What Anti-Anxiety Meds Can I Take That Will Not Worsen Tinnitus?

[Dale1234]

Dear Dr. Nagler,

I would appreciate your valued input to my situation. I will describe everything I know/have learned. I'm 34 years old, active, and normal weight, no current stresses in my life for years.

I have sleep maintenance insomnia, I wake after 4hrs sleep and very often unable to return to sleep. Initial sleep onset is ok. I had a sleep lab, no OSA's etc. Have had this for 3.5 years. during a very high period of stress (CBT-i) sleep restriction, my anxiety went through the roof and gave myself tinnitus. Both ears, central, 4 kHz constant tone. Usually slightly quieter in the morning and gets louder as the day progresses.

To try to resolve my sleep issue, I have done all CBT-i recommendations more than once, only 7-8hrs in bed, good sleep hygiene etc. When I sleep well (very very rarely) I feel normal and myself. I need at least >6 hours to feel ok.

I found deep breathing before sleep helps a little. Also the supplement L-theanine helps too. I guess these help by stimulating GABA.

I am quite sensitive to stresses, any exam, test, a new drug... and I'll not sleep for hours, my heart races away. I definitely have some sort of GAD.

To treat this I have tried:

Citalopram (20mg), Amitriptyline, Mirtazapine (7.5mg), Aripiprazole (1mg)

However, each of them I found after only the first time of taking the med, the loudness of the tinnitus increased and I stopped with the exception of Pregabalin. However after some reading I have concerns about Pregabalin as a treatment option for insomnia and GAD, considerable withdrawal issues, links to hearing loss etc.

Both the Aripiprazole and Pregabalin gave some improvement in sleep, I still woke at the same sort of time, when I returned to bed I was able to get 'light' dreaming sleep (as I understand it not the type of sleep I really want). The Aripiprazole anti-anxiety effect didn't seem to be very strong. The Citalopram anti-anxiety effect was almost too strong for me, I had this separation feeling.

Is there anything else you can suggest to try?

My GP and Psychiatrist are at a loss and do not have the expertise in insomnia, anxiety and tinnitus combination! Haha.

Thank you,
Dale

 

[Dr. Nagler]

Hello @Dale1234. And thank you for your question.

Goodness, though, there are so many moving parts. You could lose sleep just thinking about it!

Perhaps let's try the KISS principle. Keep It Simple Stupid. [It's what I tell myself as I start each day.]

First of all, none of the drugs used for anxiety or insomnia causes auditory damage. True, some have the potential to temporarily aggravate tinnitus in some cases, but none causes actual damage, which means that any exacerbation of tinnitus you feel might be due to one of the drugs can be expected to resolve within a few days of cessation if the drug. And if it doesn't, then the culprit was likely not the drug in the first place.

Second, it's very hard to tell after just one or two doses whether an exacerbation is due to a drug, due to coincidence, due to some other factor, or due to your anxiety about the possibility that the drug in question might aggravate your tinnitus. So if you are going to go the pharmacological route, you have to give the drug in question a fair trial.

And third, it is far more important to get enough sleep and wake up refreshed than it is to actually sleep through the night. Sure, it is preferable to sleep through the night so you get adequate REM sleep, but it is not a do-or-die type of thing. So that being said, in my opinion for a person in your shoes it is crucial that at least for the next six to eight weeks (until you get into a rhythm), you get up, get out of bed, and physically start your day at the same tine each and every day (weekday, weekend, and holiday) regardless of what time you go to bed the night before - and that you force yourself not to nap during the day regardless of how much you might want to. Now this is not a forever thing, but as I see it it is essential to jump start things.

So there ya go. Hope it helps.

Stephen M. Nagler, M.D.