By Jordan Stern, MD
If you suffer from tinnitus, that constant ringing, buzzing, hissing, whistling, or other phantom noises in your ears, you know how maddening and disruptive it can be. While tinnitus is often associated with hearing loss from noise exposure or aging, there is another potential contributing factor you may not have considered - Sleep Apnea.
Sleep Apnea is a sleep disorder where breathing is briefly and repeatedly interrupted during sleep. These pauses in breathing cause drastic drops in oxygen levels and increased carbon dioxide levels in the blood. The body then rouses itself just enough to resume breathing, though you may not be consciously aware that you are waking up many times per night.
While Sleep Apnea is known to have major impacts like increasing risks for heart disease, high blood pressure, stroke, and other conditions, the connection to tinnitus is less obvious. However, research studies have found a link between the two conditions that is worth exploring.
The Low Oxygen Connection
The leading theory about why Sleep Apnea can contribute to tinnitus development or worsen existing tinnitus has to do with the periods of low oxygen levels (hypoxia) that occur with each apnea episode. This reduction in oxygen getting to the brain and inner ear is thought to injure the delicate hair cells of the inner ear that transmit sound signals to the brain.
Damage to these hair cells is one of the primary physiological sources of tinnitus. So the repetitive cycles of low oxygen during Sleep Apnea may progressively damage these hair cells over time, generating or exacerbating tinnitus symptoms.
The Inflammation Factor
Another way Sleep Apnea may increase tinnitus risk is through inflammation. The low oxygen and disrupted sleep from Sleep Apnea create systemic inflammation throughout the body, including in the sensitive inner ear region. This inflammation can also damage hair cells and hearing structures, making tinnitus more likely.
The excessive inflammation from Sleep Apnea may also make an existing case of tinnitus subjectively louder and more bothersome for the sufferer. While the sensations of tinnitus arise from problems with hair cells and hearing nerves, the parts of the brain that process and attach emotional significance to the sounds play a big role in how disruptive tinnitus feels.
The Pain and Concentration Connections
Living with chronic, unrefreshing sleep from Sleep Apnea can take a major psychological toll over time. The fatigue, daytime sleepiness, depression, anxiety, and lower quality of life from Sleep Apnea may make tinnitus seem louder and more unbearable than it would otherwise.
Sleep Apnea's disruption of sleep cycles also diminishes memory, focus, and concentration abilities. For people with tinnitus, these cognitive impacts can make it extremely difficult to push the phantom sounds to the background and ignore them.
Compounding Factors
In addition to directly contributing to tinnitus development and severity through hypoxia and inflammation pathways, Sleep Apnea's effects may also exacerbate other common tinnitus triggers like stress, anxiety, insomnia, and depression. These factors can create a vicious cycle of worsening symptoms for both conditions.
Does Treating Sleep Apnea Help Tinnitus?
While there is still a need for more research on the Sleep Apnea-tinnitus connection, initial studies indicate that using CPAP, oral device or other therapies to treat Sleep Apnea can provide some relief for tinnitus sufferers.
In one study, patients with both conditions who used CPAP therapy for three months experienced subjective improvements in tinnitus severity and loudness compared to a control group. Other studies found Sleep Apnea treatment reduced tinnitus intensity and helped patients better cope with the sounds.
Of course, results vary from individual to individual. But taking steps to identify and properly treat Sleep Apnea could provide a welcomed reprieve for some of the tens of millions of Americans plagued by chronic tinnitus.
The Bottom Line
The evidence continues to mount for a tangible connection between the snoring, disrupted sleep, and low oxygen levels of Sleep Apnea and the debilitating ringing, buzzing, and sound distortions of tinnitus. If you have tinnitus, getting evaluated for Sleep Apnea is a reasonable step that could potentially improve both conditions simultaneously.
Medical Research
Association of Sleep Characteristics with Tinnitus and Hearing Loss. Feb. 2024 National Library of Medicine.
Negative sleep characteristics (less hours of sleep, diagnosis of a sleep disorder, trouble sleeping, or OSA symptoms) were not associated with audiometry-measured hearing loss in multivariable models adjusted for demographics and comorbidities but were significantly associated with bothersome tinnitus. This association remained significant without substantial attenuation in multivariable models additionally adjusting for hearing levels.
Negative sleep characteristics were associated with tinnitus while there was no clinically meaningful association between sleep and hearing loss. Our findings suggest that the relationship between poor sleep and tinnitus is likely contributed by central processes without a major role of mediation via the peripheral auditory system.
Obstructive Sleep Apnea and Auditory Dysfunction—Does Snoring Sound Play a Role? Oct. 2024 National Library of Medicine
In this study, we tried to clarify the relationship between OSA and auditory dysfunction. We found that OSA brought about more tinnitus than hearing loss, and those patients with excessive daytime sleepiness had a higher risk of tinnitus. Furthermore, high-frequency snoring sounds, which are transmitted to the ear canal, may have a role in contributing to tinnitus.
A preliminary study on the correlation between obstructive Sleep Apnea hypopnea syndrome and chronic tinnitus, 2018 National Library of Medicine
More than 1/3 of patients with OSAHS had chronic tinnitus, both age and hearing loss maybe the risk factors of tinnitus in patients with OSAHS, but neither BMI nor the lowest SPO₂ was clearly related to chronic tinnitus.
Tinnitus and Sleep Apnea: How Are They Related? 2024 Healthline
Treating Sleep Apnea can sometimes help relieve symptoms of tinnitus. Physical activity and quitting smoking may help, as well as CPAP machines or oral appliances.
FAQs
A second visit is scheduled to review the results of your sleep test and discuss treatment options. If you choose treatment with an oral appliance, you will either see our sleep apnea dentist for a digital scan of your teeth or we’ll ship a home impression (mold) kit. If you choose treatment with CPAP, we’ll arrange for a CPAP company to deliver the equipment to your home. Insurance usually covers this treatment, and the CPAP provider will verify coverage for you. Once you’ve received the CPAP, you’ll make an appointment with our sleep specialist to review the use and efficacy of the treatment.
Insurance coverage for oral appliance treatment requires a diagnosis of sleep apnea and symptoms other than just snoring. Our Billing Team gets a pre-authorization for in-network coverage of the treatment and communicates with you regarding any financial responsibility, which may include copays, coinsurance, and deductibles, prior to ordering the appliance. We’ll then ship or email the impressions to the dental lab or manufacturer to make your appliance. Blue Cross and Medicare limit the types of appliances they will pay for. If you want a different type of appliance, not covered by Blue Cross or Medicare, this becomes a self-pay service.
We’ve made thousands of oral appliances for our patients, and we work with many manufacturers and dental labs including: Panthera, Prosomnus, Glidewell, Whole You, Somnomed, Dynaflex, Oventus, and others. We’ll ship the appliance to your home and schedule a virtual fitting session with our staff to instruct you on its use and care. If you require in person adjustments, we’ll schedule a visit in one of our facilities. The time it takes for you to receive your oral appliance depends on how quickly your insurance provides a pre-authorization, and how quickly the lab manufactures the appliance. The process can take as little as 2 weeks, and as long as 3 months or more for some payers.
We’ll ship a home sleep test usually 4 to 8 weeks after you’ve started using the appliance and have adjusted it according to the quality of your sleep. We suggest using the "Snore Lab" app on your smartphone, in addition to observations from your bed partner, and your overall daytime function and energy levels; to help you titrate (adjust) your appliance. Virtual or in person visits are scheduled every 6-12 months thereafter to assure proper efficacy of the treatment, and proper fit of the appliance.
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