- Jul 17, 2019
- 116
- Tinnitus Since
- 07/2019
- Cause of Tinnitus
- TMJ, Neck Issues, and Accompanying Postural Deviations.
I will preface this discussion by advising you not take any one thing I suggest out of context. make you aware that these things may not work for everyone, alert you to the fact that the information given below should not be used diagnose or treat any health or medical condition, and strongly recommend you consult with your doctors before attempting some of the less conservative treatments and strategies I outline.
I am now wrapping up Month 3 of my treatment plan for tinnitus likely caused by TMJ/Bruxism and associated Musculoskeletal Misalignment and Neuromuscular Imbalance. Several people have expressed interest in my treatment plan and learning more about it. I have achieved much relief with this treatment plan thus far, and its first priority and highest tenant is achieving better sleep. I am a innately curious and mildly obsessive Oceanographer and Physical Scientist who employs a holistic and systematic approach to most things including my tinnitus treatment; an example of which is demonstrated below. From my investigations, this seems to be ideal approach to perform in a nested and iterative manner for the diagnosis and treatment of tinnitus. When trying to achieve better sleep, it is important to understand cause-and-effect relationships and distinguish between upstream (primary/causes) and downstream (secondary/symptoms) when it comes to disentangling your own sleep issues and your own tinnitus diagnosis and treatment. A compilation of my notes, recommendations, and specific details of their implementation for my specific case are included below. Hopefully, at least one other person will find some relief from their tinnitus using some of the recommendations I put forward in their own journeys with this horrid condition or at least will be in a better condition to deal with it a daily basis because they are getting more higher-quality sleep.
Educate Yourself About Sleep
@boliston suggested this book in an earlier thread which I bought and read which has helped with my sleep issues - https://www.amazon.com/Sleep-Solution-Why-Your-Broken/dp/0399583602. Also I subscribed to Dr. Michael Breus's weekly email list here - https://thesleepdoctor.com/. Ignore all of the products he endorses and tries to push on his subscribers. Regardless, this has led me to a lot of useful information (including the attached sleep guide), free sleep courses, and podcasts that have helped since my tinnitus onset in July 2019. Several of my work colleagues with tinnitus listen to these podcasts at night which help them drift off to sleep - https://www.sleepwithmepodcast.com/. The host basically rabbles on about useless stuff that is so boring it puts people to sleep. It works so well, he actually holds live events for people to attend to catch some Zzzs (see below video). It does not work for me, but may work for others.
Track Your Sleep to Increase Sleep Awareness & Understanding
I started tracking my sleep which helped me understand my sleep fragmentation and architecture and develop my sleep strategies that I employ at present. I use this - https://www.amazon.com/Withings-Nok...&s=hpc&sprefix=withings,stripbooks,329&sr=1-3. Others devices include the Dreem 2 Headband - https://dreem.com/en - and the Oura Ring - https://ouraring.com/ - that @Phat Tuna has had some success with. If your inability to sleep stems from stress or anxiety, some device like those listed above help improve sleep awareness which is generally one of the first steps on the road to understanding and overcoming any issue. I stressed most about sleep itself and dreaded the when the time came to fall asleep. Now that I track my sleep, I stress a lot less about it and sleep better. Pairing a sleep journal with a sleep-tracking device can help you validate what is working and what is not over time.
On a normal 8-hour night, I strive for 20-25% (90-120 minutes) REM sleep (helps with emotional processing and memory consolidation; the less REM sleep I get, the more irritated I am and the more my tinnitus bothers me), 25-33% (120-180 minutes) Deep Sleep (body heals, fight inflammation, restore immune system, etc...; the less deep sleep I get, the more sore and fatigued I feel in the morning), and the remainder Light Sleep. I have pretty good attainment for these goals at present. If you sleep a lot but do not feel refreshed upon waking up, chances are you are stuck in the Light Sleep phase, your sleep is fragmented, or you may have a pre-existing sleep disorder.
Make Your Sleep Space into a Comfortable Space
Make sure you are comfortable in bed. Get a comfortable mattress or mattress topper that is optimized for your sleeping style and preferred sleep position (https://www.onhealth.com/content/1/best_sleeping_positions_sleep) and try a weighted blanket if necessary over a conventional comforter. Set the temperature to a comfortable one; some like it warmer and some like it cooler. Find the one that works for you. I also like to have air circulating when I sleep so I run a ceiling fan or tower fan on a lower setting at night and run a HEPA Air Filter as well. This is not a complete list. Considerable what a comfortable sleep space is oo you and create it. If you are not comfortable in bed, you won't be able to relax.
Practice Good Sleep Posture
Be mindful of your sleep posture. Try to keep your spine in a neutral position. Invest in a cervical neck pillow for back and/or side sleeping and consider using a lumbar support pillow. My recommendations for back sleepers - https://www.amazon.com/YourFacePill...ds=my+face+sleep+pillow&qid=1579936156&sr=8-4 - and for slide sleepers - https://www.amazon.com/Natures-Gues...ical+neck+pillow&qid=1579936247&s=hpc&sr=1-17 or https://infinitemoon.com/product/the-curve/. I rotate between these three pillows for sleep. It is good to have a pillow that is the right height for your neck depending on your preferred sleeping position(s) - https://www.spine-health.com/wellness/sleep/pillow-support-and-comfort, so purchasing a pillow you can add or remove fill to and adjust pillow height is a good approach. The human neck curves slightly forward (to sustain the weight of the head when upright), and it's important to maintain this curve when in a resting position and take care not to hyper-extend forward neck curvature when sleeping. Sleeping with the neck in a forward-flexed position can trigger or worsen musculoskeletal misalignment, cause neck and back pain, worsen sleep disordered breathing due to narrowing the airway, and trigger bruxism. I noticed this was part of my default sleep posture and now set my pillow further back to keep my head over my shoulders where it belongs when sleeping on my side.
Treat Bruxism and Teeth Clenching/Grinding
If you suffer from bruxism, raise the temperature or try sleeping with a humidifier. Incorporate mindfulness or meditation as part of your sleep strategies to relieve stress before bed. Use a night guard to reduce the strain of grinding and clenching on your teeth. Invest in a TMJ orthotic to treat your bruxism. My orthotic keeps my jaw in a relaxed position, transfers the strain of clenching and grinding from my molars to my front teeth, and prevents my lower jaw from shifting backward; the latter two can trigger or worsen sleep disordered breathing due to narrowing or collapsing of the airway. Sleep with your mouth taped shut (I use this - https://www.amazon.com/Sleep-Strips...ywords=sleep+mouth+tape&qid=1579937428&sr=8-4 - to facilitate and encourage nose breathing to reduce prevalence of mouth breathing which can in turn in trigger bruxism and teeth grinding and clenching. When applying the tape, curve your lips inward which will keep upper and lower jaw slightly apart and help bruxism, grinding, and clenching further. Try using something like a Breathe Right Nasal Strip (https://www.amazon.com/Breathe-Right-Snoring-Drug-Free-Sensitive/dp/B001G7QPX2) to keep your nasal passages open, minimize chances of nasal valve collapse, improve nose breathing, and reduce prevalence of mouth breathing that can trigger bruxism. I have a slightly deviated septum so I use these every night. Try to treat your bruxism, clenching, and grinding early on to prevent further issues down the road.
Normalize & Manage Stress Hormone Levels
Consider your cortisol, adrenaline, and norepinethrine (stress hormone) levels and their diel variability. I only focused on cortisol for my purposes (more info on cortisol - https://www.webmd.com/a-to-z-guides/what-is-cortisol#1) which is something that helps control sleep-wake cycles. Cortisol is produced and released by the adrenal glands. Sustained and chronic long-term stress can exhaust your adrenal glands. I am scientist working in government and academia with two advanced degrees who needs to publish and secure funding to continue my research so I fit that description. This led to me Adrenal Fatigue Syndrome (AFS) which conventional medical docs cannot come to a consensus on whether or not it is a real condition. Naturopathic docs and folks working in alternative medicine definitely agree it is a real condition. More info on AFS - https://www.annelemonswellness.com/blog-1/2017/12/31/adrenal-fatigue-what-is-it-and-how-do-i-fix-it - and a two good book I bought and read - https://www.amazon.com/Adrenal-Fati...yndrome&qid=1579463404&sr=8-4&tag=tinntalk-20 and https://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152. Cortisol should be highest in the morning when you wake up and lowest when you go to bed at night. Depending how stressed you are and if you have AFS, cortisol can be chronically high, chronically low, and/or out-of-phase with your circadian rhythm. For me, cortisol levels were always on the higher end and roughly 3 hours of out phase with the nominal normal times I try to go to sleep at night and wake up in the morning. I currently live on the US West Coast but spent several years on the US East Coast, and due to poor sleep hygiene, prolonged computer use, or whatever reason, my circadian rhythm defaulted to US East Coast time. Once you understand how cortisol is changing with time of day, it may offer hope for addressing part of your sleep issues and possibly have a positive influence on your tinnitus or at least to improve sleep to better deal with it on a daily basis. My treatment was very conservative and included daily exercise and meditation to relieve stress, and practicing good sleep hygiene and syncing circadian rhythm with my diel cortisol variability to improve sleep and slowly move it from US East Coast to US West Coast Time (still working on this part). I drink tea containing herbs with adaptogenic properties like holy ginger, rooibos, and ashwagandha at different times of day that help raise cortisol levels if they are too low or lower them if they are too high throughout the day as well to help normalize my cortisol levels and reprogram my diel cortisol cycles. If interested in exploring this treatment pathway for your sleep problems, seek out an Endocrinologist who ascribes to AFS and/or similar conditions or a Naturopathic Doctor. LESS CONSERVATIVE CORTISOL SUPPRESSION & CONTROL TREATMENTS ARE VERY CONTROVERSIAL AND DANGEROUS IF NOT DONE PROPERLY. DO NOT SELF-DIAGNOSE AND PURSUE ANY SUCH TREATMENTS FOR THIS ON YOUR OWN.
Exercise
There are several benefits to regular exercise which I will not re-state here. For me exercise helps relieve stress and manage my cortisol levels which has the downstream effect of improving my sleep. I also mention this because if you have suspect you have AFS or stress hormone regulation issues, be conservative with your exercise and start slow. I went from walking at a brisk pace for 45 minutes 5x a week to interval training alternating between walking for 0.5 miles and running for 0.5 miles for 45 minutes 5x a week for one week with no transition period and was out of commission with chronically fatigued legs for about two weeks before I resumed my walking routine.
Boost & Expedite Sleep's Natural Restorative Functions at Night
While you sleep, your body heals, fights inflammation, sustains proper bone metabolism, and restores your immune system along with several other important restorative tasks overnight. @engineerLA postulated that inflammation plays a part in most people's tinnitus onset and progression, and I tend to agree with this assertion. In my case, I had inflammation in my temporomandibular joints, my sinuses, and probably my Eustachian Tubes as well. He put forward several suggestions for fighting inflammation in this thread - https://www.tinnitustalk.com/thread...-—-new-protocols-and-supplements-to-try.6514/. I perform several of his suggestions every morning after I wake up and before going to bed at night. Sinus irrigation and use of saline nasal spray are especially useful for me. It is my opinion that taking steps on your own to reduce inflammation and promote healing will further quicken and improve the effectiveness of good sleep's restorative powers; this is however purely based on my own observations and the improvements I have seen in my own tinnitus. I would take this one step further and encourage others to perform necessary tasks to combat muscle soreness and fatigue to quicken recovery and improve sleep as pain is also something that interrupt sleep. I will leave this open-ended for others to reflect on based on their own health. In my case, there is a battery of gentle stretches and releases I perform every night before going to bed to stretch and lengthen muscles that chronically contract during the day and decompress and work out knots of tension elsewhere. I continue to have problems with fatigued legs on and off, and I use a massage gun (https://www.amazon.com/Professional..._6?keywords=massage+gun&qid=1579945380&sr=8-6) to stimulate the muscles in my legs, increase delivery of oxygenated blood to the muscles, and flush out any lactic acid that has built up in the muscles over time before bed. Be sure to hydrate after doing something like this. I have noticed gradual improvements with my fatigued legs over time since doing this and achieving better sleep. I also use the massage gun on important postural muscles as well.
Detect & Treat Sleep-Disordered Breathing
Sleep-disordered breathing manifests as partial collapse of the airway (hypopnea) or full collapse of the airway (apnea) while sleeping and is measured using the Apnea-Hypopnea Index (AHI - https://www.sleephealth.org/ufaqs/what-is-ahi-represent/). Its most serious forms are Obstructive and Central Sleep Apnea; both of which can cause tinnitus as well thru several different pathways but not limited to triggering bruxism, suppression of blood oxygen levels, and reduction in the delivery of oxygenated blood to ears. Certain things predispose individuals to developing sleep apnea like high stress, obesity, and craniocervical misalignment (e.g., forward head posture). If sleep-disordered breathing is suspected, please consult your doctor and get a referral to a sleep doc and schedule a sleep study to help get a definitive diagnosis. Then, discuss sleep apnea treatment options with your docs like APAP/CPAP, orthotics, and lifestyle changes to name a few. My sleep tracking device also tracks sleep-disordered breathing (which I had) and detected several periods at night early on when I would wake up at night without knowing it (would not remember in the morning) before returning to sleep shortly thereafter. Both are hallmarks of sleep apnea. I took this data and information to my doctors who referred me to a sleep doc who then ordered a polysomnography test (another name for a lab sleep study). I was diagnosed with mild sleep apnea. I now take steps to address things like my bruxism and forward head posture when sleeping using those approaches detailed above, use a TMJ orthotic that doubles as a more conservative sleep apnea orthotic, and made several lifestyle changes that have helped me go from 235 to 195 lbs at 6'2" since my tinnitus onset in July 2019. My sleep tracking device now captures fewer sleep-disturbed breathing events and periods when I wake up at night without knowing it which has reduced sleep fragmentation and improved sleep quality and duration.
Develop and Maintain Good Sleep Hygiene
Sleep hygiene is listed last because considerations for sleep strategies from the above items are ultimately what will end up comprising your sleep hygiene plan. The few sleep specialists I have spoken with all say that your sleep hygiene plan should begin after leaving work. I tend to disagree and consider my sleep hygiene plan to start upon waking in the morning. Most important for good sleep hygiene is to go to sleep and wake up at the same times each day and not to deviate more than 60-90 minutes from those times you adhere to during the week on the weekends so try to resist the urge to sleep in. Also, be mindful of the fact that just because you spent 8 hours in bed does not necessarily mean you slept for 8 hours; another thing sleep tracking can help with. A rough example of my sleep hygiene plan when not at sea with accompanying info below to help with designing your own -
Mornings - 0615 to 1200 - Wake up at 0615. 45-60 minutes of Cardio 5x a week and stretches other 2x a week. Breakfast with tea with one tea bag of each - https://www.amazon.com/Yogi-Tea-Blu...keywords=yogi+slim+life&qid=1579948049&sr=8-3 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for caffeine and cortisol control. Transit to work. Work between 0845 and 1200.
Afternoons - 1200 to 1745 - 1200-1300 - 20 minutes of stretching, 10 minute shower, 30 minute Lunch with tea - https://www.amazon.com/Yogi-Tea-Tan...rds=yogi+stress+relief&qid=1579948366&sr=8-14 - for stress relief and cortisol control. Work between 1300 and 1745.
Evenings - 1745-2130 - Transit home from work. On the way home I take 1000 mg each of Taurine and NAC on a daily basis on a relatively empty stomach to calm my mind that is always thinking. Dinner at 1830 followed by a anti-inflammatory smoothie. I usually follow this recipe - https://ohmyveggies.com/kale-smoothie/. I usually add fresh pineapple, turmeric extract, and sometimes mango as well. I am still fine-tuning my own version of this smoothie. My latest versions of the smoothie contains almond milk, kale, ginger, cinnamon, pineapple, and turmeric; all of which are anti-inflammatories and the smoothie is not overly sweet. In my case, this really further calms the nerves and helps reduce stress in the evenings. After dinner, I do my 30 minutes of light stretches which are not enough to elevate my heart rate before bed. Before showering, I take 1 mg of melatonin and 1000 mg of L- Tryptophan (be sure to take these types of supps 60-90 minutes the time you want to fall asleep). After showering I irrigate my sinuses and drink more tea - one tea bag of each https://www.amazon.com/Celestial-Se...keywords=sleepytime+tea&qid=1579949556&sr=8-5 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for stress relief and lower cortisol levels to prepare for sleep. I am usually in bed by 2045. I am usually asleep between by 2130. Between 2045 and 2130, I usually decompress in some way whether it is watching Netflix, reading, using this facial massager to relax - https://www.amazon.com/gp/product/B07Z7P7FJX/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1 - which is extremely useful if have TMJ and sore mastication muscles around your temples, or performing meditation/deep breathing exercises using my BrainTap/Sleep RX combo (https://braintap.com/sleep-rx-bundle/). I do not like any noise when I sleep so I wear soft foam earplugs to block out the louder noises.
On weekends, my times for going to bed and waking up usually move later by 60-90 minutes and learning to do nothing on weekends is essential for learning to decompress and retain your sanity when you have tinnitus.
Remember not to eat anything heavy at least 2 hours before bed and avoid strenuous exercise before bed as well.
I limit my computer use on weekends and days off between 1000 and 1800 only (except for right now) and do not use my computers outside of normal business hours on weekdays. When I leave work, I am done for the day. I also wear blue light blocking glasses whenever using a PC now to combat suppression of melatonin production in the brain from blue light exposure. When using a computer, I maintain good posture and rotate between a kneeling chair, regular chair with a lumbar support, and standing desk.
I mostly avoid excessively sugary, spicy, and salty foods along with red meat and have adopted a more neutral diet. I also eat about 80% of my food raw now which also helps my transient and occasional acid reflux. Only meats, fish, and eggs are cooked and I opt to boil rather than fry. Raw vegetables are also steamed occasionally. I also abstain from alcohol and tobacco.
Positive thinking and retaining some sense of humor will go a long way to help with sleep also.
With a sleep hygiene plan, develop one and stick to it. Be consistent. After a couple of weeks, it will all seem involuntary and routine.
That is all for now. Wishing everyone luck with their sleep troubles and hopefully you find one bit of useful and beneficial of information in what is discussed above that will help treat and/or deal with their tinnitus
All the best,
-Oceanofsound26
I am now wrapping up Month 3 of my treatment plan for tinnitus likely caused by TMJ/Bruxism and associated Musculoskeletal Misalignment and Neuromuscular Imbalance. Several people have expressed interest in my treatment plan and learning more about it. I have achieved much relief with this treatment plan thus far, and its first priority and highest tenant is achieving better sleep. I am a innately curious and mildly obsessive Oceanographer and Physical Scientist who employs a holistic and systematic approach to most things including my tinnitus treatment; an example of which is demonstrated below. From my investigations, this seems to be ideal approach to perform in a nested and iterative manner for the diagnosis and treatment of tinnitus. When trying to achieve better sleep, it is important to understand cause-and-effect relationships and distinguish between upstream (primary/causes) and downstream (secondary/symptoms) when it comes to disentangling your own sleep issues and your own tinnitus diagnosis and treatment. A compilation of my notes, recommendations, and specific details of their implementation for my specific case are included below. Hopefully, at least one other person will find some relief from their tinnitus using some of the recommendations I put forward in their own journeys with this horrid condition or at least will be in a better condition to deal with it a daily basis because they are getting more higher-quality sleep.
Educate Yourself About Sleep
@boliston suggested this book in an earlier thread which I bought and read which has helped with my sleep issues - https://www.amazon.com/Sleep-Solution-Why-Your-Broken/dp/0399583602. Also I subscribed to Dr. Michael Breus's weekly email list here - https://thesleepdoctor.com/. Ignore all of the products he endorses and tries to push on his subscribers. Regardless, this has led me to a lot of useful information (including the attached sleep guide), free sleep courses, and podcasts that have helped since my tinnitus onset in July 2019. Several of my work colleagues with tinnitus listen to these podcasts at night which help them drift off to sleep - https://www.sleepwithmepodcast.com/. The host basically rabbles on about useless stuff that is so boring it puts people to sleep. It works so well, he actually holds live events for people to attend to catch some Zzzs (see below video). It does not work for me, but may work for others.
Track Your Sleep to Increase Sleep Awareness & Understanding
I started tracking my sleep which helped me understand my sleep fragmentation and architecture and develop my sleep strategies that I employ at present. I use this - https://www.amazon.com/Withings-Nok...&s=hpc&sprefix=withings,stripbooks,329&sr=1-3. Others devices include the Dreem 2 Headband - https://dreem.com/en - and the Oura Ring - https://ouraring.com/ - that @Phat Tuna has had some success with. If your inability to sleep stems from stress or anxiety, some device like those listed above help improve sleep awareness which is generally one of the first steps on the road to understanding and overcoming any issue. I stressed most about sleep itself and dreaded the when the time came to fall asleep. Now that I track my sleep, I stress a lot less about it and sleep better. Pairing a sleep journal with a sleep-tracking device can help you validate what is working and what is not over time.
On a normal 8-hour night, I strive for 20-25% (90-120 minutes) REM sleep (helps with emotional processing and memory consolidation; the less REM sleep I get, the more irritated I am and the more my tinnitus bothers me), 25-33% (120-180 minutes) Deep Sleep (body heals, fight inflammation, restore immune system, etc...; the less deep sleep I get, the more sore and fatigued I feel in the morning), and the remainder Light Sleep. I have pretty good attainment for these goals at present. If you sleep a lot but do not feel refreshed upon waking up, chances are you are stuck in the Light Sleep phase, your sleep is fragmented, or you may have a pre-existing sleep disorder.
Make Your Sleep Space into a Comfortable Space
Make sure you are comfortable in bed. Get a comfortable mattress or mattress topper that is optimized for your sleeping style and preferred sleep position (https://www.onhealth.com/content/1/best_sleeping_positions_sleep) and try a weighted blanket if necessary over a conventional comforter. Set the temperature to a comfortable one; some like it warmer and some like it cooler. Find the one that works for you. I also like to have air circulating when I sleep so I run a ceiling fan or tower fan on a lower setting at night and run a HEPA Air Filter as well. This is not a complete list. Considerable what a comfortable sleep space is oo you and create it. If you are not comfortable in bed, you won't be able to relax.
Practice Good Sleep Posture
Be mindful of your sleep posture. Try to keep your spine in a neutral position. Invest in a cervical neck pillow for back and/or side sleeping and consider using a lumbar support pillow. My recommendations for back sleepers - https://www.amazon.com/YourFacePill...ds=my+face+sleep+pillow&qid=1579936156&sr=8-4 - and for slide sleepers - https://www.amazon.com/Natures-Gues...ical+neck+pillow&qid=1579936247&s=hpc&sr=1-17 or https://infinitemoon.com/product/the-curve/. I rotate between these three pillows for sleep. It is good to have a pillow that is the right height for your neck depending on your preferred sleeping position(s) - https://www.spine-health.com/wellness/sleep/pillow-support-and-comfort, so purchasing a pillow you can add or remove fill to and adjust pillow height is a good approach. The human neck curves slightly forward (to sustain the weight of the head when upright), and it's important to maintain this curve when in a resting position and take care not to hyper-extend forward neck curvature when sleeping. Sleeping with the neck in a forward-flexed position can trigger or worsen musculoskeletal misalignment, cause neck and back pain, worsen sleep disordered breathing due to narrowing the airway, and trigger bruxism. I noticed this was part of my default sleep posture and now set my pillow further back to keep my head over my shoulders where it belongs when sleeping on my side.
Treat Bruxism and Teeth Clenching/Grinding
If you suffer from bruxism, raise the temperature or try sleeping with a humidifier. Incorporate mindfulness or meditation as part of your sleep strategies to relieve stress before bed. Use a night guard to reduce the strain of grinding and clenching on your teeth. Invest in a TMJ orthotic to treat your bruxism. My orthotic keeps my jaw in a relaxed position, transfers the strain of clenching and grinding from my molars to my front teeth, and prevents my lower jaw from shifting backward; the latter two can trigger or worsen sleep disordered breathing due to narrowing or collapsing of the airway. Sleep with your mouth taped shut (I use this - https://www.amazon.com/Sleep-Strips...ywords=sleep+mouth+tape&qid=1579937428&sr=8-4 - to facilitate and encourage nose breathing to reduce prevalence of mouth breathing which can in turn in trigger bruxism and teeth grinding and clenching. When applying the tape, curve your lips inward which will keep upper and lower jaw slightly apart and help bruxism, grinding, and clenching further. Try using something like a Breathe Right Nasal Strip (https://www.amazon.com/Breathe-Right-Snoring-Drug-Free-Sensitive/dp/B001G7QPX2) to keep your nasal passages open, minimize chances of nasal valve collapse, improve nose breathing, and reduce prevalence of mouth breathing that can trigger bruxism. I have a slightly deviated septum so I use these every night. Try to treat your bruxism, clenching, and grinding early on to prevent further issues down the road.
Normalize & Manage Stress Hormone Levels
Consider your cortisol, adrenaline, and norepinethrine (stress hormone) levels and their diel variability. I only focused on cortisol for my purposes (more info on cortisol - https://www.webmd.com/a-to-z-guides/what-is-cortisol#1) which is something that helps control sleep-wake cycles. Cortisol is produced and released by the adrenal glands. Sustained and chronic long-term stress can exhaust your adrenal glands. I am scientist working in government and academia with two advanced degrees who needs to publish and secure funding to continue my research so I fit that description. This led to me Adrenal Fatigue Syndrome (AFS) which conventional medical docs cannot come to a consensus on whether or not it is a real condition. Naturopathic docs and folks working in alternative medicine definitely agree it is a real condition. More info on AFS - https://www.annelemonswellness.com/blog-1/2017/12/31/adrenal-fatigue-what-is-it-and-how-do-i-fix-it - and a two good book I bought and read - https://www.amazon.com/Adrenal-Fati...yndrome&qid=1579463404&sr=8-4&tag=tinntalk-20 and https://www.amazon.com/Adrenal-Fatigue-Century-Stress-Syndrome/dp/1890572152. Cortisol should be highest in the morning when you wake up and lowest when you go to bed at night. Depending how stressed you are and if you have AFS, cortisol can be chronically high, chronically low, and/or out-of-phase with your circadian rhythm. For me, cortisol levels were always on the higher end and roughly 3 hours of out phase with the nominal normal times I try to go to sleep at night and wake up in the morning. I currently live on the US West Coast but spent several years on the US East Coast, and due to poor sleep hygiene, prolonged computer use, or whatever reason, my circadian rhythm defaulted to US East Coast time. Once you understand how cortisol is changing with time of day, it may offer hope for addressing part of your sleep issues and possibly have a positive influence on your tinnitus or at least to improve sleep to better deal with it on a daily basis. My treatment was very conservative and included daily exercise and meditation to relieve stress, and practicing good sleep hygiene and syncing circadian rhythm with my diel cortisol variability to improve sleep and slowly move it from US East Coast to US West Coast Time (still working on this part). I drink tea containing herbs with adaptogenic properties like holy ginger, rooibos, and ashwagandha at different times of day that help raise cortisol levels if they are too low or lower them if they are too high throughout the day as well to help normalize my cortisol levels and reprogram my diel cortisol cycles. If interested in exploring this treatment pathway for your sleep problems, seek out an Endocrinologist who ascribes to AFS and/or similar conditions or a Naturopathic Doctor. LESS CONSERVATIVE CORTISOL SUPPRESSION & CONTROL TREATMENTS ARE VERY CONTROVERSIAL AND DANGEROUS IF NOT DONE PROPERLY. DO NOT SELF-DIAGNOSE AND PURSUE ANY SUCH TREATMENTS FOR THIS ON YOUR OWN.
Exercise
There are several benefits to regular exercise which I will not re-state here. For me exercise helps relieve stress and manage my cortisol levels which has the downstream effect of improving my sleep. I also mention this because if you have suspect you have AFS or stress hormone regulation issues, be conservative with your exercise and start slow. I went from walking at a brisk pace for 45 minutes 5x a week to interval training alternating between walking for 0.5 miles and running for 0.5 miles for 45 minutes 5x a week for one week with no transition period and was out of commission with chronically fatigued legs for about two weeks before I resumed my walking routine.
Boost & Expedite Sleep's Natural Restorative Functions at Night
While you sleep, your body heals, fights inflammation, sustains proper bone metabolism, and restores your immune system along with several other important restorative tasks overnight. @engineerLA postulated that inflammation plays a part in most people's tinnitus onset and progression, and I tend to agree with this assertion. In my case, I had inflammation in my temporomandibular joints, my sinuses, and probably my Eustachian Tubes as well. He put forward several suggestions for fighting inflammation in this thread - https://www.tinnitustalk.com/thread...-—-new-protocols-and-supplements-to-try.6514/. I perform several of his suggestions every morning after I wake up and before going to bed at night. Sinus irrigation and use of saline nasal spray are especially useful for me. It is my opinion that taking steps on your own to reduce inflammation and promote healing will further quicken and improve the effectiveness of good sleep's restorative powers; this is however purely based on my own observations and the improvements I have seen in my own tinnitus. I would take this one step further and encourage others to perform necessary tasks to combat muscle soreness and fatigue to quicken recovery and improve sleep as pain is also something that interrupt sleep. I will leave this open-ended for others to reflect on based on their own health. In my case, there is a battery of gentle stretches and releases I perform every night before going to bed to stretch and lengthen muscles that chronically contract during the day and decompress and work out knots of tension elsewhere. I continue to have problems with fatigued legs on and off, and I use a massage gun (https://www.amazon.com/Professional..._6?keywords=massage+gun&qid=1579945380&sr=8-6) to stimulate the muscles in my legs, increase delivery of oxygenated blood to the muscles, and flush out any lactic acid that has built up in the muscles over time before bed. Be sure to hydrate after doing something like this. I have noticed gradual improvements with my fatigued legs over time since doing this and achieving better sleep. I also use the massage gun on important postural muscles as well.
Detect & Treat Sleep-Disordered Breathing
Sleep-disordered breathing manifests as partial collapse of the airway (hypopnea) or full collapse of the airway (apnea) while sleeping and is measured using the Apnea-Hypopnea Index (AHI - https://www.sleephealth.org/ufaqs/what-is-ahi-represent/). Its most serious forms are Obstructive and Central Sleep Apnea; both of which can cause tinnitus as well thru several different pathways but not limited to triggering bruxism, suppression of blood oxygen levels, and reduction in the delivery of oxygenated blood to ears. Certain things predispose individuals to developing sleep apnea like high stress, obesity, and craniocervical misalignment (e.g., forward head posture). If sleep-disordered breathing is suspected, please consult your doctor and get a referral to a sleep doc and schedule a sleep study to help get a definitive diagnosis. Then, discuss sleep apnea treatment options with your docs like APAP/CPAP, orthotics, and lifestyle changes to name a few. My sleep tracking device also tracks sleep-disordered breathing (which I had) and detected several periods at night early on when I would wake up at night without knowing it (would not remember in the morning) before returning to sleep shortly thereafter. Both are hallmarks of sleep apnea. I took this data and information to my doctors who referred me to a sleep doc who then ordered a polysomnography test (another name for a lab sleep study). I was diagnosed with mild sleep apnea. I now take steps to address things like my bruxism and forward head posture when sleeping using those approaches detailed above, use a TMJ orthotic that doubles as a more conservative sleep apnea orthotic, and made several lifestyle changes that have helped me go from 235 to 195 lbs at 6'2" since my tinnitus onset in July 2019. My sleep tracking device now captures fewer sleep-disturbed breathing events and periods when I wake up at night without knowing it which has reduced sleep fragmentation and improved sleep quality and duration.
Develop and Maintain Good Sleep Hygiene
Sleep hygiene is listed last because considerations for sleep strategies from the above items are ultimately what will end up comprising your sleep hygiene plan. The few sleep specialists I have spoken with all say that your sleep hygiene plan should begin after leaving work. I tend to disagree and consider my sleep hygiene plan to start upon waking in the morning. Most important for good sleep hygiene is to go to sleep and wake up at the same times each day and not to deviate more than 60-90 minutes from those times you adhere to during the week on the weekends so try to resist the urge to sleep in. Also, be mindful of the fact that just because you spent 8 hours in bed does not necessarily mean you slept for 8 hours; another thing sleep tracking can help with. A rough example of my sleep hygiene plan when not at sea with accompanying info below to help with designing your own -
Mornings - 0615 to 1200 - Wake up at 0615. 45-60 minutes of Cardio 5x a week and stretches other 2x a week. Breakfast with tea with one tea bag of each - https://www.amazon.com/Yogi-Tea-Blu...keywords=yogi+slim+life&qid=1579948049&sr=8-3 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for caffeine and cortisol control. Transit to work. Work between 0845 and 1200.
Afternoons - 1200 to 1745 - 1200-1300 - 20 minutes of stretching, 10 minute shower, 30 minute Lunch with tea - https://www.amazon.com/Yogi-Tea-Tan...rds=yogi+stress+relief&qid=1579948366&sr=8-14 - for stress relief and cortisol control. Work between 1300 and 1745.
Evenings - 1745-2130 - Transit home from work. On the way home I take 1000 mg each of Taurine and NAC on a daily basis on a relatively empty stomach to calm my mind that is always thinking. Dinner at 1830 followed by a anti-inflammatory smoothie. I usually follow this recipe - https://ohmyveggies.com/kale-smoothie/. I usually add fresh pineapple, turmeric extract, and sometimes mango as well. I am still fine-tuning my own version of this smoothie. My latest versions of the smoothie contains almond milk, kale, ginger, cinnamon, pineapple, and turmeric; all of which are anti-inflammatories and the smoothie is not overly sweet. In my case, this really further calms the nerves and helps reduce stress in the evenings. After dinner, I do my 30 minutes of light stretches which are not enough to elevate my heart rate before bed. Before showering, I take 1 mg of melatonin and 1000 mg of L- Tryptophan (be sure to take these types of supps 60-90 minutes the time you want to fall asleep). After showering I irrigate my sinuses and drink more tea - one tea bag of each https://www.amazon.com/Celestial-Se...keywords=sleepytime+tea&qid=1579949556&sr=8-5 and https://www.amazon.com/Tulsi-Origin..._1_4?keywords=tulsi+tea&qid=1579948091&sr=8-4 - for stress relief and lower cortisol levels to prepare for sleep. I am usually in bed by 2045. I am usually asleep between by 2130. Between 2045 and 2130, I usually decompress in some way whether it is watching Netflix, reading, using this facial massager to relax - https://www.amazon.com/gp/product/B07Z7P7FJX/ref=ppx_yo_dt_b_asin_title_o06_s00?ie=UTF8&psc=1 - which is extremely useful if have TMJ and sore mastication muscles around your temples, or performing meditation/deep breathing exercises using my BrainTap/Sleep RX combo (https://braintap.com/sleep-rx-bundle/). I do not like any noise when I sleep so I wear soft foam earplugs to block out the louder noises.
On weekends, my times for going to bed and waking up usually move later by 60-90 minutes and learning to do nothing on weekends is essential for learning to decompress and retain your sanity when you have tinnitus.
Remember not to eat anything heavy at least 2 hours before bed and avoid strenuous exercise before bed as well.
I limit my computer use on weekends and days off between 1000 and 1800 only (except for right now) and do not use my computers outside of normal business hours on weekdays. When I leave work, I am done for the day. I also wear blue light blocking glasses whenever using a PC now to combat suppression of melatonin production in the brain from blue light exposure. When using a computer, I maintain good posture and rotate between a kneeling chair, regular chair with a lumbar support, and standing desk.
I mostly avoid excessively sugary, spicy, and salty foods along with red meat and have adopted a more neutral diet. I also eat about 80% of my food raw now which also helps my transient and occasional acid reflux. Only meats, fish, and eggs are cooked and I opt to boil rather than fry. Raw vegetables are also steamed occasionally. I also abstain from alcohol and tobacco.
Positive thinking and retaining some sense of humor will go a long way to help with sleep also.
With a sleep hygiene plan, develop one and stick to it. Be consistent. After a couple of weeks, it will all seem involuntary and routine.
That is all for now. Wishing everyone luck with their sleep troubles and hopefully you find one bit of useful and beneficial of information in what is discussed above that will help treat and/or deal with their tinnitus
All the best,
-Oceanofsound26
Member
