A Pattern in My Tinnitus: When I Wake Up in the Middle of the Night, the Tinnitus Is Very Loud

[Tom Cnyc]

Hey! As always, thanks for lending your time.

Before getting into this - I want to set the stage to say that I really don't struggle with tinnitus anymore. I live my life as if I don't have it - except unlike most people that haven't experience it - I use earplugs when everyone else should also.

But with that said I wanted to ask about a definite pattern I experience. When I wake up in the middle of the night my tinnitus is very loud. Every time, when I wake up a few hours later int he AM - it's returned to its low levels.

This is NOT just because the room is quiet. I live in a quiet area and the room volumes are the same. Similarly, I have 30 dB earplugs in my ears right now in a quiet office (I had them in because moments ago in my open floor plan it was hard to concentrate on my work with the chatter) and now it's quiet.

There is an absolutely undeniable pattern at play here. And while I don't think this is the lead to a cure - I'm curious if this is common / there are theories as to why it happens.

Thoughts appreciated.
-Tom

 

[Dr. Nagler]

Hello @Tom Cnyc -

The phenomenon you describe - an increase in tinnitus loudness when you wake in the middle of the night - is fairly common. It is also seen when waking from a mid-day nap, which is why I tend to agree with you that more is at play than the quiet of the night.

There are a number of theories as to why it happens. The explanation that makes most sense to me involves the reticular formation. The reticular formation is a primitive structure in the brain stem. It is basically a "vital sign monitor." When you wake from sleep, the RF checks to see whether or not you are alive. It looks for heartbeat, respiration, blood pressure, temperature - normal bodily signs. It does not care whether or not these signs are good or bad - just that they are present. As far as the reticular formation is concerned, for a tinnitus sufferer tinnitus has over time become part of life. And when you wake, your RF checks to see whether or not your tinnitus is present. If it doesn't find your tinnitus immediately, your RF seeks it with a vengeance - especially if you wake in the middle of the night or wake from a mid-day nap, when there has been inadequate REM sleep and when, therefore, your RF is already on "high alert" that something might not be quite right. The result: temporarily markedly augmented tinnitus perception when you wake in the middle of the night or wake from a nap.

Some tinnitus sufferers dread napping for that very reason. Me? I love to nap. And when I wake, my tinnitus is always louder. I take it as a sign that my brain is doing what it is supposed to be doing.

Hope this helps.

All the best -

Stephen M. Nagler, M.D.