First, there are many, many causes of tinnitus, most of which seem to have little or no "medical" significance in the sense of your overall health. The biggest cause of tinnitus in the US is repeated exposure to loud noises by the way. And noises loud enough to cause problems with tinnitus may not strike people as being "Loud" because we are so accustomed to a rather loud background noise environment---particularly if we live in a urban area.
I've had tinnitus for years. And migraines. And in the last few years, I've developed vertigo, which has now been diagnosed as "migraine related vertigo." So the things that I say below are simply based on my own experiences and they may or may not work for you. But I offer them as things you might try.
My history: I have been sleeping with ear plugs for 20 years. I am a very light sleeper and the slightest whisper will wake me up. I have also suffered from tinnitus since childhood. Ten years ago I suffered a 'bout of strep throat which migrated to my right eustachian tube and I've had problems with that ever since. And sleeping with earplugs seems to make it worse, stuffiness, pain, irritation.
Earplugs definitely are the reason your tinnitus is worse when you've got the earplugs in you ears. Here's why: Tinnitus is essentially caused by your middle and inner ear and brain deciding there is NOISE present, when in fact there is no noise present. It is often there (in the background) ALL the time, but as long as there is REAL noise, the brain filters out the tinnitus---i.e. the tinnitus fades into the background and is not as noticeable. But when you put the earplugs in, you block out all the REAL noise and hence there is nothing the brain can use to filter out the tinnitus. So the tinnitus is interpreted by the brain as REAL noise and it becomes very noticeable---sometimes to the point of being painfully loud for some folks.
The standard "treatment" for tinnitus is "Avoid ABSOLUTE silence
". Literally---avoid silence. Many tinnitus sufferers find that having some low volume white noise ALWAYS present in the background is all that's needed to take the edge off the tinnitus. So you might want to try a white noise machine both during the day AND at night when you are trying to get to sleep. It's important, however, to realize that the VOLUME of the white noise needs to be very soft: You do NOT want to turn the volume up so that it seems louder than the tinnitus---that too will likely make the tinnitus worse because LOUD noises damage the middle and inner ear and are a frequent cause of tinnitus. Rather, you want the white noise volume to be very quiet---quieter than the tinnitus actually. But just that wee bit of white noise at a barely audible level lets the brain start filtering out the tinnitus----i.e. "ignoring it" because there is some real noise competing with the tinnitus.
Nature sounds cds by the way are very useful for trying to deal with tinnitus. As are very quiet fans---if the airflow bothers you point the fan so that it doesn't blow directly on you. An AM radio turned on to a part of the band where there is NO station can also be used---if the volume is kept really, really low---just barely on the threshold of your hearing. If you must use music, the volume has to be VERY, VERY low---again just barely on the threshold of you hearing.
Now I know this idea of using white noise to fight the tinnitus SOUNDS counter intuitive to you because you go on to write:
I continue to sleep with the earplugs because without them it takes hours to fall asleep and as I said before, I am awakened by noise very easily.
So the questions that I have are these:
- What kinds of noises are present in your sleeping environment on a REGULAR basis?
- Other than earplugs what have you attempted to do in order to muffle or block out the noises that are particularly irritating?
- Are you sure the tinnitus itself is not what's waking you up?
I ask because I really think you need to start weaning yourself from using the earplugs every night and sometimes during the day when you are NOT being exposed to loud noises.
So where would I start if I were you? Well, first I'd start by trying some white noise CD's and making sure that the windows are CLOSED at night. Heavy drapes and a decent rug will also help muffle the level of noise in your bedroom. Shut the door to the bedroom to minimize hearing creaks from the rest of your house or apartment at night.
Then I'd tackle the "it takes hours to fall asleep without earplugs" problem.
- First: Go to bed ONLY when you are SLEEPY and learn to distinguish being sleepy from being tired or exhausted.
- Second, make sure you CANNOT see the clock when you are in bed. You can start by simply turning the clock so it faces the other way. But if you find you keep turning it around to look at it because you feel like you've been lying awake for hours, you will need to move the clock away from the bed so you can't keep looking at the clock---that "look at the clock" behavior pattern FEEDS the problem with falling asleep in a timely fashion.
- Third, when you think you've been lying in bed for more than 30 minutes and it's clear you are no longer sleepy enough to get to sleep soon, get out of the bed and do something soothing and relaxing in a DIFFERENT room for a few minutes until you start to feel sleepy again. It might help to do a bit of (light, boring) reading. Or maybe a nice cup of of warm milk or an herbal "sleepy time tea" will help. But don't get on the computer and web browse. And don't watch TV. I find listening to quiet music in my living room in the semi-dark helps.
- Fourth, kick the electronic gadgets out of the bedroom. That means "no tv, no computer, no cell phone accessible from the bed, etc." You want to reserve your bed for sleep and nothing but sleep (and sex).
I wake up with itchy ears which I attribute to the earplugs. I first read that my ear canals may need lubrication as the ear plugs wipe out the ear wax, plus I'm always using q-tips to scratch inside my ear canals (I know I shouldn't but sometimes I can't help it). Then I read it may be a fungus in my ear canal due to overuse of earplugs. I wear them when I read, to block out the noises in the house like the squawking bird, barking dog, bickering kids, neighbors yard equipment, etc.... So I started using tea tree oil and lavender oil. The drops seem to take the itching away for the day so I suppose I must develop a consistency when using them and not just wait until the itching starts again.
All this points to overuse
of the earplugs in my opinion. If you are worried about a fungal infection in you ears or excess wax and itching, you NEED to get to an ENT to discuss proper ear hygiene.
Also using the earplugs to block common background noises like "squawking birds, barking dogs, bickering kids, neighbors yard equipment" MAKES the tinnitus much, much WORSE. That is as long as these "blocked" noises are NOT right outside your window or in the very next room. And if it's difficult to concentrate with these common background noises, that's where the soft, white noise of your choice always being present in the background comes in: Use it to distract yourself from the irritating noises rather than trying to create pure silence through the earplugs. Remember: Complete and total silence makes the tinnitus WORSE by making it IMPOSSIBLE to ignore!
I am also renewing my Flonase prescription today for the post nasal drip that contributes to the ear issues.
In addition to the Flonase, you might also want to start using a neti pot or NeilMed Sinus Rinse Bottle once or twice a day to help clear those sinuses out. Neti pots and the Sinus Rinse Bottles really do work in reducing congestion substantially and they are nowhere near as uncomfortable as you might think they are.
I was diagnosed with restricted air flow-not sleep apnea (because I couldn't sleep during the sleep test, even with Ambien) in Jan '11. Fortunately, that was enough to prescribe CPAP with my insurance. I've been using CPAP for 2 months now and although I am sleeping better because of it, I have been noticing louder tinnitus. I used to be able to ignore it for the most part but now it's so loud I can't ignore it, at least not upon waking. It seems worse in the morning on nights that I sleep well with CPAP as I'm still adjusting to the whole new set-up and don't always sleep continuously through the night.
Please be aware of this (not very welcome) fact too: You may be noticing the CPAP noise and the sound of your own breathing and thinking of those as tinnitus
since you are sleeping with earplugs every night. The reason is this: Most of the noise of the machine itself is conducted through the hose and the sound of your breathing is often amplified by the mask and the hose and is also then conducted through the hose. The earplugs cannot
block this conducted noise: It gets into your middle and inner ears by traveling through the hose and your bedcovers and pillows and then into your head through your skull. Because the ambient noise conducted through the air has been blocked by the earplugs, the only REAL noise being detected by your ears is the conducted noise. And it can seem incredibly loud when you're lying there in bed trying to get to sleep.
The ONLY fix for this conducted noise problem is to ditch the earplugs and have some benign, neutral or pleasant white noise in the background that is barely audible. For me, I find that I have to use my iPod: I have it in an iHome (so I don't have to wear earphones or earbuds) and I play a playlist consisting of Gregorian chants by monks all night long. (When I had it on a timer, I'd wake up once the music STOPPED.) The trick is I have the volume very, very low and all the Gregorian chants sound enough alike that I can't pick out where in the playlist the iPod is when I wake up at night. Because the chants are in Latin I also can't focus or start "singing along" in my head when I'm first getting to sleep at night.
I have also continued getting migraines though it was hoped that CPAP would eliminate those. So my main problems are the headaches and the tinnitus.
As I said at the beginning, I'm a life long sufferer of migraines and tinnitus. In my case both conditions long predate my estimated onset of my OSA. And I don't believe my OSA had anything to do with my developing these conditions.
It is discouraging to read that CPAP may be the reason and that no one has really gotten distinct answers or help.
While I think CPAP pressure CAN aggravate the ears via the eustachian tubes and cause ear pain, I'm not sure that CPAP itself is the reason you are noticing migraines more. Or rather, I should say this: In my own case, loud noises and over stimulation in general can trigger migraines. And in the early going I certainly had more than my fair share of sleepless nights with the accompanying stress induced tension headache and the occasional migraine headache. I don't think I ever recall the CPAP triggering a migraine, but if I had a migraine already going when I went to bed, the CPAP would certainly aggravate the migraine---sometimes significantly. Are you under medical treatment for your migraines? If not, you might want to ask your PCP for a referral to a neurologist that specializes in headaches. There are things that can be done for migraine headaches. If they are very frequent (two or three times a week) or very severe and disabling when they occur, there are prescription medicines that can help. But they must be taken exactly as prescribed, or the headaches can get worse instead of better.
As far as the tinnitus is concerned: Again, I think if you would ditch the earplugs at night, the tinnitus would likely become much more tolerable and in time you might even not notice it on a day-to-day basis. But as long as you are blocking out significant amounts of ambient noise in an effort to make the inside of your head seem SILENT, that tinnitus is going to continue to get worse, not better.
And I also think conducted noise from the hose is aggravating the tinnitus and possibly the headaches. And the earplugs are the major reason you'd be hearing the conducted noise.
I too am tired of multiple trips to the doctors and the charges that come with them, especially when you are no better off after you leave. And I am not particularly fond of my sleep doctor.
I know how you feel about multiple trips to the doctors without feeling like you have gotten anything out of them. Since August 2010, I've been to doctors (PCP, ENT, neurologist, sleep doctor, etc) for a grand total of 20+ times, not counting 4 sleep tests, an MRI, a CAT scan, and two rounds of vertigo testing. With very little to show for it in terms of making me feel better.
But if you are not fond of the sleep doctor, you might want to get a referral to a different one.
I know this is terrible to say(don't want to offend the deaf) but sometimes I get so frustrated with all the noise I wish I could turn my ears off.
Are you aware that MANY deaf people complain BITTERLY about the tinnitus they live with on a CONSTANT basis? As I said, the silence you crave and are trying to acheive through the use of earplugs is making the tinnitus WORSE, not better.
I suppose it's a toss-up now...get sleep using CPAP and earplugs, but suffer louder tinnitus, headaches and constant ear issues, or sleep without them, still get headaches, keep others awake with my snoring, get very little accomplished in life due to the extreme fatigue then get depressed.
In the long run, I think you need to learn how to sleep without the earplugs since I think it's the earplugs that lead to your noticing the conducted noise and tinnitus which are in turn causing problems with your sleep.
The ear problems too may decrease substantially if you manage to wean yourself off the earplugs. It could be that having the earplugs in at night with the CPAP on makes it more difficult for the eardrum and eustachion tubes to work on equalizing the pressures between the inner, middle, and outer ears. Not being able to equalize the pressure is what typically leads to ear pain in a person without a genuine middle ear infection.
And who knows, maybe it was your own snoring that was causing you to wake up to the "slightest" noise pre-CPAP. And in that case, maybe the fact that you are no longer snoring with CPAP will be enough to let you sleep without the earplugs once you are more completely adjusted to the CPAP.