Tinnitus is a disruptive condition that causes ringing and other sounds in your ears that no one else can hear. It's estimated that at least 15% of the world's population struggles with tinnitus. As you can imagine, loud ringing, throbbing, and whooshing sounds make things like sleeping severely difficult. The good news? There are promising treatments and therapies you can use to help manage tinnitus.

Using external sounds to help manage the ringing in your ears is one strategy that might help you get relief and sleep better. From customized sound therapy to white noise machines, keep reading to learn more about tinnitus and how sound therapy may be able to help you.

What Is Tinnitus?

Tinnitus is a constant sound in your ears or a perception of sound. Tinnitus itself isn't a disease but a condition. But instead, a sign that something's wrong with your auditory system. In fact, according to Harvard Health, anyone that's been exposed to deafening noises (like going to a concert) has had tinnitus briefly. When the sounds last more than six months, it's diagnosed as chronic tinnitus.

Many people think tinnitus starts in the ear, but the source is in your brain. Scientists believe that tinnitus comes from your brain cells trying to make sense of what you hear in your ears. However, researchers still aren't sure why or how the brain creates the perception of sound. Some people think it may be your brain's way of compensating for the loss of sensory hair cells in your ear (that sense sound). By turning up the sensitivity of the sound, you also become overly sensitive to loud noises. Another theory is that your neural circuits could be out of balance.

In the U.S. alone, over 50 million people have some form of tinnitus. 20 million have moderate chronic tinnitus, while 2 million suffer from extremely debilitating cases.

Causes of tinnitus

Tinnitus can also result from different health conditions outlined by the National Institute on Deafness and Other Communication Disorders.

• Ear or sinus infection
• Noise-induced hearing loss (typical for people who work in noisy environments like construction workers and musicians)
• Hormonal changes in women
• Thyroid abnormalities
• The first sign of hearing loss in older people
• Side effects of medications

Tinnitus can also be a comorbidity of other conditions like hearing loss, mental health problems (like anxiety and depression), sleep disorders, and more. Some people may try to directly treat those conditions first to see if their tinnitus goes away as their other condition improves.

Tinnitus disorder is when someone also experiences states like emotional distress and cognitive dysfunction (which can lead to behavioral changes) with tinnitus symptoms.

According to the American Tinnitus Association, certain groups are more susceptible to tinnitus.

• Males are more likely than females (possibly due to the high number of male workers in loud environments like construction)
• Tinnitus is more common in older populations
• Active military personnel and veterans
• Musicians and music fans
• Caucasians are more likely to get tinnitus
• People with a history of depression, anxiety, and obsessive-compulsive disorder (according to the ATA, these will not cause tinnitus but can make symptoms worse)

Subjective tinnitus vs. objective tinnitus

The vast majority of tinnitus cases are subjective, meaning only you can hear the sounds. Tinnitus is rarely objective, meaning your doctor can also hear the sound. Usually, objective tinnitus is caused by some blood vessel or muscle disorder. Objective tinnitus makes up less than one percent of tinnitus cases.

Pulsatile tinnitus

You may have also heard of a rare type of tinnitus called Pulsatile tinnitus. Pulsatile tinnitus patients usually hear a rhythmic throbbing, thumping, or whooshing. It's also been described as hearing a heartbeat in your ear.

The cause of pulsatile tinnitus can either be minor or a sign of a more serious underlying health condition like atherosclerosis, blood vessel disorder, malformations, high blood pressure, head or neck tumors, anemia, head trauma, and more. It's also more common in older people.

What are the symptoms of tinnitus?

Ringing is a typical symptom, but you may also hear buzzing, hissing, clicking, or a roaring sound like ocean waves. The pitch varies so that you may experience high-pitched whining or deeper, low sounds. The sounds can also be seen coming from one ear or both.

You may have it in one or both ears, and it may be mild and quiet or loud and highly disruptive. Most commonly, the condition is triggered by age-related hearing loss, repeated exposure to loud noises, or ear wax blockages. Sometimes a medication can cause tinnitus by damaging auditory nerves.

So what's the big deal? We hear sounds all the time; what makes these different? Beyond the annoyance of whirring sounds disrupting your day, these sounds can be debilitating, making it hard to complete your daily life and get basic tasks done. People with tinnitus are more likely to experience depression and anxiety, have issues sleeping, and can become socially isolated. People with tinnitus have also become more fatigued, possibly due to loss of sleep caused by tinnitus. Or it could be the simple fact that trying to live a "normal" life with a debilitating condition is exhausting. In this way, tinnitus becomes more than just a physical health issue but a mental health one.

How Tinnitus Impacts Sleep

It's not surprising that loud, annoying sounds throughout the night make it hard to sleep. Tinnitus is associated with difficulty falling asleep and maintaining sleep, as well as perceived overall poor quality of sleep. One study found that in a group of patients with tinnitus, half experienced poor quality sleep. The rate is even higher in patients with more intense tinnitus. For example, a survey of more than 14,000 patients (aged 45 to 79)with loud tinnitus were three times more likely to suffer from insomnia. Another study followed patients with long-lasting tinnitus (over 6 months). They found that 77% of people experienced more delayed sleep, early morning awakenings, morning fatigue, and chronic fatigue than those without tinnitus.

When you fall asleep, your brain can block out external stimuli, for the most part (like the sound of a TV). But researchers still don't know much about how this happens. We know that during the non-dreaming stages of your sleep, your brainwaves move slowly. A team at the University of Oxford suggested (along with other findings on tinnitus) that when your brain wave activity is slower, tinnitus signals in your brain may surge, which would wake you up.

Treating Tinnitus

Currently, scientists haven't found a definitive cure for tinnitus. The main goal is to find the right treatment for you that helps you manage and hopefully find relief from your tinnitus symptoms. Plenty of treatment options available can help people manage their condition and reduce the intensity of the sound. Here are some common types of treatments.

• Sound therapy (we'll get into these in just a minute)
• Behavioral therapy (like tinnitus retraining therapy, cognitive behavioral therapy, progressive tinnitus management, and more)
• Drug therapy
• TMJ treatments
• Taking care of your overall well-being
• Hearing aids

If tinnitus is bothering you to the point that your sleep (or any aspect of your day) is suffering, you should see your doctor. You'll get some relief if an underlying cause can be found and treated. Even if a cause, like age-related hearing loss, can't be found or treated, some therapies will help you cope.

How sound therapy helps treat tinnitus

If you have tinnitus, all you want is to eliminate those unwanted sounds. Adding more sound may seem counterintuitive, but it can help. Sound therapies are based on four different mechanisms that relieve tinnitus:

• External sounds can mask the sounds caused by tinnitus.
• External sounds can distract you from the tinnitus sounds.
• Sound therapy may help to habituate you to hear certain frequencies. This can make them seem like an unimportant sound and make it easier for you to go about your day.
• Neuromodulation uses sounds to turn down the activity of nerves that may be the cause of tinnitus.

Types of sound therapy for tinnitus

According to the American Tinnitus Association, people can use various devices, applications, and techniques to help combat tinnitus. Things like white noise machines are popular to help mask the sound of tinnitus. Nature sounds or other ambient-type sounds are also popular. Hearing aids are also seen as a tool for tinnitus as they can be a great distraction from the perception of the tinnitus sound.

Notched-music devices are similar to white noise machines. However, these medical-grade devices play custom sounds and frequencies generated by algorithms to fit the needs of each specific patient.

A big difference between notched-music devices and general white noise machines is that notched-music devices are usually only worn at specific times and can help relieve the intensity of tinnitus over time. White noise machines can be used at any time but are generally only known to be effective while you're listening to them or directly after.

Now combination devices also use both general and customized ongoing sounds to help patients. So far, combining integrated sound generators and hearing aids has been promising in helping patients manage their tinnitus, especially for people with hearing loss. Other tools that can be used to manage tinnitus include hearing aids, sounds, and sleep apps like BetterSleep.

It should be noted that for best results, it's recommended that sound devices are used in combination with patient counseling and education. Also, remember that there is no single perfect treatment that will work for everyone. It's essential to be open with your doctor and treatment team about what's working and what's not to find the best treatment option for you!

Your doctor or audiologist can help you try different devices and therapies to use sounds to combat tinnitus. But you may also want to try some nighttime tools for better sleep. The wide range of sounds available on BetterSleep provides options from white noise to city sounds and nature. Try some of these to find out which sounds and volumes relax your tinnitus and help you get to sleep.