Getting your sleep back

Ask people what tinnitus has cost them and sleep comes up first, ahead of concentration, mood and hearing. It is also usually the first thing to improve on a program, often within weeks, which makes it a good place to start.

Why the two feed each other

Quiet makes tinnitus more noticeable. Being unable to sleep raises stress. Raised stress makes tinnitus more intrusive. Poor sleep lowers your tolerance for it the next day.

The loop runs in both directions, which is good news. You can break it at either end, and the sleep end is often easier to influence.

What we recommend, in order of impact

Sound in the room, set correctly. A fan, sound machine, or app. Set the level just below your tinnitus so you can still faintly detect it. Full masking feels better on night one and works against habituation.A fixed wake time. More powerful than a fixed bedtime. Consistency stabilises the sleep drive that makes falling asleep easier.Get out of bed if you are awake. More than about twenty minutes awake and lying there teaches your brain that bed is where you monitor tinnitus. Get up, do something dull in low light, return when sleepy.Cut caffeine after midday. Caffeine does not cause tinnitus, but it fragments sleep, and fragmented sleep amplifies everything.Deal with the racing mind separately. If you are lying awake working through tomorrow, the tinnitus is a passenger. A wind down routine and a notepad beside the bed help more than anything tinnitus specific.

What to be careful with

Alcohol makes falling asleep easier and the second half of the night worse. Many people notice their tinnitus is more intrusive the morning after drinking.

Sleeping tablets have a role short term under medical supervision, but they do not address the loop and tolerance builds. Talk to your GP rather than self managing.

When to get help with it

If you have been sleeping badly for more than a few weeks, it is worth raising at your assessment. Sleep is part of every plan we build, not an afterthought, and it is measured at each review along with everything else.