rest.
Lisa Caldwell - founder of The Hearing Coach
Lisa Caldwell, founder of The Hearing Coach, helps people with tinnitus using mindfulness meditation techniques she discovered after losing the hearing in her right ear and developing tinnitus in 2005. A certified instructor, Lisa has created customizable tools and training designed to improve the lives of those with tinnitus.
"I recommend that my clients listen to a guided body scan when they’re ready to sleep," says Caldwell. "It’s the first mindfulness practice I teach in my Mindfulness for Tinnitus course."
"The long-term aim of each practice in the course is to teach us how to shift our attention away from our tinnitus towards wherever we want to focus, whether that’s a book, a report for work, or a conversation with friends," Caldwell explains. "And in the short term, those same practices help us relax and switch off our hyperfocus on our tinnitus."
The body scan is so effective at relaxing the body that many of her clients fall asleep before it finishes. If you'd like to try a guided body scan, you can access it below.
6. Try the Ujjayi Breathing Technique
Ujjayi breathing is a yoga technique that’s not widely known, but it can be highly effective for falling asleep. Glenn Schweitzer, the author of Rewiring Tinnitus and Mind Over Meniere’s, who has both tinnitus and Meniere’s disease, recommends it and has found that it induces sleepiness faster and more effectively than any other breathing technique.
Glenn Schweitzer - author of Rewiring Tinnitus and Mind Over Meniere’s
Here’s how it works, according to Schweitzer:
Ujjayi breathing involves deep, slow breaths through the nose, where the back of your throat is gently constricted to create a “hah” sound, just as though you were going to fog up a mirror by breathing.
There is a small learning curve to this technique as it can be somewhat confusing to learn to breathe through the throat constriction. But once you get it, it’s easy.
Find a comfortable position in bed where you are most likely to be able to fall asleep.
Inhale deeply through your nose, feeling your belly rise, for a count of 4 seconds, slightly constricting the back of your throat (the same throat constriction you would make to fog a
mirror while exhaling through your mouth).
Exhale slowly through your nose for a count of 4-6 seconds, maintaining gentle constriction to create the same “hah” sound.
Focus on the rhythm of your breath and keep going until you feel yourself drifting off. (I usually feel the effects within 10-15 breaths, but I recommend continuing for 5-10 minutes.)
7. Reduce Caffeine, Alcohol, and Tobacco
Caffeine, found in coffee, tea, chocolate, and many energy drinks, is a stimulant that can interfere with sleep. Experts recommend avoiding caffeine for at least eight hours before bedtime.
Experts also advise avoiding alcohol for at least three hours before bed because it can disrupt sleep patterns and affect the quality of rest.
Nicotine is a stimulant, which makes it harder to fall asleep and stay asleep. Smoking also reduces oxygen supply, negatively affecting the inner ear, and may heighten tinnitus symptoms.
8. Stick To a Regular Sleep Schedule
Aim to go to bed and wake up at the same time each day, including weekends. If tinnitus causes you to wake up earlier than planned, that’s okay—it’s about training your body to sleep at a set time each night. Waking up and sleeping at different times can mess with your body’s natural rhythm, making it harder to get restful sleep. Avoid naps during the day, as sticking to the same wake-up time each day helps keep your body clock on track.
9. Keep Active
Regular exercise helps reduce stress and improve sleep quality. People who stay active tend to sleep better than those who don’t. Just avoid intense workouts close to bedtime, as they can interfere with your sleep cycle.
If you have a poor night’s sleep, try not to take it too easy the next day. Staying engaged and active can help you feel better and prevent fatigue from taking over.
10. Explore Sound Therapy
Some experts recommend sound therapy, or sound enrichment, to help make tinnitus less distressing. Schweitzer recommends finding a sound masking strategy:
“If you still have some of your hearing, the simplest strategy to improve your ability to sleep with tinnitus is to incorporate background noise in your bedroom to lower the perceived volume of your tinnitus as you go to sleep. This can help to reduce discomfort and distress, enabling you to sleep more deeply, and to fall asleep more easily,” he explains.
“Even when your tinnitus is very loud, sound masking can still be helpful because it creates a wall of sound that blocks out quiet environmental noises that can wake you if you are not sleeping deeply. It also prevents you from having to wake up in complete silence, which is a challenging environment for many tinnitus sufferers.”
Any sound that you find relaxing can be effective—whether it’s broadband noise like white noise, ambient music, nature sounds, desk fans, or other environmental noises. It’s also helpful to have a variety of sounds that work for you, especially if your tinnitus fluctuates. That way, you can easily switch to another option if one isn’t working as well for you.
“To play the sounds, you have many choices. White noise and nature sound machines can be helpful. There are also many headphones designed to be worn to sleep, as well as pillow speakers,” continues Schweitzer.
“But in my opinion, the best option is to use a portable Bluetooth speaker combined with one of the hundreds of sound therapy apps available in the app store on your phone. When using apps, you have a much larger library of options to choose from, and dedicated Bluetooth speakers offer a much higher sound quality compared to sound machines or simply using the speakers on your smartphone.”
A note on sound therapy: While sound therapy can be helpful for sleep, it’s often most effective when used alongside other strategies, like cognitive behavioural therapy (CBT)—which we’ll explore next.
11. Try Cognitive Behavioral Therapy (CBT)
CBT is recognized as one of the most effective treatments for both tinnitus and chronic insomnia. It helps individuals reframe negative thoughts and change behaviours that contribute to distress, ultimately reducing the emotional impact of tinnitus and improving sleep quality.
As Dr. Aazh explains: “Tinnitus rehabilitation based on cognitive behavioural therapy (CBT), helps the individual to understand and modify the relevant cognitive processes (e.g., conflict between automatic thoughts and core beliefs) and behavioural patterns (e.g., safety-seeking and/or ritualistic behaviours) in order to break the vicious cycle of tinnitus-induced anxiety and annoyance. When the individual successfully reduces the annoyance caused by tinnitus using CBT, then tinnitus loses its significance and is more likely to fade away into the background as opposed to remaining at the centre of their attention.”
By shifting focus away from tinnitus and reducing emotional distress, CBT empowers individuals to regain control, improving both their sleep and overall quality of life.
12. Consider Acceptance and Commitment Therapy (ACT)
In addition to CBT, Acceptance and Commitment Therapy (ACT) can be helpful for managing both tinnitus and sleep difficulties. Instead of fighting the tinnitus, ACT encourages people to accept it, which can help lighten the emotional load. It helps build psychological flexibility, so you can focus on what really matters to you and take action toward a fulfilling life, even with tinnitus in the background. This shift in how you think about the sound can make it easier to let go of the stress and sleep more peacefully.
13. Try a Tinnitus Management App
Dr. Edmund Farrar - Co-founder of Oto
“Sleep really is difficult with tinnitus—I was the same. I’d never struggled before, but for the first time, I was,” shared Dr. Edmund Farrar, an ex-military doctor who co-founded the tinnitus therapy app Oto after seeing how difficult it was for patients to access support.
Oto offers instant access to evidence-based tinnitus treatment, providing a personalized program that combines CBT, sound therapy, and relaxation techniques to reduce the impact of tinnitus on daily life.
"Learning meditation and mindful breathing personally helped me a lot with my sleep and tinnitus. It really helps with accepting the sound and shifting focus away from it onto the breath. There are some great exercises in the Oto app for this,” explains Dr. Farrar.
The Oto app offers a 7-day sleep course specifically designed for people with tinnitus who struggle to sleep, along with additional support like sleep stories, meditations, and a sleep SOS feature for when you need help in the moment.
14. Don’t Toss and Turn
If you’re struggling to fall asleep or find yourself waking up in the middle of the night and unable to drift back off, don’t just lie there tossing and turning. Instead, try this simple strategy shared by Schweitzer to quickly ease the anxiety and frustration, helping you get back to sleep faster:
First, get out of bed, go to the kitchen, and eat a very small snack. Digestion requires a lot of physiological energy and can help to calm the frustration you are experiencing.
After you finish eating, move to a comfortable chair or couch in another room. Put on some music or background noise to partially mask your tinnitus and read a book or a magazine for the next 10-20 minutes (make sure to read an actual book to avoid backlit screens).
As soon as you start to feel sleepy, go back to your bed and try again. This will break the pattern of frustration and should make it easier to fall asleep.
When to See a Doctor or Specialist
If your tinnitus is new, changes, or worsens, it’s important to see a doctor. They can run tests to identify any underlying causes that may be treatable and recommend appropriate treatment options. If you're also struggling with insomnia and it’s affecting your daily life, consider discussing short-term sleep aids with your doctor. While medication isn’t a long-term solution, it can provide relief during a short-term crisis when used under medical guidance.
Additionally, if your tinnitus is accompanied by hearing loss, dizziness, or pain, consult an ENT (ear, nose, and throat) specialist or an audiologist. These symptoms may indicate an underlying medical condition, such as inner ear or balance issues, that require professional evaluation. An ENT can assess your condition, conduct necessary tests, and provide treatment or referrals to other specialists, if necessary.
For more targeted support, an audiologist or sleep specialist can offer personalized treatments, such as hearing aids or sleep therapy.
A Holistic Approach
In summary, improving sleep with tinnitus is often best approached holistically, using multiple strategies to address both the physical and psychological aspects of the condition.
Howard Presland - founder of TinniSoothe
Howard Presland, who has tinnitus himself, founded the wearable white noise device TinniSoothe after struggling to find an effective way to manage his symtpoms. He emphasizes that no single treatment can fully eliminate tinnitus, but combining various methods can help reduce its impact.
In his words, “As the founder of a wearable sound therapy device, focused on providing 24/7 tinnitus relief, you might expect me to say that TinniSoothe is the answer for those who struggle to sleep due to tinnitus. It helps for sure, but there is no single answer to tinnitus management, day or night. Sound therapy doesn't magically eliminate tinnitus—nothing does—but it can significantly reduce the intensity and the perception of threat. This, in turn, can often facilitate faster habituation. Why? Because it is lessening the brain’s fixation on the tinnitus sound, and reducing your thoughts about your tinnitus. The key word here is 'thoughts'—since they are at the root of much of the tinnitus distress people experience. After all, 'thoughts' are usually what keeps us up at night.”
“Combining sound therapy with Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) can help individuals manage their thoughts and emotional responses to tinnitus more effectively. These techniques teach patients to fully experience their perceptions and emotions and to better manage the negative thoughts associated with tinnitus. Combining sound therapy with CBT, such as the program provided by Oto, will likely achieve better results—both day and night. Relaxation and mindfulness, as well as prioritizing your general well-being, can all help you to progress from hoping… to coping,” Presland notes.
Presland also emphasizes the importance of limiting alcohol and caffeine, due to their impact on sleep. He concludes, “As a result of all these things, you may get that deep night's sleep you deserve.”
Tinnitus Resources
Tinnitus UK: https://tinnitus.org.uk/
American Tinnitus Association: https://www.ata.org/
Hashir International: https://hashirtinnitusclinic.com/
Glenn Schweitzer: https://linktr.ee/rewiringtinnitus
Oto—Tinnitus Therapy App: https://www.joinoto.com/
TinniSoothe—wearable white noise device: https://tinnisoothe.com/ (20% discount code for Tinnitus Week: TINNI20)
Lisa Caldwell (The Hearing Coach): https://thehearingcoach.com/
Frieder Kühne (Tinnitus Coach): https://outringtinnitus.com/
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