Tinnitus and Sleep Apnea: Is there a connection?

I have sleep apnea and sleep with a CPAP machine so my wife doesn't complain. I also have tinnitus and it's quite noticeable.

Get this: If I take a nap without the CPAP machine, I can wake up an hour later with really bad tinnitus. Sleep with the machine, no problem with tinnitus at all.

Internet searches show I'm not alone!

For example:

Tinnitus Decreases Seen With Treating Sleep Apnea WITH ORAL APPLIANCES
The Buzz on Tinnitus (see comments by Steven Y. Park, MD):

This may have been total coincidence, but many years ago, a handful of patients that I treated for sleep-related breathing disorders have told me that their ringing improved after either simply changing their sleep positions or not eating late. So for the past 4-5 years, I’ve noticed that almost every patient that comes to see me specifically for ringing or mention it as an additional symptom all have significant upper airway anatomic narrowing. Anatomically, they all have narrowing of the space behind the tongue due to smaller than normal jaws or enlarged tonsils, or both. All these people have various degrees of sleep-breathing disorders, the more severe kind being obstructive sleep apnea, and the lesser version being upper airway resistance syndrome.

....

There have been numerous reports of severe post-combat PTSD that resolved completely after an underlying sleep apnea condition was picked up and treated appropriately. I won’t be surprised if I see more people being helped for their tinnitus by treating an undiagnosed obstructive sleep apnea condition (80-90% of people with obstructive sleep apnea are not diagnosed in this country).

Obviously, not all people with tinnitus will have these issues. However, if you have tinnitus and can’t sleep on your back, get checked out for a sleep-breathing problem. Being able to sleep better will have many other significant health benefits.

 

 For example these two comments from two different people noticed the same thing:

In my case, I have a complete relief about one day in a week (two days is I am lucky). On such occasions, if I dose off --even for 20 min.-- in an afternoon -say--, the tinnitus comes back. Also, tinnitus is most felt upon arising in the morning. (see http://www.sleepnet.com/diag2/messages/269.html).

I have both sleep apnea and tinnitus.  I sleep with a cpap machine (8 years now).  If I take a nap on sunday afternoons, in a chair without the machine, I usually wake up with much stronger tinnitus, and probably a headache.  (You'd think I'd learn by now!)  Just started to look for a connection between the two.

Also, if my cpap mask is adjusted to reduce the outgoing ventilation , the tinnitus is quite bad when I wake up. Normally i leave a small air gap in my nose which reduces re-breathing. If I fully engage the mask so it is air tight and go to sleep, I wake up with loud tinnitus.

Speculation: So that can explain why tinnitus gets WORSE with some people using CPAP and better with others...it all depends on the pressure and mask used. If you use too low a pressure on certain masks, you'll increase re-breathing and make your tinnitus worse. If the mask, etc. is working, it should make it better.

I've had this happen way too many times to be a coincidence. It seems very much a cause and effect.

Has this happened to you? Contact me using the contact info on my home page and I'll post your story here.

Steve,

I am fairly certain there is a relationship between tinnitus and sleep apnea for me. I don't use a mask, but I do go to some lengths to prevent myself from sleeping on my back. On ~10 occasions, I have woken up to find myself on my back (despite my precautions) and with both a headache and pronounced tinnitus, which slowly improves over the next 4-5 days.

Interestingly, I have also noticed that intense exercise near max heart rate exacerbates my tinnitus. Both sleep apnea and intense exercise cause blood oxygen saturation to decrease. Brain in general, and auditory hair cells in particular, are highly metabolically active tissues and require a lot of oxygen. So, it makes sense to me that sleep apnea could cause tinnitus.

I'm having surgery in a few weeks. If it is successful in treating my sleep apnea, it will be interesting to see whether it also improves my tinnitus.

Regards, Dan Pierce

More postings:

Steve,

 

Noted your story on the web regarding Tinnitus and sleep apnea.

 

My story is not much different. I have used a CPAP machine but now after losing some weight I do not need it as much.

 

What I have noticed is that every time I take a short nap - say 5-20 minutes duration, I wake up with tinnitus categorised by a higher frequency and amplitude. Up until August 2009, my tinnitus could only be described as low intensity say 1-2 on a scale of 10 - sometimes hardly noticeable. I have had this for many years and never really worried me.

 

However after falling asleep for a short nap (about 10 minutes) in front of the TV last August, I woke up with Tinnitus on a scale of about 8-9. Extremely disturbing and could not get any sleep for weeks. Tried everything but nothing worked until I started to use the CPAP machine and improved my fitness.

 

Now I seem to have it more under control using a variety of methods. I have kept an accurate diary starting from January this year. The following represents the factors that trigger my tinnitus.

 

Short naps - these are worst of all - I try to avoid these as much as possible

Electromagnetic radiation - mostly high frequencies - purchased a meter and I try to avoid being close to emissions particularly when sleeping

Stress - I try and reduce life's stressors as much as possible

Poor sleep - I make sure I get a good night's sleep and use systems to prevent snoring as well as trying to keep my weight down

 

If you know anyone that can solve the short nap mistery - let me know. My ENT thinks it has something to do with levels of melatonin.

 

Regards,

 

Sam

 

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Google led me to your web page.  For the past 4 months I have had intermittant tinnitus which lasts 1-2 days at a time, then vanishes for a day (or rarely 2 days) and then the cylce repeats.  I have kept logs, stopped all meds I am on (including vitamins), stopped caffeine and alcohol and other supposed stressors without any change, found no correlation with exericise or anything else I can think of.

What is most surprising is how a brief nap, as short as 20 minutes, can bring on the tinnitus in the midst of a non-tinnitus day.  That's what led to my google search and your experience.  I never thought of sleep apnea, as I don't think Ihave any other symtoms of it, but am going to look a little deeper.  My other hypothesis is that tinnitus is more of a neurologic problem akin to a seizure disorder and that even brief episodes of sleep may turn off some inhibitory mechanism in the brain.  But that would not explain the changes you have noted with different pressure settings on your machine.  You have definitely given me something else to think about.  Thanks, and good luck with your tinnitus.  I think only a fellow sufferer can understand how troublesome it is.  Please keep up your web page on the topic.

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I have read, with great interest, your blog on Tinnitus and Sleep Apnea.  I also seem to have a similar problem.

 

I am not a doctor but I've been doing a lot of research on health and medecine.

 

Let me explain my situation:

 

I do not drink alcoholic beverages but I do intake cafeine and smoke.  Why do I mention smoking?  Because, I suspect, it may be directly related to my problem.  Here are my facts and speculations:

 

I suffer from sleep disturbances.  I frequently wake up 2 to 3 hours after falling asleep, and not able to go back to sleep for a few more hours. I suspect I have mild sleep apnea due to smoking.  Smoking can cause hypoventilation, meaning I do not breathe deeply or sufficiently (and even occasionally stop breathing) while sleeping.  When my brain recognizes there is not enough oxygen inhalation, the heart races trying to bring in more oxygen in the body.  When my heart races, I wake up with tinnitus and also with elevated blood pressure (I checked with a BP monitor).  My BP goes down after a few minutes of walking around, but the tinnitus stays for a while.

 

My solution would be to stop smoking, and to do mild cardiovascular exercise (such as running) to exercise my lungs, and to balance the "oxygen/carbone dioxide" ratio in my body.  But my problem is, with years of many short night sleep, I have develop CFS (chronic fatigue syndrome).  Being always tired saps my will power, which makes it almost impossible for me to stop smoking. It's a vicious, vicious circle.

 

I am in the process of trying Melatonin to see if it will improve my sleep.  If it works, and I feel more rested, I may try to stop smoking cold-turkey and start mild running (with breathing exercises).  I'm crossing my fingers.

 

You didn't mention if you smoke.  You may not be a smoker, but you may be (or may have been) exposed to second hand smoke which could possibly have the same negative effect on your respiratory system.

 

Anyway, I hope my letter is of some use to you. Stay well...

 

Yvon

Moncton, New Brunswick, Canada

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I goggled under Apnea and Tinnitus and came across your link and find your experience interesting and want to share mine. I have had continuous tinnitus for the past 11 months due to allergies and /or an infection. Lost some hearing n the low tones (5000)

I also just had a sleeping test last Sunday for Apnea and a deviated septum. By 2 am. in the morning the technician put on a CPAP mask because I was experiencing apnea. I noticed after the test concluded the next morning that I woke up with out tinnitus and after driving home my tinnitus was somewhat reduced. The technician adjusted the mask to ensure that there was flow also escaping. I am waiting for my Apnea/nose ENT to visit after test results and perhaps get a CPAP

By the way, I have been able to lower my tinnitus from the time it first appeared.  My noise was very loud similar to a woodpecker. What have worked for me is:

• Low sodium diet of no more than 1000 to 1500 mg a day
• Diuretics of 50 mg a day hydrochlorothiazide
• Cymbalta  60 mg, to ease the ear nerve

I also noticed that the ENT for the deviated septum prescribed me nose spray that besides opening my ear helped me with alleviating the Tinnitus further. The name of the prescribed nasal spray is;

• OMNARIS – contains ciclesonaide (probably steroids). Medicine says that can be taken “perennial”

Things that have not done much for me and have tried

• Steroid injected in my ears – probably did it too late after first notice minor loss of hearing.
• Bethahistine – 12 -24 mg/day – only good for Menaire’s patients.

Ernesto Perez

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Steve – like others I came across your site with the search linking Apnea and Tinnitus.    I was hit with Tinnitus about 8 months ago and experience ringing, in various levels of intensity, about 5 out of each 7 days.  As it happens I have a background in empirical research, though no longer work as a scientist, and have been attempting to track variables that seem to have an impact.  The one factor that is absolutely undeniable is that sleeping is the key variable for triggering or releasing tinnitus episodes.  For some time I assumed the trigger was tied to prolonged periods in vertical or horizontal positions, impacting blood pressure, flow, inner ear, etc.  However several recent experiences have convinced me that is not so much orientation, but rather blood oxygen levels.  Thus, the google search yesterday and this email today.

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Hi, Steve:

First off, congratulations on all of your work – pleased to discover your site and causes and will follow with interest. 

I have been trying to find the cause of my Tinnitus and have gone the usual routes to try and sort it out including Temporal Mandibular Joint (TMJ) assessment, Chiropractic, Hearing Tests, but wasn’t 100% sure of the connection between sleep and Tinnitus. However I definitely have had the cause and effect of taking a nap and waking up with strong Tinnitus quite a few times and recently had a very clear episode where my Tinnitus had disappeared for a couple of days and came back when I had a nap. Reading through the various stories on your page completely resonates with my experience.

I recently visited a TMJ specialist as I have a minor click/lock in my jaw, and after examining me and asking some questions (one of which was whether I woke up tired), they recommended that I have a sleep assessment done. That’s when I started to really put the pieces together. I suspect I may have some kind of sleep disorder, maybe not severe, but the nap connection is definitely there. 

So, I can definitely add another example to the list – very helpful to know there are others out there.

I’ll send a follow up after my sleep test also.

Regards

Mike Fedryk

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Hi,

I was pleased to find your blog on apnea and hearing issues.  I am a retired psychology prof. who has done a little research on apnea and the psychological effects of treatment.  Our research revealed strong positive impacts on attention and mood.  It is unfortunate that positive airway pressure therapies cause problems. I believe the problems I am having with tinnitis and hearing loss are at very least exacerbated by my APAP. The problem is, in my opinion, that the apap puts unequalized pressure on the middle ear.  This has to cause the eardrum to flex outward carrying all of the attached and articulated ossicles with it.  Since there are small muscles with associated reflex pathways that have been designed by nature to protect the inner ear by dampening too loud sounds, it seems likely to me that any prolonged unbalanced deformation of the eardrum could cause problems with the function of the ossicles thus interfering with hearing.  One example that I am experiencing is low-frequency hum in my left ear.  That seems to be related more to spasms of my middle ear muscles than anything else, but in any case, I can't hear outside low-frequency sounds when this is happening. 

This whole issue reminds me of some common computer problems.  We often can't be sure if the problem is due to I/O equipment failure, processing hardware, network software/hardware or OS/application software.  Diagnosing a problem sometimes requires a team of such sophistication it is easier and less costly to replace the entire system!  I wish I could do that with my auditory system. 

At this juncture my ear Dr. says it is probably meniere's disease, but the fact that I don't have vertigo (or only have very slight vertigo), doesn't fit that pattern.  I did discover that my apap's max pressure setting was set at 20, so that could be a contributor. I fixed that today, so we shall see how things go with that.

Please keep working on this issue.  In my opinion what we need is a treatment for apnea that does not involve positive airway pressure devices. 

Thanks,

R. Hardy

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I've got a rare strain of sleep apnea, oxygen shortages done damage to the body and brain, it brought on secondary polycytheamia.

Before I started C-pap treatment I had tinnetus quite often, then it dissappeared. I was shocked to hear it again in March this year as I thought it had gone away, it was a once off till July then I had it again. For the past 2 months it's been with me on a regular basis only in my other ear. The polycytheamia hasn't gone away yet either, but it's slowed down considerate. I mentioned the tinnetus to a sleep specialist and she told me it's got nothing to do with sleep apnea. She told me the same thing about my vitamin

B12 deficiency and restless leg movement. I know she's wrong, she actually told me sleep apnea doesn't cause oxygen shortages that do damage. This decease runs in my family and killed half of them. On the internet it's documented under Pickwikian syndrome. It's taken me 2 years to find a sleep specialist that knows about this strain of sleep apnea. The only advice I can give people is don't believe everything a specialist tells you.

Michael Strong,  Australia

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Here is my series of events.
- Light swooshing tinnitus in right ear in July
- Had severe insomnia in July; Diagnosed with moderate OSA in August
- Used CPAP from August thru January
- Tinnitus went away
- Switched to Oral appliance in January thru March
- Tinnitus went crazy in March; Loud swooshing in right ear, light ringing in left
- Went back to CPAP for last week; Swooshing is gone but now have ringing in both ears

I am waiting on MRI to check for tumors and if there is a specific cause for the tinnitus.  I'm hoping that staying with CPAP will help it go away.  I'm in my early 30s, not overweight at all.  In fact, I exercise and run frequently.  The sleep apnea (according my doc) is due to a small jaw and I've never had tonsiles removed.  There seems to be a definite link to tinnitus. I will keep you posted if you'd like to share on your website.

Great article, by the way.  Very helpful.
Al