How to sleep with tinnitus: a bedtime routine you can test

This page describes a routine that people with tinnitus use at bedtime. It makes no promise about your night, because the controlled evidence does not support one. Read it as a set of mechanics: what to play, how loud, for how long, and when to stop fiddling.

Before the routine

See a doctor first. Ringing in one ear only, ringing that pulses along with your heartbeat, or a sudden drop in hearing all need an assessment rather than an app. The US National Institute on Deafness and Other Communication Disorders advises starting with a primary care doctor, who can check for earwax or an infection blocking the ear canal. If the ringing keeps you awake night after night, ask an audiologist about cognitive behavioural therapy, which carries stronger clinical support than sound does. Slo does not diagnose or treat anything.

Step 1: choose one sound and stop shopping

Pick a single steady sound and stay with it for a week. Rain, brown noise and a fan recording are the usual starting points because they hold a fairly constant character with no speech in them. Swapping tracks every night turns the sound itself into the thing you lie there listening to.

Try rain if you want a little texture, or brown noise if you want something flatter and lower.

Step 2: fix the volume early in the evening

Set the level while you are still sitting up. Two rough tests: you should be able to talk over it without raising your voice, and you should still hear a phone ringing in another room. Then leave the slider alone.

A loud masking sound is a bad trade. It replaces one sound you cannot ignore with a second one, and it makes your ears work harder for no reason anyone can show.

Step 3: pick a timer length

A timer answers a real question: do you want the sound through the whole night, or only while you fall asleep? Both are common. Start at 45 to 60 minutes, which covers most people’s settling period. If you tend to surface at three in the morning into a silent room, run it all night instead and see which you prefer after a week.

Step 4: layer only if a single sound annoys you

Layering means running two quiet sounds together, for example rain under a low fan hum. The point is texture, not volume: a mix that lands louder than one sound alone has missed the idea. In the Slo browser mixer you can drop each layer well below where you would set a single track.

Two layers is plenty. Three starts to sound like weather happening at you.

Step 5: leave it alone for a week

Change one thing at a time and give it seven nights. Note only two things in the morning: whether you noticed the ringing while settling, and whether you noticed the background sound. If you kept noticing the background sound, it is the wrong sound or it is too loud.

Stop the whole experiment if the sound makes your ears feel tired, or if lying in bed starts to feel like a nightly test you might fail. Sleep habits, daylight, caffeine and worry all shape a night too, and none of them come out of a speaker.

Questions people ask

Should I sleep with sound every night?

Plenty of people do, and plenty of people would rather not. No study settles it. Decide by how you feel after a week either way.

Is silence worse for tinnitus?

Silence is not worse. Tinnitus is simply more noticeable in a quiet room, because there is less around it to listen to. That is a point about attention, not about your ears getting worse.

What volume is safe?

Keep it low enough for conversation over the top of it. Long exposure to loud audio is a hearing risk in its own right, so an all-night sound is a reason for restraint.

Does an app do what a clinic does?

No. The Cochrane review of sound therapy for tinnitus found no evidence to support the superiority of sound therapy over waiting list control, placebo or education with no device, and it studied clinical devices rather than apps. Slo is a player with a timer and a mixer.

Read next

• Sound masking for tinnitus sets out what masking is and what the evidence stops short of.

Sources

• Cochrane review of sound therapy for tinnitus, Sereda and colleagues 2018: CD013094
• Tinnitus page at the US National Institute on Deafness and Other Communication Disorders
• Tinnitus article in the MedlinePlus medical encyclopedia

Filip Kowalski is the developer of Slo and writes about sound, sleep, and focus.