4 reasons why your tinnitus is worse at night

Imagine being woken at night by a sound so aggravating, but only you can hear it.

Circulation


Owen Wiseman
@AVogel_ca


15 October 2019

What is tinnitus?

The sensation of ringing in your ears.

What causes tinnitus?

Unfortunately, no clear explanation exists for why this condition occurs. However, to get a better idea of what could potentially be causing the sensation, a bit of anatomy is needed. The ear is divided into three sections:

  1. External ear – the familiar tissue we all know, comprised of the auricle (pinna) and the external auditory canal connecting the external to the middle. The auricle acts much like a receptor dish, catching sounds from the external world and directing them down the canal to vibrate the tympanic membrane. These vibrations travel through the middle and inner ear for further interpretation.
  2. Middle ear – the middle ear consists of three distinct bones known as the ossicles. The first of these is the malleus, a hammer shaped bone attaching to the tympanic membrane and vibrating in time with the sounds from the external world. The second bone is the incus, while acts as an intermediate between the malleus and final bone known as the stapes, a saddle-shaped bone that transmits the vibrations to the inner ear via a thin membrane. The middle ear is the most common site for an ear infection, formally known as acute otitis media, to develop. Something known as the Eustachian tube is responsible for equalizing the pressure in the middle ear through its connection to the nose. When this becomes clogged, bacteria that don't require oxygen begin to divide rapidly and cause pressure in the middle ear.
  3. Inner ear – finally, we find ourselves in the vastly more complex world of the inner ear consisting of the cochlea, vestibule, and semicircular canals. The cochlea is a fluid filled, snail shell looking structure that contains the hair cells attached to nerves that convert the vibrations into electrical signals. These signals travel up the auditory nerve to centres of the brain responsible for converting the signals into sound patterns we recognize as bird calls, drums, dogs barking, or cars passing. The vestibule and semicircular canals are the sites containing the receptors for balance. Collectively, this combination of structures is known as the vestibulocochlear system.

Why would tinnitus be worse at night?

Even if you don't realize it, the brain is picking up on sounds on a near constant basis, but as you become accustomed, these sounds are dampened and don't catch our mental attention. The brain uses these sounds to orient itself in the world and prepare for any potential predators. When the world goes silent, the brain will begin filling the silence with its own sensations.

This could not be more apparent than it is at Microsoft's anechoic chamber, described as a place where "sound goes to die". The chamber has a sound level measured at -20.6 decibels...passive human breathing is around 10 decibels, so this chamber is quiet in the most absolute sense of the word. Sensory deprivation has been shown to induce hallucinations and psychotic-like experiences as the brain tries to insert information, like auditory input, into a place where there isn't any.

  1. Lack of auditory input. Depending on how quiet your bedroom is, you may be more apt to experience an episode.
  2. Medications. According to the Center for Hearing Loss Help, there are over 450 medications that can instigate tinnitus or aggravate it, many based on adverse reports. Some individuals may take aspirin before bed to manage their pain, but high doses of aspirin are associated with tinnitus.
  3. Cerumen, more commonly known as earwax, is constantly produced. When it builds up in the ear, it can cause tinnitus. As it accumulates and solidifies, it will pick up on our own bodies vibrations which are more prominent at night due to the lack of input. This could include the rush of blood passing through the carotid arteries or the vibrations sent out by a pounding heart.
  4. Many people may choose to unwind with a drink at the end of the day and alcohol can increase the blood traveling to the inner ear and aggravate tinnitus. An additional danger with excess alcohol consumption is the potential for permanent hearing loss as the toxin can shrink the auditory cortex, the area responsible for processing sound.

If you're looking to increase blood flow to the brain, then an option to consider is Ginkgo. The ginkgolides contained within Ginkgo biloba has the ability to dilate blood vessels and circulate more oxygen to the areas of the ear from outer to inner. When the structures of the ear are better perfused, they function better and minimize the risk of experiencing ringing in the ears.

Another consideration is to add a white noise generator to your room if a ceiling fan is not an option. This will introduce sound to the environment and diminish the need for the brain to fill the void with sounds of its own. Many mobile applications now offer a similar service and the ability to set timers on the white noise so the sounds aren't present throughout the night and potentially bothering your bed partner.

References

https://www.aafp.org/afp/2009/1101/p1011.html
https://www.ata.org/sites/default/files/Drugs%20and%20Tinnitus%20-%20Neil%20Bauman%20PhD%20-%20April%20%2709.pdf
http://discovery.ucl.ac.uk/1468060/1/Mason_439379.pdf
https://www.jneurosci.org/content/35/44/14822
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127578
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2031886/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3157487/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3387310/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6042678/
https://www.ncbi.nlm.nih.gov/pubmed/15251092/
https://www.ncbi.nlm.nih.gov/pubmed/25425885/
https://news.microsoft.com/stories/building87/audio-lab.php
https://www.tinnitus.org.uk/drugs

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