Introduction
Very long post here! If you are interested in really trying to figure out a possible sleep and tinnitus effect, please read and let me know what you think. I can not verify the accuracy of all the charts and information in the links but I assume some of it is correct. If anyone finds any false information and is knowledgeable about it, please post a correction. If you are familiar with some of the information please skip to the next section(s). Please excuse the haphazardness of this article. I typed it without an outline.
The reason I put this together is because I've been trying to figure out for a while how some people sleep and wake up with loud T, soft T, or random. This is the best theory on why that I have come up with so far but need constructive criticism because I could be wrong somewhere or be completely wrong!
Section 1: Circadian Rhythm
One thing I have mentioned before is the body clock. Our body clocks can be different and are not exactly 24 hour periods.
Normal Circadian Rhythms have approximately a 24 hour cycle but can be reset by exposure to things like light and heat. (For example, many humans in the past would have the light and heat of the sun). Unfortunately, due to electric lights it can throw people's body clocks off.
Here are some example images of a circadian rhythm and the biological changes that take place:
Source: https://learn.pharmacy.unc.edu/insomnia/node/6
Source: https://selfhacked.com/2015/09/06/what-it-means-to-keep-to-a-circadian-rhythm/
The above link also has information about circadian rhythms so if you need to learn more, please click the link.
One thing to note however, is that there are Circadian Rhythm sleep disorders:
According to Wikipedia:
Non-24-hour sleep–wake disorder and other persistent circadian rhythm sleep disorders are believed to be caused by an inadequate ability to reset the sleep/wake cycle in response to environmental time cues. These individuals' circadian clocks might have an unusually long cycle, and/or might not be sensitive enough to time cues. People with DSPD (Delayed sleep phase disorder), more common than Non-24, do entrain to nature's 24 hours, but are unable to sleep and awaken at socially preferred times,
Source: https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder#Circadian_rhythm_abnormalities
To maintain a good circadian rhythm it is recommended to not nap:
"Don't nap! In general, short naps may not hurt sleep, but they can affect fragile circadian rhythms. Napping during the day can damage a good sleep rhythm and keep you from enjoying a full sleep at night. If you suffer from insomnia, the best thing to do is keep from napping during the day. If naps are absolutely necessary, make sure you only nap once a day and keep it under ½ hour."
According to http://www.talkaboutsleep.com/circadian-rhythm-sleep-tips/
Below is an image of what can happen to a "normal" person during a nap. REM and NREM sleep will be explained in the next section. It may shed some light on why people can take a nap and wake up with low T or high T.
Source: http://lifehacker.com/how-long-to-nap-for-the-biggest-brain-benefits-1251546669
Section 2: Alcohol
Here is a chart for what happens during "normal sleep" Keep in mind SWS (Slow Wave Sleep is 3 stages of sleep (some sources say 4) which is known as NREM (Non-Rapid Eye Movement) and then there is REM sleep which is Rapid Eye Movement Sleep.:
Now notice what happens to Gaba and Glutamate during normal REM sleep. They are not increasing or decreasing (may not be the scientific term). Then look at the following chart and notice what happens during alcohol in REM sleep. GABA decreases but glutamate increases! :
Some of these neurotransmitters have been mentioned on this site as having an effect on tinnitus.
Section 3: Melatonin
Melatonin at night which the body secretes can also affect REM sleep. Therefore, this might also affect tinnitus due to different hormonal and neurotransmitters changes which happen at different stages of sleep.
With most people melatonin seems to INCREASE REM sleep. The following link is information from a someone who took melatonin and gave details on REM and NREM sleep. It is very interesting.
http://jayquantified.blogspot.com/2012/08/melatonin-preliminary-results.html
However, there are some people with REM sleep behavior disorder:
Melatonin can reduce rapid eye movement (REM) sleep without atonia in REM sleepbehavior disorder (RBD). Melatonin doses of 3–12 mg appear efficacious in reducing clinical RBD symptoms. Minimal side effects may favor melatonin over clonazepam as initial therapy in RBD.
According to:
http://www.sleep-journal.com/article/S1389-9457(14)00412-2/abstract
To me this is puzzling as it seems that melatonin increases REM sleep, yet according to the source above, it says it reduces REM sleep with RBD. If anyone can explain this or it is inaccurate, please post below.
I would like to post some graphs of melatonin levels for the day in the hopes that maybe someone can figure out something. Keep in mind that this is for a "normal sleep schedule and circadian rhythm" for a "normal" person.
Source: http://www.sandhillsneurologists.com/2015/04/melatonin-and-sleep/
HOWEVER, you must account for age as some charts do not show. Observe the following:
Source: http://www.benbest.com/nutrceut/melatonin.html
My question is this: Would falling asleep during a certain level of melatonin, change the outcome of sleep cycles and therefore affect tinnitus somehow? Obviously, people need to go to bed at the proper time everyday though. Please let me know your theories.
Finally, melatonin has been found to help some people with tinnitus. Please read the complete study using the source link below:
Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.
Source: https://www.ncbi.nlm.nih.gov/pubmed/21859051
Section 4: Benzodiazepines and Caffeine
Now establishing these issues I can further get to how benzodiazepines and caffeine affect stages of sleep. Observe the following charts (If you are using a computer instead of a smartphone or tablet, you may have to hold down the CTRL button and hit the + button repeatedly to zoom in. The - button will zoom out with CTRL is held down):
This one is how caffeine and benzodizepines can affect it (see charts):
http://www.sleepsources.org/uploads/sleepsyllabus/fr-j.html
Some interesting things to note. In the "normal" (within 8 hours) sleep above, you can see that there is 5 REM stages that happen (REM sleep happens 5 times during the sleep in that example). The first REM stage happens in between about 70 to 90 minutes in. The 4th REM stage is within 7 hours.
In the benzodiazepine sleep data listed, REM takes longer to achieve. It takes over 4 hours to get to the first REM cycle. The benzo induced sleep does not achieve the 4th REM sleep within 8 hours. In fact, it shows the person was awake for a short period of time before the 4th REM stage!
Check out the caffiene chart on the page also to see how it distorts sleep. Very interesting!
Section 5: Anti-depressants
Anti-depressants also affect REM and NREM sleep. Here is a chart on how certain anti-depressants affect sleep:
http://www.psychiatrictimes.com/sleep-disorders/effects-antidepressants-sleep
The source above is a great read, so if you are interested in this subject, please read this.
Section 6: Anticonvulsants
Another type of drug that can have an effect on REM and NREM sleep is anticonvulsants. However, they can have much different effects depending on the specific drug. For example:
Lamictal (Lamotrigine) "increased REM sleep, reduced number of entries into REM sleep, decreased number of phase shifts, and decreased percentage of slow-wave sleep."
Neurontin (Gabapentin) "increased REM sleep percentage, increased mean duration of REM periods, reduced number of awakenings, and reduced stage 1 sleep percentage"
Source: https://www.ncbi.nlm.nih.gov/pubmed/10718681
If you take an anticonvulsant please research on the internet how it effects your sleep if you think this information could be useful.
Section 7: Beta-Blockers
According to a study I found, drugs such as propranolol, metoprolol, and pindolol increased the amounts of awakening throughout the night. In addition, they reduced the amount of REM sleep. The drug atenolol reduced REM frequency.
Source: https://www.ncbi.nlm.nih.gov/pubmed/2865152
Another study showed that the supplement melatonin can aid certain sleep problems with beta blockers:
https://sleep.med.harvard.edu/news/482/Making+Headway+on+Beta-Blockers+and+Sleep
Conclusion
Therefore, benzos, caffeine, anti-depressants, alcohol, anti-convulsants, beta-blockers, and melatonin can all affect sleep cycles. (There are other things as well but I need to limit the scope of this post) Whether or not one of these things helps your tinnitus, makes it worse, or does nothing I do not know. I'm just stating this information and for those that take benzo's before sleep, let me know how your sleep is in the morning. For those who have never taken benzo's but have fluctuating T, try shutting off all electric lights and computers for a while before sleep and avoid taking a nap for a couple of days and let me know what happens. For those that take caffeine, let me know if it reduces it or increases it. I don't recommend messing around with caffeine or benzo's though because they can have bad consequences going cold turkey. Let me know what you all think.
My thinking is, if the sleep cycles can be manipulated safely in whatever way it needs to be, can it lower T on a regular basis? I also believe that good sleep hygiene and a steady circadian rhythm can improve mood.
Finally, I would like to conclude with this information on a study that showed all tinnitus patients studied had markedly different sleep cycles and a shortened duration of REM sleep. This is one of the main reasons I believe that REM/NREM sleep values can affect tinnitus. Keep in mind in the study THI stands for Tinnitus Handicap Inventory and the "Control" group is people that do not have tinnitus:
All tinnitus patients had a statistically significant alteration in sleep stages. Average percentage of stage 1 + stage 2 was 85.4% ± 6.3, whereas, in the control group, the average percentage of stage 1 + stage 2 was 54.9 ± 11.2 (p < 0.001). Stages 3 and 4 and rapid eye movement (REM) sleep was lacking in all tinnitus patients with an average percentage of 6.4 ± 4.9 of REM sleep, and 6.4 ± 4.9 of stages 3 + 4. The control group showed an average percentage of 21.5 ± 3.6 of REM sleep and 21.5 ± 3.6 of stages 3 + 4 (p < 0.001). No correlation was found between the decrease of REM and the increase of the THI score in the tinnitus group (r = 0.04). However, a mild correlation was found between the increase of light sleep (stage 1 + stage 2) and the THI score reported by the tinnitus group.
Source: https://www.ncbi.nlm.nih.gov/pubmed/24005841
In my opinion, this subject is well worth looking into.
For those interested in all this, print and fill out this form and see if you can find a pattern. It is an enhanced sleep diary form
http://sleepcenter.ucla.edu/workfiles/forms/sleep-diary.pdf
Very long post here! If you are interested in really trying to figure out a possible sleep and tinnitus effect, please read and let me know what you think. I can not verify the accuracy of all the charts and information in the links but I assume some of it is correct. If anyone finds any false information and is knowledgeable about it, please post a correction. If you are familiar with some of the information please skip to the next section(s). Please excuse the haphazardness of this article. I typed it without an outline.
The reason I put this together is because I've been trying to figure out for a while how some people sleep and wake up with loud T, soft T, or random. This is the best theory on why that I have come up with so far but need constructive criticism because I could be wrong somewhere or be completely wrong!
Section 1: Circadian Rhythm
One thing I have mentioned before is the body clock. Our body clocks can be different and are not exactly 24 hour periods.
Normal Circadian Rhythms have approximately a 24 hour cycle but can be reset by exposure to things like light and heat. (For example, many humans in the past would have the light and heat of the sun). Unfortunately, due to electric lights it can throw people's body clocks off.
Here are some example images of a circadian rhythm and the biological changes that take place:
Source: https://learn.pharmacy.unc.edu/insomnia/node/6
Source: https://selfhacked.com/2015/09/06/what-it-means-to-keep-to-a-circadian-rhythm/
The above link also has information about circadian rhythms so if you need to learn more, please click the link.
One thing to note however, is that there are Circadian Rhythm sleep disorders:
According to Wikipedia:
Non-24-hour sleep–wake disorder and other persistent circadian rhythm sleep disorders are believed to be caused by an inadequate ability to reset the sleep/wake cycle in response to environmental time cues. These individuals' circadian clocks might have an unusually long cycle, and/or might not be sensitive enough to time cues. People with DSPD (Delayed sleep phase disorder), more common than Non-24, do entrain to nature's 24 hours, but are unable to sleep and awaken at socially preferred times,
Source: https://en.wikipedia.org/wiki/Circadian_rhythm_sleep_disorder#Circadian_rhythm_abnormalities
To maintain a good circadian rhythm it is recommended to not nap:
"Don't nap! In general, short naps may not hurt sleep, but they can affect fragile circadian rhythms. Napping during the day can damage a good sleep rhythm and keep you from enjoying a full sleep at night. If you suffer from insomnia, the best thing to do is keep from napping during the day. If naps are absolutely necessary, make sure you only nap once a day and keep it under ½ hour."
According to http://www.talkaboutsleep.com/circadian-rhythm-sleep-tips/
Below is an image of what can happen to a "normal" person during a nap. REM and NREM sleep will be explained in the next section. It may shed some light on why people can take a nap and wake up with low T or high T.
Source: http://lifehacker.com/how-long-to-nap-for-the-biggest-brain-benefits-1251546669
Section 2: Alcohol
Here is a chart for what happens during "normal sleep" Keep in mind SWS (Slow Wave Sleep is 3 stages of sleep (some sources say 4) which is known as NREM (Non-Rapid Eye Movement) and then there is REM sleep which is Rapid Eye Movement Sleep.:
Now notice what happens to Gaba and Glutamate during normal REM sleep. They are not increasing or decreasing (may not be the scientific term). Then look at the following chart and notice what happens during alcohol in REM sleep. GABA decreases but glutamate increases! :
Some of these neurotransmitters have been mentioned on this site as having an effect on tinnitus.
Section 3: Melatonin
Melatonin at night which the body secretes can also affect REM sleep. Therefore, this might also affect tinnitus due to different hormonal and neurotransmitters changes which happen at different stages of sleep.
With most people melatonin seems to INCREASE REM sleep. The following link is information from a someone who took melatonin and gave details on REM and NREM sleep. It is very interesting.
http://jayquantified.blogspot.com/2012/08/melatonin-preliminary-results.html
However, there are some people with REM sleep behavior disorder:
Melatonin can reduce rapid eye movement (REM) sleep without atonia in REM sleepbehavior disorder (RBD). Melatonin doses of 3–12 mg appear efficacious in reducing clinical RBD symptoms. Minimal side effects may favor melatonin over clonazepam as initial therapy in RBD.
According to:
http://www.sleep-journal.com/article/S1389-9457(14)00412-2/abstract
To me this is puzzling as it seems that melatonin increases REM sleep, yet according to the source above, it says it reduces REM sleep with RBD. If anyone can explain this or it is inaccurate, please post below.
I would like to post some graphs of melatonin levels for the day in the hopes that maybe someone can figure out something. Keep in mind that this is for a "normal sleep schedule and circadian rhythm" for a "normal" person.
Source: http://www.sandhillsneurologists.com/2015/04/melatonin-and-sleep/
HOWEVER, you must account for age as some charts do not show. Observe the following:
Source: http://www.benbest.com/nutrceut/melatonin.html
My question is this: Would falling asleep during a certain level of melatonin, change the outcome of sleep cycles and therefore affect tinnitus somehow? Obviously, people need to go to bed at the proper time everyday though. Please let me know your theories.
Finally, melatonin has been found to help some people with tinnitus. Please read the complete study using the source link below:
Melatonin is associated with a statistically significant decrease in tinnitus intensity and improved sleep quality in patients with chronic tinnitus. Melatonin is most effective in men, those without a history of depression, those who have not undergone prior tinnitus treatments, those with more severe and bilateral tinnitus, and those with a history of noise exposure.
Source: https://www.ncbi.nlm.nih.gov/pubmed/21859051
Section 4: Benzodiazepines and Caffeine
Now establishing these issues I can further get to how benzodiazepines and caffeine affect stages of sleep. Observe the following charts (If you are using a computer instead of a smartphone or tablet, you may have to hold down the CTRL button and hit the + button repeatedly to zoom in. The - button will zoom out with CTRL is held down):
This one is how caffeine and benzodizepines can affect it (see charts):
http://www.sleepsources.org/uploads/sleepsyllabus/fr-j.html
Some interesting things to note. In the "normal" (within 8 hours) sleep above, you can see that there is 5 REM stages that happen (REM sleep happens 5 times during the sleep in that example). The first REM stage happens in between about 70 to 90 minutes in. The 4th REM stage is within 7 hours.
In the benzodiazepine sleep data listed, REM takes longer to achieve. It takes over 4 hours to get to the first REM cycle. The benzo induced sleep does not achieve the 4th REM sleep within 8 hours. In fact, it shows the person was awake for a short period of time before the 4th REM stage!
Check out the caffiene chart on the page also to see how it distorts sleep. Very interesting!
Section 5: Anti-depressants
Anti-depressants also affect REM and NREM sleep. Here is a chart on how certain anti-depressants affect sleep:
http://www.psychiatrictimes.com/sleep-disorders/effects-antidepressants-sleep
The source above is a great read, so if you are interested in this subject, please read this.
Section 6: Anticonvulsants
Another type of drug that can have an effect on REM and NREM sleep is anticonvulsants. However, they can have much different effects depending on the specific drug. For example:
Lamictal (Lamotrigine) "increased REM sleep, reduced number of entries into REM sleep, decreased number of phase shifts, and decreased percentage of slow-wave sleep."
Neurontin (Gabapentin) "increased REM sleep percentage, increased mean duration of REM periods, reduced number of awakenings, and reduced stage 1 sleep percentage"
Source: https://www.ncbi.nlm.nih.gov/pubmed/10718681
If you take an anticonvulsant please research on the internet how it effects your sleep if you think this information could be useful.
Section 7: Beta-Blockers
According to a study I found, drugs such as propranolol, metoprolol, and pindolol increased the amounts of awakening throughout the night. In addition, they reduced the amount of REM sleep. The drug atenolol reduced REM frequency.
Source: https://www.ncbi.nlm.nih.gov/pubmed/2865152
Another study showed that the supplement melatonin can aid certain sleep problems with beta blockers:
https://sleep.med.harvard.edu/news/482/Making+Headway+on+Beta-Blockers+and+Sleep
Conclusion
Therefore, benzos, caffeine, anti-depressants, alcohol, anti-convulsants, beta-blockers, and melatonin can all affect sleep cycles. (There are other things as well but I need to limit the scope of this post) Whether or not one of these things helps your tinnitus, makes it worse, or does nothing I do not know. I'm just stating this information and for those that take benzo's before sleep, let me know how your sleep is in the morning. For those who have never taken benzo's but have fluctuating T, try shutting off all electric lights and computers for a while before sleep and avoid taking a nap for a couple of days and let me know what happens. For those that take caffeine, let me know if it reduces it or increases it. I don't recommend messing around with caffeine or benzo's though because they can have bad consequences going cold turkey. Let me know what you all think.
My thinking is, if the sleep cycles can be manipulated safely in whatever way it needs to be, can it lower T on a regular basis? I also believe that good sleep hygiene and a steady circadian rhythm can improve mood.
Finally, I would like to conclude with this information on a study that showed all tinnitus patients studied had markedly different sleep cycles and a shortened duration of REM sleep. This is one of the main reasons I believe that REM/NREM sleep values can affect tinnitus. Keep in mind in the study THI stands for Tinnitus Handicap Inventory and the "Control" group is people that do not have tinnitus:
All tinnitus patients had a statistically significant alteration in sleep stages. Average percentage of stage 1 + stage 2 was 85.4% ± 6.3, whereas, in the control group, the average percentage of stage 1 + stage 2 was 54.9 ± 11.2 (p < 0.001). Stages 3 and 4 and rapid eye movement (REM) sleep was lacking in all tinnitus patients with an average percentage of 6.4 ± 4.9 of REM sleep, and 6.4 ± 4.9 of stages 3 + 4. The control group showed an average percentage of 21.5 ± 3.6 of REM sleep and 21.5 ± 3.6 of stages 3 + 4 (p < 0.001). No correlation was found between the decrease of REM and the increase of the THI score in the tinnitus group (r = 0.04). However, a mild correlation was found between the increase of light sleep (stage 1 + stage 2) and the THI score reported by the tinnitus group.
Source: https://www.ncbi.nlm.nih.gov/pubmed/24005841
In my opinion, this subject is well worth looking into.
For those interested in all this, print and fill out this form and see if you can find a pattern. It is an enhanced sleep diary form
http://sleepcenter.ucla.edu/workfiles/forms/sleep-diary.pdf
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