Sleep sounds for tinnitus

The short answer

Background sound at night is a reasonable, low-risk thing to try with tinnitus, but it is a comfort tool, not a treatment. Two Cochrane reviews found no good evidence that sound devices reduce tinnitus loudness or distress better than education or counselling. What steady sound can do is soften the stark contrast of a silent bedroom while you fall asleep.

Listen

• Notched Soft White

  White noise with a narrow notch cut at 3.2 kHz, softer at the top end.

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• Gentle Rain

  A quiet rain patter over a soft bed, if plain noise feels clinical.

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Why tinnitus feels louder at night

In a quiet bedroom there is nothing else for your hearing to attend to, so the ringing takes center stage. A steady background sound narrows that contrast.

The same idea shows up in research on outside noise. Stanchina 2005 found that what woke sleepers was the size of the jump from background to peak, and a steady bed of white noise kept that jump small. That study was about hospital noise, not tinnitus, and only four people finished it, so read it as an explanation of the idea rather than proof.

What the trials found

Theodoroff 2017 randomised 60 adults with bothersome tinnitus to three kinds of sound device used during sleep. Reactions to tinnitus improved on average in every group, and a sound matched to each person's tinnitus lowered loudness ratings a little more than a plain bedside sound generator. There was no group without sound, so the trial cannot say how much of the improvement came from the sound itself.

Two Cochrane reviews take the wider view. Hobson 2012 (6 trials, 553 adults) found no significant change in tinnitus loudness or severity from masking devices compared with education, relaxation or counselling. Sereda 2018 (8 trials, 590 adults) found no evidence that sound generators or hearing aids beat a waiting list, placebo or education, and rated the evidence low quality. Both stress that this is a lack of good evidence, not proof that sound does nothing.

Which sounds to try

No trial has crowned a best sound for tinnitus at night, so choose one you would happily hear for hours. Broadband noise, rain and other steady nature sounds are common choices.

Notched sound is the one idea with a specific finding behind it: Okamoto 2010 showed that music with a narrow band removed around a listener's own tinnitus pitch reduced perceived loudness. The notch was matched to each person. A fixed notch, like the one in Notched Soft White, is only a rough approximation, so think of it mostly as a softer white noise.

Volume and safety

Start low. The aim is to soften the contrast with silence, not to cover your tinnitus completely, and a lower level is easier on your ears over a whole night. A bedside speaker avoids pressure on your ears; if you prefer headphones, choose flat sleep headphones and keep the volume down.

If your tinnitus is new, is in one ear only, pulses with your heartbeat, or comes with hearing loss or dizziness, see a doctor or audiologist before anything else.

In Aviana

Aviana has Notched Soft White, pink and brown noise, and dozens of rain, water and wind recordings. Layer two or three, set each one's volume, and choose Fade out and stop so the sound ends after you fall asleep. Every track shows the research behind it, including where that research is thin.

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The research

1. Theodoroff 2017

   60 adults, three sleep-time sound devices: all groups improved on average, with no silent comparison group.

   Randomized Controlled Trial of a Novel Device for Tinnitus Sound Therapy During Sleep. American Journal of Audiology, 2017.

2. Hobson 2012

   Cochrane review, 6 trials: masking devices did not change tinnitus loudness or severity more than education or counselling.

   Sound therapy (masking) in the management of tinnitus in adults. Cochrane Database of Systematic Reviews, 2012.

3. Sereda 2018

   Cochrane review, 8 trials: no evidence that sound generators beat placebo or education; low-quality evidence overall.

   Sound therapy (using amplification devices and/or sound generators) for tinnitus. Cochrane Database of Systematic Reviews, 2018.

4. Okamoto 2010

   Music notched at each listener's own tinnitus pitch reduced perceived loudness.

   Listening to tailor-made notched music reduces tinnitus loudness and tinnitus-related auditory cortex activity. Proceedings of the National Academy of Sciences, 2010.

5. Stanchina 2005

   Steady white noise kept the jump from background to peak small, so noise woke four sleepers less.

   The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Medicine, 2005.

Questions