Intermittent tinnitus

[Bacus]

Hello,this is my first time writing. I have had tinnitus in my left ear since feb.and noticed that sleep always triggers my tinnitus. This can happen at anytime during the night, I will get up with a shrill in my left ear( usually followed by a dream) . Distressing to say the least.this high pitched sound will stay with me for the rest of the day.
Not a productive day. Then for the next day or two there will be an absent of sound.
My coping mechanism is severe ly tested. I have been to my family G.P, and an ENT specialist, besides prescribing clonazapam they seem to be ignorant of my condition. Their medical observation is a lot of people have tinnitus and are not bothered by it.
I live in a small town in southern Ontario ,Canada and getting the right type of help is challenging .
Any help or advise will be appreciated
Bacus

 

[Golly]

Hi Bacus:

I believe our condition is quite common. My advice is to work with your doctors (possibly see a neurologist) and come up with a course of action that works for you. Drugs like Klonopin do help; but they can be addictive, so beware. I take Mirtazapine (15mg) nightly to regulate my sleep.

There are other medications that apparently work for some people with intermittent, sleep-related tinnitus. Let me know if you'd like to hear about these.

Hang in there! Golly

PS. I lived in London, Ontario for seven years.

 

[Bacus]

Hi Golly,
thank you for your advise, reading about benzos, the addictive nature and the painful withdrawl scares the crap out of me
I have been taking up to 1 mg.of klonopin for sleep.
Will talk to my doctor about changing to either mirtazapine or amitripline . Do you know of the potential side effects, and please advise are these addictive.
Sorry for my ignorance I have hardly taken any pharma meds, and tinnitus is challenging . At this stage i am looking for a good night
Sleep.
Read your other blogs and will appreciate any help from u.
Regards

 

[Golly]

Hi Bacus:

Amitriptyline (Elavil) is an older, tricyclic antidepressant that has good sleep-inducing properties. If you are only taking it for that purpose (that is, as a sleep aid and not an antidepressant), a dose as low as 10mg is often sufficient. While non-addictive, there are side effects that you need to ask your doctor about (some less serious, like dry-mouth, and some more serious, like heart-related ones).

Mirtazapine (Remeron) is a tetracyclic antidepressant that has fewer side effects than Amitriptyline, but is also terrific for sleep (and is also non-addictive). Interestingly with Remeron, the less you take, the more tired you get! You might find that as little as 3.75mg (a quarter of the smallest dose) is enough.

Note that weight gain is a potential side effect of both these drugs.

You should also note that Amitriptyline helps some people better deal with tinnitus. I am not sure if it's volume reduction or anti-anxiety properties, or something else. But I think that this effect is observed when people take therapeutic doses (i.e. 50mg and up). The same benefits may be associated with Mirtazapine, but it is less well documented.

I'll definitely stay in touch with you. Feel free to contact me any time.

Best, Golly

 

[Bacus]

Hi Golly,
Thank you for the info. Seems remeron is the better of two. Not too happy about the weight gain.
As you know in Canada ,it is very difficult to change doctors because of the health care system. My old doctor does not take well to the patients recommendation .
You mentioned that there are other sleep medication that work for intermittent tinnitus ,I will love to hear about them.
I have tried melotonin and most of the over the counter medication......no success.
I thank u for your help.
Regard
Bacus

 

[Golly]

Hi Bacus;

In my opinion, the weight gain connection is overblown. First of all, I believe only about 15% of patients experience this side-effect. Second, just as many experience increased appetite as a side-effect. I suspect that if you control your urge to over-eat (if indeed you feel it), you will be fine in this regard. I have now been on Remeron for almost four months and have not gained a pound. But as always, do your research and talk to your doctor.

I think you might want to discuss these kinds of medications with a psychiatrist who will be more familiar with these drugs and more comfortable prescribing them. Also, you should probably consult a neurologist. They often have interesting insights into tinnitus. Certainly, they are the first specialists to see (besides ENTs) to rule out known causes (treatable and otherwise).

The other medications I was alluding to are not necessarily for sleep. For example, Gabapentin (Neurontin) is often prescribed off-label to treat tinnitus. The jury is out as to whether this one works better than a placebo (it didn't for me in the low doses I took). But it is worth a shot if a doctor will work with you on this. (Gabapentin is pretty good for sleep, too.)

-Golly

 

[jazz]

I think you might want to discuss these kinds of medications with a psychiatrist who will be more familiar with these drugs and more comfortable prescribing them. Also, you should probably consult a neurologist. They often have interesting insights into tinnitus. Certainly, they are the first specialists to see (besides ENTs) to rule out known causes (treatable and otherwise).

The other medications I was alluding to are not necessarily for sleep. For example, Gabapentin (Neurontin) is often prescribed off-label to treat tinnitus. The jury is out as to whether this one works better than a placebo (it didn't for me in the low doses I took). But it is worth a shot if a doctor will work with you on this. (Gabapentin is pretty good for sleep, too.)

-Golly

Bacus,

I agree with Golly that neurologists and psychiatrists understand the brain better than ENT's, including neurootologists who specialize in the ear.

About the antiepileptic drugs like gabapentin, they do help some people. This is because tinnitus and epilepsy share a down regulation of GABA receptors. GABA is an inhibitory neurotransmitter. It works in conjunction with glutamate, an excitatory neurotransmitter. Normally, these neurotransmitters are in balance. In neurological disorders like tinnitus, this balance tips to favor glutamate. This results in an overactivity of neurons--known as glutamate excitotoxicity. Drugs like gabapentin help to restore this balance. (Of course, this is a simplification. But I believe the main points are correct.)

Regarding gabapentin, the clinical studies are not conclusive, but this is because of research issues, according to a 2011 review published in the American Journal of Audiology. (http://aja.asha.org/cgi/content/short/20/2/151) Talk to your physician about trying gabapentin or another antiepileptic drug, especially carbamazepine. And there are other drugs. Flexeril, a muscle relaxant, has recently been mentioned on TT as well as namenda. (Here's a link to the latter: https://www.ncbi.nlm.nih.gov/pubmed/23015804)

Remember that tinnitus is a symptom, not a disease, so something that works for one person may not work for another. It's important to be open minded and work closely with a doctor, trying several approaches. For many on this board, moreover, vitamins and other supplements have also helped, especially magnesium. Magnesium has several functions that makes it good against tinnitus, and its positive effects were published in 2011 in a phase II clinical trial. (https://www.ncbi.nlm.nih.gov/pubmed/22249877)

Here's an article in gabapentin and its uses:
https://en.wikipedia.org/wiki/Gabapentin

Finally, you may also find this 2009 review article of tinnitus pharmacology interesting: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136369/

Good luck and be strong!

 

[Mr Registered User]

Here's some more uneducated info from me:

Tinnitus coming on during sleep -- could it be sinus-related? Do you have an sinus block, and/or does your ear ever feel blocked or stuffed up?
if so, perhap Google: "sinuses eustachian tube dysfunction tinnitus".

How about acid reflux? I've read that, during sleep, food particles can not only reflux up to the throat, but even up to the sinuses!

 

[Bacus]

Thank you Golly and Jazz,
I appreciate your advise and will consider your recommendations.
I wonder if it is possible to habituate intermittent tinnitus .ie a shrill brain rattling ,tinny noise.
I am considering buying the TRT book from amazon, as there is no TRT centres where I live.
Nothing but the best and good wishes .
Bacus

 

[Golly]

Hi Bacus:

There are people who swear by TRT. I am not sure how intermittency affects its efficacy, but it's worth asking around.

Indeed, habituation is probably impeded somewhat when tinnitus is intermittent. Part of the problem is the (largely false) belief that you can control the timing of the "good days." Further, there exists the temptation to live for the "good days," which should be avoided lest you effectively write off half of the life you have left to live!

I must admit that after two plus years with intermittent tinnitus, I remain acutely aware of the sensation of head-noise on "bad days." However, tinnitus no longer makes me panic. I understand that is something that I will have to live with until I find a suitable medication or treatment. Also, I know that I can have a great time with my kids regardless of what noises I hear. I believe that once you become comfortable knowing that you can still enjoy life regardless of this condition, part of the habituation (the acceptance) is made easier.

Chat with others on this board and find a path that feels right for you. It may be TRT, or you might want to experiment with medications (under a doctor's supervision) as I have done. Or, perhaps it's a sinus issue as suggested by Mr. Registered User. But you won't find out until you do your research and know your options.

Finally, take comfort in the fact that you are not alone. What's more, there is plenty of promising research being conducted as we write!

-Golly