How to Sleep with Tinnitus, a Rare Symptom of MS
This week, the sound of music returned. Not music anybody else can hear, and hardly musical, if you ask me. It's my tinnitus, and it comes and goes as it pleases.
Hard to fall asleep with tinnitus
My neurologist can't say for sure whether it's related to my MS, but even if it were, there's not much for it. Often it's repeated intervals of music (right now I have the jingle for Two Broke Girls on repeat, with a high-pitched whine in the background).
I try to ignore it the best I can, but sometimes it can be hard to hit the hay at night without noticing the repetitive noise that has followed you, from inside your head, as you try to fall asleep.
What is tinnitus?
We know this symptom more commonly as ringing of the ears. It could be a high-pitched whine, or it could sound like church bells.
Other sound effects have been reported as well, such as murmurs, clicking sounds, whistling, hissing, crinkling, whooshing noises, even music (maybe these are what “earworms” are?).
Different types of tinnitus
Some people experience pulsate tinnitus, in which there’s a loud pulsing sound reverberating in the ear canal that’s synched to the rhythm of their heartbeat.
Tinnitus can be mild (creating more of a background effect) or severe (loud enough to prevent adequate hearing). It can occur intermittently, following noisy events, or it can be an ongoing problem.
Tinnitus, if ongoing and loud, can create anxiety that can drastically affect one’s ability to sleep at night.
Why do people have tinnitus in the first place?
Ringing ears are a symptom of many different problems, many of them unrelated to MS, such as excessive ear wax, polyps or other growths in the ear canal, the use of certain medications, or illnesses like Ménière's disease.
It is important to have your ears checked out first before assuming your hearing is compromised by your neurological condition.
When tinnitus is related to MS
It’s actually pretty rare to have ringing ears as a side effect of MS. Less than five percent suffer from it. That said, tinnitus is often the sign that confirms an MS diagnosis when other tests are less conclusive. Sudden tinnitus or hearing loss can signal a relapse, but just as likely, it can be related to heat exposure or even sensory overload. You may also develop sensitivity to noise, a state referred to as hyperacusis.
Some research suggests that those plaques that affect the auditory pathways can lead to hearing problems, which can be as severe as complete hearing loss.
However, sometimes, people with MS who suffer from tinnitus or hearing loss don’t have lesions in these locations, but rather, in the white matter around the ventricles.
Tell your neurologist or MS specialist if you have ringing ears. It’s not likely they can do anything for you at that visit, but they might refer you to an ear, nose and throat specialist (ENT or otolaryngologist) to rule out other, more common causes.
There’s really no treatment for tinnitus, without first identifying the root cause. Some people suggest seeing a chiropractor if your symptoms are ongoing; an adjustment might be all that’s needed for the sounds to go away. Talking to your doctor about the use of certain medications (especially pain relievers like aspirin and Tylenol) may help.
The good news is that most tinnitus is self limiting, meaning it will resolve on its own following a visit to get your ears flushed, a change in medications, or avoidance of environments that seem to trigger it.
If you check out just fine, you may wish to ask your neuro to schedule an MRI to determine if your tinnitus could be symptomatic of a relapse.
It's difficult to avoid at nighttime
One of the things that makes tinnitus hard to live with is that it’s easy to ignore during a noisy, busy day, but easy to hear and difficult to avoid at bedtime when the world has gone quiet.
Ways to defeat tinnitus so you can sleep better
Here are some suggestions I’ve assembled from several support groups that seem to help keep one’s ringing ears from hijacking a good night’s sleep.
- Relax. Sometimes it’s the anxiety caused by tinnitus that keeps us up, as much as the tinnitus itself.
- Meditate. For some people, ten minutes of mindful breathing can help resolve tinnitus over time.
- Avoid stimulants. You want to be able to fall asleep with ease; caffeine and nicotine, in particular, will prevent good sleep onset.
- Go to bed sleepy. Our circadian rhythms help us to transition from wakefulness to sleepiness. Once you’re feeling sleepy, that is the perfect time to go to bed because the additional darkness and rest should help complete that transition naturally. When you go to bed before you are sleepy, it could just be an exercise in frustration.
- Keep a sleep schedule. Always try to get up at the same time of the day. This is not directly related to tinnitus, but it does relate to good sleep hygiene. If you rise at the same time every day, you can establish better rhythms that will improve your ability to fall asleep at night. If your sleep schedule is a bit wacky because of ringing ears, take heart that a regular wake time can actually reset your rhythms in a way that fosters better sleep overall.
- Keep your bedroom cool. Uhthoff’s Phenomena (a symptom of MS in which your body struggles to function properly due to overheating) has been found to sometimes, although rarely, lead to tinnitus. A cool bedroom is key to better overall sleep, as well.
- Put away your media. If you consume a lot of entertainment via your television, tablet, cell phone, laptop, or other electronic device, consider putting it away at bedtime. Not only is the blue light emission going to stall your transition to sleep, but movies, television shows, YouTube videos, and other kinds of media tend to make us feel more alert.
- Turn down the noise. Tinnitus can be sparked by loud sound volumes on different gadgets, so if you do enjoy a TV show right before bed, keep the volume low.
- Conversely, turn it up. Some people find that listening to music helps them to mask their tinnitus so they can relax enough to fall asleep.
- Retrain. Tinnitus retraining therapy uses scheduling listening to help bring relief for those with severe, ongoing problems with ringing ears.
- Mask. There are new sleep applications available either as nightstand radios, sound pillows, headphones, or smartphone apps, which can be used to emit soothing sounds that can both help you to relax and mask the sound of background tinnitus. Also, a simple white noise machine can do the trick.
May is Mental Health Awareness Month. We want to check in. How are you feeling?