How to Treat Insomnia on Top of Hyperacusis and Tinnitus?

[MasterFA]

First, thank you to this forum for providing a platform to seek help.

This is my first post, and I'm hoping to get advice from those with experience.

I've been habituated to low-level tinnitus for many years, but now I'm facing a completely different challenge.

Since mid-October, I've been struggling with loud and painful hyperacusis. While that condition has shown some improvement with ups and downs, my main concern has shifted to louder tinnitus and persistent insomnia.

It's been two months, and I haven't taken any significant medical steps to break this cycle. However, I'll be seeing an audiologist who specializes in tinnitus and hyperacusis later this week.

In the meantime, I've been prescribed amitriptyline for a few months, along with occasional Ativan (lorazepam).

Opinions on these medications seem very divided online, but I know I need to take action.

Does anyone have recommendations or advice? Am I overlooking a better approach?

Thank you.

 

[pants]

I find sleeping to be the most challenging aspect of living with tinnitus. Good sleep is essential for overall well-being. Most nights, I take 1 mg of Melatonin. On nights when I need deep, uninterrupted sleep, I also take 3.25 mg of Zopiclone, though I limit this to about once a week.

 

[MasterFA]

Thank you, @pants. I'm taking notes.

 

[danahall5885]

There is a new sleeping medicine out, Dayvigo; however, it's scheduled as a narcotic. It was advertised as non-ototoxic. Who knows?

 

[RunningMan]

Dayvigo is a DORA-class sleep medication. I tried it temporarily at 10 mg, but it didn't improve my sleep, and I felt groggier in the morning. As a result, I switched back to 50 mg of Quviviq, another DORA-class sleep medication with a shorter half-life. However, I'm not sure how much it actually helps—I still wake up too early.

These medications are generally considered pretty safe.

ChatGPT:

"Dayvigo (lemborexant) is classified as a Schedule IV controlled substance by the U.S. Drug Enforcement Administration (DEA), which means it has a recognized medical use but also carries some potential for abuse and dependence.

The reason for this classification is primarily due to the medication's sedative effects, which can potentially be misused. Although lemborexant works differently from narcotics (it is an orexin receptor antagonist, not an opioid), medications with sedative or hypnotic properties—like those that promote sleep—can carry risks of abuse, misuse, or dependency in certain cases. This is why the DEA places it under control.

Schedule IV substances are considered to have low potential for abuse relative to substances in higher schedules (like Schedule I, II, or III). However, misuse or inappropriate use can still lead to physical or psychological dependence. The scheduling helps ensure that lemborexant is used appropriately and monitored by healthcare providers to minimize these risks.

It's important to note that the controlled substance designation does not necessarily mean Dayvigo is dangerous or likely to be abused, but it reflects caution due to its sedative effects."

 

[MasterFA]

@RunningMan, thank you for sharing.

Would you recommend those types of light sleeping pills over an antidepressant like Amitriptyline or Nortriptyline, particularly for someone who isn't dealing with depression?

I don't seem to notice any improvement with my tinnitus, and I'm afraid it might actually be making things worse. My tinnitus has probably doubled in intensity since my hyperacusis started last month, so I can't fully determine if the medication is the cause. It was already very loud, which is why I agreed to try the medication in the first place.

Is there hope for the tinnitus to decrease again as my hyperacusis heals? I've experienced a reduction in permanent tinnitus over the years, which I believe is what you'd call habituation.

If it does improve, as we often hear in success stories (even if it takes a long time), is it safe to take those sleeping pills daily? Could they be combined with melatonin, perhaps?

Thank you again for the suggestion. I'm in a tough spot because I don't want to delay withdrawal if it's necessary.

Thanks!

 

[RunningMan]

@RunningMan, thank you for sharing.

Would you recommend those types of light sleeping pills over an antidepressant like Amitriptyline or Nortriptyline, particularly for someone who isn't dealing with depression?

I don't seem to notice any improvement with my tinnitus, and I'm afraid it might actually be making things worse. My tinnitus has probably doubled in intensity since my hyperacusis started last month, so I can't fully determine if the medication is the cause. It was already very loud, which is why I agreed to try the medication in the first place.

Is there hope for the tinnitus to decrease again as my hyperacusis heals? I've experienced a reduction in permanent tinnitus over the years, which I believe is what you'd call habituation.

If it does improve, as we often hear in success stories (even if it takes a long time), is it safe to take those sleeping pills daily? Could they be combined with melatonin, perhaps?

Thank you again for the suggestion. I'm in a tough spot because I don't want to delay withdrawal if it's necessary.

Thanks!

I definitely recommend Quviviq over Nortriptyline. Amitriptyline is much better for sleep than Nortriptyline. But I think it's worth trying Quviviq first if you don't need to treat any other conditions treated with Amitriptyline. It works for some people, it doesn't work for others, some people have side effects they can't handle, and some have trouble getting insurance to cover it. So, there's no way to know without trying. Yes, you would take it every day. It might take a while before it works well, if it does at all. Or it might stop working after a while. You can take it with Melatonin. I have often, although Melatonin doesn't seem to help me, at a variety of different doses that I've tried.

Tinnitus does get better for some people, but I've never experienced an improvement. If it's stable and not too intense, you might be able to habituate to it so that it doesn't bother you, like when you had mild tinnitus. I was the same way, starting out habituated over 20 years ago only to dishabituate when it went severe about 3 years ago.

 

[MasterFA]

I definitely recommend Quviviq over Nortriptyline. Amitriptyline is much better for sleep than Nortriptyline. But I think it's worth trying Quviviq first if you don't need to treat any other conditions treated with Amitriptyline. It works for some people, it doesn't work for others, some people have side effects they can't handle, and some have trouble getting insurance to cover it. So, there's no way to know without trying. Yes, you would take it every day. It might take a while before it works well, if it does at all. Or it might stop working after a while. You can take it with Melatonin. I have often, although Melatonin doesn't seem to help me, at a variety of different doses that I've tried.

Tinnitus does get better for some people, but I've never experienced an improvement. If it's stable and not too intense, you might be able to habituate to it so that it doesn't bother you, like when you had mild tinnitus. I was the same way, starting out habituated over 20 years ago only to dishabituate when it went severe about 3 years ago.

Thank you so much for sharing!

You have much more experience with medication than I do, and I could really use some insight. I hope I'm not bothering you with my questions.

1. How was your experience with Nortriptyline? Did it reduce your tinnitus or simply help you cope better? What dose would you recommend if it's just for managing tinnitus and not for depression?
2. Did you have hyperacusis? If yes, what did you do to treat it? Was it just a matter of time and using proper protection?
3. How are you currently masking your tinnitus, especially since it's severe?

At the moment, I don't have many options other than antidepressants. Unfortunately, doctors don't seem interested in prescribing sleeping medication.

Again, thank you so much!