How to sleep with tinnitus

Nights are often the hardest part of tinnitus. The house goes quiet, the ringing stands out, and worry about not sleeping can keep you awake more than the sound itself. The good news is that sleep with tinnitus can improve, and the steps that help have been studied.

Why does tinnitus seem louder at night?

Mostly because everything else gets quieter. Moving from a busy day to a still bedroom makes tinnitus easier to notice.¹ Then a familiar loop can start: you notice the sound, think “I’ll never get to sleep”, your body tenses, and sleep slips further away. Tinnitus UK, in a leaflet written by psychologists at the Royal National Throat Nose and Ear Hospital in London, calls this a cycle of sleeplessness, worry and awareness of tinnitus.¹

Two points from that leaflet are reassuring. Many people with tinnitus sleep well, and those who sleep well don’t seem to have “different tinnitus” from those who struggle. Worry about sleep, and about tinnitus in general, probably affects sleep quality more than the sound does.¹

Insomnia is common in people with tinnitus.³ That’s why the UK’s NICE guideline asks clinicians to check whether tinnitus is affecting sleep and to consider a short questionnaire such as the Insomnia Severity Index.²

Does background sound help you sleep with tinnitus?

It helps many people, as long as it stays soft. Tinnitus UK suggests background sound to mask the quiet of the room, such as a fan, a radio on low, or natural sounds like waves or rain.¹ The NHS also advises against total silence.⁸

Be realistic about what sound can do. A 2021 review of 38 studies rated the evidence that continuous noise improves sleep as very low quality, and warned that it may also affect sleep and hearing.⁴ So treat sound as a comfort, not a sleeping pill:

• Keep the level low, ideally just below your tinnitus.
• Choose a steady, unexciting sound you won’t want to follow.
• Use a timer that fades out once you’re asleep, or keep it on all night if waking to silence bothers you.

Our guide to white, pink and brown noise explains how to choose one.

Which sleep habits help most?

Sleep runs on routine. These suggestions come from Tinnitus UK’s sleep leaflet:¹

• Get up at the same time every day, weekends included, and try not to nap.
• Go to bed when you feel sleepy, not just because of the time.
• Keep the bed for sleep. Skip TV, puzzles and work in bed.
• Turn the light off when you get into bed, and don’t try hard to sleep. Resting is useful too.
• Get up if you’re not asleep in 25 to 30 minutes. Do something relaxing in another room, then go back when you feel sleepy.
• Unwind for at least an hour before bed.
• Write down worries for 15 to 20 minutes each evening, well before bedtime.
• Cut down on caffeine and nicotine, especially in the evening.
• Skip alcohol and over-the-counter sleep aids. They may help you drop off but can disrupt sleep later in the night.
• Stay active during the day, but not right before bed.
• Don’t take it easy after a bad night. Keeping to your usual day often helps more.

One myth to drop: coffee doesn’t seem to make tinnitus louder. In a blinded trial with 66 regular coffee and tea drinkers, switching to decaf had no effect on tinnitus severity, and caffeine withdrawal caused unpleasant symptoms of its own.⁷ Cutting evening caffeine is about sleep, not about the ringing.

What is CBT for insomnia, and does it help with tinnitus?

CBT for insomnia (CBT-I) is a structured program that changes sleep habits and the worries around sleep. The American Academy of Sleep Medicine strongly recommends multicomponent CBT-I for adults with chronic insomnia. It also suggests some of its parts on their own, including stimulus control, sleep restriction and relaxation, but not sleep hygiene tips as a stand-alone treatment.⁵

For tinnitus specifically, a UK trial randomly assigned 102 people with tinnitus-related insomnia to group CBT-I, audiology-based care or a sleep support group.⁶

• CBT-I reduced insomnia and improved sleep efficiency (the share of time in bed spent asleep) more than audiology-based care, and the gains held at 6 months.
• More than 80% of the CBT-I group improved in a clinically meaningful way, compared with 47% with audiology-based care and 20% in the support group.
• CBT-I also reduced tinnitus distress.

It was a single trial, so more research is needed, but the results are encouraging. If poor sleep has lasted for weeks, ask your doctor whether CBT-I is available to you.

What if tinnitus wakes you up at night?

Everyone wakes several times a night, usually without remembering it. Tinnitus UK notes that other things are more likely to wake you than tinnitus. But if you wake enough to notice the sound, you may stay awake longer and remember it the next day.¹ When that happens:

1. Keep the light low and try not to check the time.
2. Breathe slowly. The NHS notes that relaxing with deep breathing may help you cope with tinnitus.⁸
3. Turn on a soft sound if the room feels too quiet.
4. If you’re still awake after about 30 minutes, get up and do something calm until you feel sleepy again.¹

When should you get help with sleep?

Talk to your doctor if poor sleep goes on, because sleep loss may be linked to another condition that can be treated.¹ Ask about CBT-I and about tinnitus support. And see a doctor soon if your tinnitus changes suddenly, is in one ear only, beats with your pulse, or comes with dizziness or hearing loss. Our guide on when to see a doctor about tinnitus explains these red flags.

Sources

1. Tinnitus and sleep (Tam, Mills and McKenna), version 4.0. Tinnitus UK, 2024.
2. Tinnitus: assessment and management (NG155), recommendations. National Institute for Health and Care Excellence (NICE), 2020.
3. Tinnitus: assessment and management (NG155), rationale and impact. National Institute for Health and Care Excellence (NICE), 2020.
4. Noise as a sleep aid: a systematic review (Riedy et al.). Sleep Medicine Reviews, 2021.
5. Behavioral and psychological treatments for chronic insomnia disorder in adults: an AASM clinical practice guideline (Edinger et al.). Journal of Clinical Sleep Medicine, 2021.
6. Cognitive behavioural therapy for insomnia (CBTi) as a treatment for tinnitus-related insomnia: a randomised controlled trial (Marks et al.). Cognitive Behaviour Therapy, 2023.
7. Caffeine abstinence: an ineffective and potentially distressing tinnitus therapy (St Claire et al.). International Journal of Audiology, 2010.
8. Tinnitus. NHS, 2024.

Last reviewed October 25, 2026. We write guides from clinical guidelines and peer-reviewed research and link every source we use. They have not been reviewed by a clinician, and they are not medical advice. Spotted an error? Write to support@tinnimo.com.