Tinnitus And Sleep Are Tangled Together. Scientists Believe That Connection Is Key To Quieting The Ringing

For people with tinnitus, the ringing is often loudest first thing in the morning, a pattern some patients call the “morning roar.” A smaller group describes something stranger: on some mornings the sound is simply gone, only to switch back on after a nap.

Tinnitus is the perception of sound that has no outside source, and it is commonly linked to hearing loss and noise exposure. The National Institute on Deafness and Other Communication Disorders says surveys estimate that 10 to 25% of adults have it. It usually does not interfere with daily life, but it can affect some people’s mood, concentration and sleep, and there is currently no cure.

Swings like these are one reason scientists have started looking closely at sleep, one of the biggest changes the brain goes through, and one that happens every night. A handful of brain-wave studies now suggest that tinnitus-related activity may follow people into sleep, though they can’t say which comes first, and their results don’t always agree. So far, the strongest evidence points to a more practical step: treating the insomnia that so often comes with tinnitus. But first, why would a sound the brain invents be tied to sleep at all?

Why Might Tinnitus And Sleep Affect Each Other?

Scientists point to a patch of wake-like activity inside a sleeping brain.

A 2022 review in Brain Communications by University of Oxford researchers noted that deep non-rapid eye movement (non-REM) sleep normally brings large, synchronized slow brain waves, and that the strength of these waves is linked to how cut off a sleeper is from the outside world. The authors proposed that tinnitus-related activity could behave like a pocket of “local wakefulness” that may keep the brain as a whole from entering restorative sleep. They also suggested that strong sleep pressure, the drive to sleep that builds the longer we stay awake, might temporarily suppress that activity, and that the brain rewiring that happens during sleep could help lock tinnitus circuits in place over time.

The authors call this framework hypothetical: these are testable ideas, not proof that tinnitus stays audible during sleep or that deep sleep switches it off.

What Are Researchers Seeing On EEG?

More wake-like activity, although the evidence remains observational.

A 2025 study in Sleep Medicine recorded brain waves, using electroencephalography (EEG), from 51 people with tinnitus and 51 people without it, both while awake and during the first sleep cycle of the night. Across all sleep stages, the tinnitus group showed more beta and gamma activity, the fast rhythms typical of an alert brain. During N2 and N3 sleep, they showed less of the slower delta and theta rhythms, which include the large slow waves of deep sleep. They also had a shorter stretch of N3, the deepest stage, and spent a larger share of time in N2.

Because the groups were compared at a single point in time and only the first sleep cycle was analyzed, the study cannot show which came first or whether something else drives both.

A 2025 study in Neurobiology of Disease from the same research team, again comparing 51 people with tinnitus and 51 without, looked at sleep spindles. These are brief bursts of brain activity, generated by circuits in the thalamus, that are a hallmark of N2 sleep. During spindles, the tinnitus group showed more high-frequency activity and stronger coupling between brain rhythms of different speeds. They also had more spindles, but those spindles were weaker and less coordinated across the brain. The pattern fits thalamocortical dysrhythmia, a theory that disrupted signaling between the thalamus, a relay hub deep in the brain, and the cortex causes slow and fast rhythms to interact abnormally. Because both papers come from the same team and use the same group sizes, they may draw on overlapping participants rather than serving as independent confirmation. Neither tested a treatment.

Does The Same Pattern Appear In Every Group?

No, and the mixed results are instructive.

A one-night study in the International Journal of Environmental Research and Public Health compared 15 adults whose tinnitus loudness shifted sharply with nighttime sleep and naps to 15 matched adults whose tinnitus stayed steady. The sleep-sensitive group spent proportionally more time in N2 and less in N3 and rapid eye movement (REM) sleep. The authors cautioned that the groups were small, that this subgroup appears to be a small minority of tinnitus patients, and that they could not correct for the many statistical comparisons they ran.

An exploratory study in Clinical Neurophysiology Practice focused on adults left deaf in one ear after surgery to remove a vestibular schwannoma, a benign tumor on the nerve that carries sound to the brain. Usable nap recordings came from 11 participants with tinnitus, five without it, and nine controls with hearing in both ears. The researchers found no statistically significant spindle differences, only a nonsignificant trend toward fewer but larger spindles in the tinnitus group, roughly the reverse of the Neurobiology of Disease pattern. The null result does not rule out a sleep mechanism: the study was small, used daytime naps of up to two hours, and spindles reflect activity across the whole spindle-generating region of the thalamus, not just its hearing-related part.

What’s The Practical Takeaway?

Treating insomnia has the clearest current support.

A randomized trial in Cognitive Behavior Therapy assigned 102 people with tinnitus-related insomnia to six group sessions of cognitive behavioral therapy for insomnia (CBT-I), two sessions of standard audiology-based care, or six sessions of a sleep support group. CBT-I reduced insomnia and improved sleep efficiency, the share of time in bed actually spent asleep, more than audiology-based care, both right after treatment and six months later.

More than 80% of CBT-I participants reported clinically meaningful improvement, compared with 47% in audiology-based care and 20% in the support group. The researchers also reported that CBT-I was more effective at reducing tinnitus distress, a measure of how much the sound bothered people rather than how loud it was.

A 2021 Sleep Medicine Reviews meta-analysis found five randomized trials of CBT-based treatment in adults with tinnitus and pooled data from four. Insomnia scores improved after treatment, though the authors flagged a risk of bias because participants, staff or outcome assessors were not consistently blinded to which treatment was given.

For anyone with tinnitus, the NIDCD advises starting with a primary care doctor, who may refer you to an ear, nose and throat specialist or an audiologist. Imaging may be ordered, especially if the tinnitus pulsates. The Oxford researchers suggest that sleep’s natural brain rhythms might one day be harnessed for treatment. For now, sleep is a promising research target that happens every night, not an off switch for the ringing.