I have tinnitus. Will I ever get to sleep? In a word, yes. Whilst many people with tinnitus have trouble sleeping, most don’t. There’s no reason why you too can’t sleep well. You might find it reassuring to know that most people who have tinnitus do not feel the need to attend tinnitus clinics since tinnitus doesn’t play an important part in their lives. Nonetheless, a lot of people do struggle with their tinnitus and do seek professional help to learn to live with it.

About half of the patients we see in our tinnitus clinic say they sleep well. This tells us that it is possible to sleep normally despite having tinnitus. In our experience it is usually not tinnitus itself that is the main factor in determining how well people sleep. Steven Wright, an American comedian and actor, said, “When I woke up this morning my girlfriend asked me, ‘Did you sleep good?’ I said ‘No, I made a few mistakes.’” In this chapter we want to help you avoid some of the common mistakes on the journey to a good nights’ sleep.

Everyone suffers from episodes of bad sleep from time to time. It’s easy to see how sleep might be disrupted when something significant happens in your life, like the onset of tinnitus. But why does the problem persist for some people and not for others? It may seem surprising, but those that say their tinnitus affects their sleep don’t have different or easier tinnitus from those who do sleep well with tinnitus. This is good news because it means that you can have tinnitus and sleep well. . .

What Does Normal Sleep Look Like?

Fiona, one of our patients, developed sleep problems after the onset of her tinnitus. She had difficulty going to sleep, woke up several times a night and had trouble getting back to sleep. She felt exhausted the next day and believed she didn’t function well. Like many other people, Fiona believed that a good night’s sleep involved a straight eight hours of uninterrupted oblivion followed by refreshed and alert wakefulness throughout the day. Let us consider how well this idea matches what is known about sleep.

Our sleep changes with age, so what’s normal when we’re 5 years old will be different when we are 12 and different again when we are 40 and 70. Sleeping is more complex than simply falling asleep and waking in the morning. Our sleep consists of repeating cycles of rapid eye movement (REM) and non-REM sleep; the latter is divided into stages 1, 2, 3, and 4, corresponding to increasing depth of sleep where 1 represents light sleep and 4 represents deep sleep. The cycles of REM and non-REM sleep last approximately 90 minutes but can vary normally from 70 to 120 minutes. This cycle repeats about four or five times a night in young adults. Babies generally have more REM sleep than adults and spend more time asleep overall than adults. It comes as a surprise to many people to learn that we routinely wake in the night as part of the pattern of sleep described above. As we age we have less deep sleep (stage 4) and tend to wake more often. The first episode of waking occurs after two to three hours of sleep. If all is well, we may be unaware of these awakenings and just roll over and return to sleep. After the first awakening, we get more REM sleep and less deep sleep for the remainder of the night. Young people may wake twice a night but older adults may wake as often as nine times a night. Older adults often experience their sleep as being light and fragmented in nature.