Hearing Loss, Deafness and Sleep

Hearing loss impacts 15% of Americans. For many of them, it touches every aspect of their life, including sleep.

However, the relationship between sleep and hearing is complicated. Does hearing loss make it easier or more difficult to sleep? Can not getting enough sleep affect your hearing? Is it possible to reduce tinnitus at night?

We’ve investigated these and other questions to help you make sense of the research on hearing loss and sleep. By the end of this article, you should feel confident in identifying how one affects the other, as well as how to prevent hearing loss and get a better night’s sleep.

How Does Hearing Loss Affect Sleep?

Sleep is complicated. Good sleep is a crucial part of our well-being, and the effects of sleep loss are wide-ranging, but because of its complexity, it can be impacted by many factors. Hearing loss or congenital deafness can both be one of those factors. Though research on the subject is still ongoing, studies show a complicated correlation.

Hearing Loss, Deafness and Sleep Issues

Insomnia is common among people who are deaf or hard of hearing. Studies have shown that two-thirds of deaf respondents reported insomnia, and prevalence is also high among people with occupational hearing loss, sudden hearing loss (SSNHL), and tinnitus.

Psychological distress might be one reason for these numbers. Sleep dysfunction and depression go hand in hand; one can be a cause or a symptom of the other. Since rates of depression are higher for both people who are congenitally deaf and people who have acquired hearing loss, mood disorders might be one of the causes of sleep problems in the community.

Of course, insomnia is not the only kind of sleep dysfunction, and poor sleep quality is a common problem for people who are deaf or hard of hearing. Ongoing low-quality sleep is a form of sleep deprivation and can result in many of the same effects as chronic insomnia.

One study provides insight into how sleep patterns in deaf people might lead to lower-quality sleep. When compared to a control group, the deaf subjects were found to wake up more often throughout the night, despite sleeping for the same length of time overall. And though they spent as much time in REM sleep as the controls, they spent less time in delta sleep.

Delta sleep is stage 3 of non-REM sleep and is also known as slow wave or deep sleep. It is the stage which resets the body’s feeling of needing to sleep, so people without enough delta sleep often report feeling exhausted and as though they barely slept at all. On a deeper level, delta sleep is also thought to play a role in memory formation and mood regulation.

While this particular study was limited to deaf individuals, it still provides a new look at the  complex topic of how hearing loss and sleep patterns are connected.

Can Hearing Loss or Deafness Help you Sleep?

The complexity of sleep’s relationship to hearing loss can be illustrated by another study, which found that middle-aged and elderly people with hearing loss slept better and longer than their hearing counterparts.

This finding matches the anecdotal experience of some people who have had hearing loss later in life. Since they are no longer disturbed by ambient noise, they find it easier to fall asleep and stay asleep.

A study involving guinea pigs also challenges the research which found deaf participants experienced less slow wave sleep. Guinea pigs with damaged cochleae (a structure in the inner ear) showed increased REM and slow wave sleep. The researchers speculated that the deeper sleep was caused by the environmental isolation caused by hearing loss.

With such variable factors, whether hearing loss helps or hurts your sleep is both personal and subjective. Changing circumstances (aging, other disorders, lifestyle changes, and other factors) can also cause or resolve sleep dysfunction, so your experience can evolve over time.

Tinnitus

People with tinnitus “hear” noise which is not caused by an external source. Sometimes described as a ringing in the ears, tinnitus can sound like a range of noises: roaring, whining, buzzing, and hissing noises are all common.

50 million Americans will experience tinnitus in their lifetime. Of those, approximately 12 million will speak to their doctor about the condition. Tinnitus is the number one disability among veterans due to their chronic exposure to loud noises. Other causes of tinnitus include hearing loss, infection, disease, hormonal imbalances, and even some medications.

The rate of sleep problems among tinnitus sufferers is estimated to be as high as 77%. Though this is probably due to the noise making it difficult to sleep, it’s possible the underlying causes of one might affect the other.

Sleep dysfunction is troublesome for anyone, but loss of sleep is particularly difficult for people with tinnitus. Tinnitus symptoms are worsened by not getting enough quality sleep, as well as the depression and anxiety sometimes caused by sleep loss. As tinnitus sufferers have a higher risk of depression and anxiety to begin with, the situation can quickly become overwhelming.

All of these factors make it even harder to sleep, starting the vicious cycle over again.

Luckily, treating even one stage of this cycle can provide overall relief. In addition to addressing its underlying cause, tinnitus itself is usually treated with a combination of counseling and what is known as sound therapy.

If you have ever used white noise to block out the sound of tinnitus, you’ve independently discovered sound therapy. Since silence worsens tinnitus symptoms, the introduction of background noise can make it easier to sleep.

Occupational Hearing Loss

Noise, vibrations, and even some chemicals can cause damage to the inner ear. When caused by working in certain jobs, this is called occupational hearing loss (OHL). Symptoms can vary, but some of the most common are hearing loss, tinnitus, and dizziness.

Though the United States government regulates hearing hazards and sets guidelines, many people still suffer from occupational hearing loss. It is one of the most common work-related illnesses in America, affecting between 22 and 30 million people every year.

Workers with occupational hearing loss are at a higher risk for sleep disorders, particularly insomnia. Tinnitus was the main complaint in one study, but even people without it were more likely to have trouble sleeping. This was true regardless of how old they were or how long it had been since their hearing was damaged.

As with other forms of hearing loss, lack of high-quality sleep can worsen the symptoms of OHL. Research suggests that insomnia can make it more difficult to hear at low frequencies while increasing the fatigue associated with hearing loss.

Occupational hearing loss is far easier to prevent than to treat, but treatment options do exist. Promising new treatments are being studied, and some symptoms can be reduced using medication or surgery.

However, the sleep disturbances associated with OHL can also be treated with white noise (for tinnitus) and improved sleep hygiene (see below). If lying down to sleep aggravates OHL-associated vertigo, physical therapy and following sleep guidelines can reduce the dizziness.

Hearing Aids and Sleep

Nearly a third of adults with hearing loss use a hearing aid. While they aren’t right for everyone, the $600 million spent on development every year has led to striking advances in the technology. Modern hearing aids are smaller, more comfortable, and more effective than those in the past.

In addition to helping people hear better, hearing aids might also reduce hearing-loss related sleep problems. A study of volunteers with tinnitus and hearing loss found that their sleep quality significantly improved after they started using hearing aids.

Most hearing aids are meant to be removed before sleep. (The exceptions are extended wear hearing devices, tiny devices inserted into the ear canal which last for several months.) Some people want to leave them in to hear children or alarms, but wearing them overnight can cause feedback and is unlikely to help with hearing during sleep.

While forgetting for one night is unlikely to cause any problems, it’s always best to give your ears a chance to breathe. Taking them out at night also allows them to charge and reduces the chance of damaging or losing them.

If you regularly forget to remove your hearing aids, make the process part of your sleep routine.

Can Poor Sleep Lead to Hearing Loss?

Given the relationship between sleep and hearing loss, it’s worth considering whether sleep dysfunction can contribute to hearing loss.

In at least one situation, this seems to be the case. Studies have shown a link between obstructive sleep apnea and hearing loss, though the exact reason for that connection is still being researched.

People suffering from sleep apnea stop breathing for short periods multiple times while they sleep. It affects around 40 million Americans and can cause a range of other symptoms, including loud snoring.

Some researchers speculate that this snoring might be loud enough to cause hearing loss. After all, loud noises damage your hearing even if you aren’t aware of them. However, most snoring falls between 50 and 60 decibels, below the 85-90 decibel guidelines for damaging noise.

Another possibility is that when an individual stops breathing, blood flow to the inner ear is reduced. Over time this might lead to inflammation of the cochlea, causing or contributing to hearing loss. The researchers who back this idea found that sleep apnea is associated with hearing damage even in individuals who don’t snore, which makes the snoring hypothesis less likely.

Aside from sleep apnea, two studies indicate that sleep problems might be linked to sudden hearing loss (SSNHL). One suggests that sleeping less than seven hours a night might be a risk factor for SSNHL, while the other links SSNHL with circadian rhythm disruption. (The circadian rhythm refers to the pattern of your sleep-wake cycle over time.)

Despite these intriguing studies, research has yet to show a cause-and-effect link between sleep dysfunction and SSNHL. As demonstrated by the sleep apnea example, it can be challenging to discover what is happening even when there’s a clear connection.

What we do know is that lack of sleep can worsen hearing loss in the short term. Sleep deprivation is known to impair brain function, including central auditory processing. People who are hard of hearing must work harder to distinguish one sound from another, a skill which involves central auditory processing. Lack of sleep can also increase listening fatigue, making it even more difficult to hear speech clearly.

How to Prevent Hearing Loss

While treatments are available for hearing loss, prevention is still much easier. Doctors suggest following these steps to protect your hearing:

1. Know what can damage your ears

Harmful noise is a leading cause of hearing loss, affecting up to 24% of American adults and 17% of teenagers.

The higher a noise is above 85 decibels, the more dangerous it can be to your hearing. Decibels describe a ratio, so a seemingly small increase in the number can mean a significant increase in power. (For example, 80 decibels is twice as loud as 70 decibels.)

Here are some common noise levels:

  • Normal conversation: 50-60 decibels
  • Garbage disposal: 80 decibels
  • A motorcycle 25 feet away: 90 decibels
  • Listening to music with headphones: 95 decibels
  • Jackhammer: 100 decibels
  • Music concert: 115 decibels
  • Chainsaw: 120 decibels

Sounds beneath 85 decibels can still damage your hearing over long periods. The problem is that loud noises inflame the inner ear and damage the tiny hairs there. Once damaged they cannot be repaired so even minor damage will add up over time. You might not even be aware that you have hearing loss since damage can occur so gradually.

2. Come prepared when you know things are going to get loud

Foam earplugs or ear protectors might be an easy choice when you’re mowing the lawn, but what about when sound matters? The 110 decibels of a rock concert can begin to damage your hearing within one minute, but few people want to sacrifice sound quality in that situation.

Reusable musician’s earplugs are an ideal alternative which will still protect your hearing. Designed to retain sound fidelity even for high frequencies, affordable versions can be found online or at your audiologist’s. They can also be used at other loud events such as fireworks displays or car races.

Even if you bring hearing protection, be kind to your ears. Avoid sitting or standing near speakers, take breaks if possible, and try to keep things quiet for the days following a loud event to avoid causing further damage.

3. Practice healthy habits when listening to music

Modern earbuds deliver excellent sound quality at the expense of your hearing. 95 decibels is the average noise level, 10 decibels above the danger line.

Hearing experts promote the 60/60 rule when listening to headphones: 60% volume for 60 minutes before taking a break. Noise-canceling headphones and earbuds can also be useful, since they mute external noise and make quieter volumes seem louder.

4. Make sure you’re not being over-exposed at work

Occupational hearing loss is an avoidable condition. Symptoms of a dangerously noisy work environment include:

  • Having to shout to be heard three feet away
  • Ear pain
  • Ringing or humming in your ears (tinnitus)
  • Temporary hearing loss

If you are worried about noise levels at your work, speak to your supervisor or HR person. They are legally obligated to follow the Occupational Safety and Health Administration’s (OSHA) standards for noise safety in the workplace.

5. Regularly get your hearing tested

OSHA guidelines require yearly hearing tests for jobs with high noise levels. This is a good idea even for people who don’t work in noisy environments since it’s easy to miss gradual hearing loss.

If hearing loss is caused by an underlying condition, early warning can make treatment more effective. In cases where it is caused by something easily resolvable (like impacted ear wax), a hearing test can make a major difference. Either way, it’s well worth an annual visit.

How to Sleep Better with Hearing Loss or Tinnitus

Practice Excellent Sleep Hygiene

Sleep hygiene refers to the routines, habits, and patterns you have around sleep. Good sleep hygiene is the first step in treating any sleep problem, including hearing-loss related sleep issues. It sets you up for sleeping successfully and improves the benefits of any other sleep treatment.

  • Most adults need 7 to 7.5 hours of sleep. (This doesn’t include time spent falling asleep.) However, don’t focus on this number. You probably already know how much sleep you need to feel your best, so use that.
  • Work out when you need to go to bed, leaving room for falling asleep. Once you find something which works, go to bed at the same time and follow the same routine every night. Your body will eventually learn that this routine means sleep is approaching.
  • Colder temperatures make it easier to sleep, while even small amounts of light can interfere with falling asleep. If you’re bothered by outside or indoor light, blackout curtains or a sleep mask can help.
  • Banish the TV and your phone from your bedroom. Your bed should only be for sleeping and sex. Using it for anything else can make it more difficult to fall asleep.
  • Screen time should be limited in the evening, as the blue light emitted by electronic screens can confuse your circadian rhythm. If you need to use your computer at night, consider purchasing blue light-filtering glasses.
  • Staying healthy during the day with a good diet, exercise, and safe exposure to sunlight can make it easier to fall asleep at night.
  • While most people know caffeine makes it more difficult to sleep, it’s also important to avoid alcohol before bed. Both interfere with sleep and make waking up in the night more likely.

If You Have Tinnitus, Introduce Gentle Sound Into Your Sleeping Environment

As covered above, sound therapy is a recognized treatment for tinnitus. Introducing white noise or other quiet sounds to your sleep routine can mean the difference between a restless or restful night of sleep.

Hearing aid-style masking devices are available which offer a steady white noise, or music altered to affect brain waves. These devices usually hook over the ear and pose some of the same sleep problems as hearing aids, namely discomfort and potential damage to your device.

Instead of using a masking device, two popular options for white noise in the bedroom are white noise machines and white noise apps. Wireless or wired sleep headphones are not necessary but can be used to block the sound from other people.

Apps and machines both have their own benefits and drawbacks:

  • White noise machines are often able to generate a range of frequencies and natural sounds. Many models have a headphone jack, making it easy to avoid disturbing anyone who dislikes white noise while sleeping. However, they are more expensive than an app and can be more limited in their sound selection.
  • White noise apps are available for smartphones and tablets. Most are free or inexpensive, and if you get tired of the available sounds on one, you can easily switch to another. It’s also more straightforward to connect wireless sleep headphones to your phone. On the other hand, using a white noise app means bringing a screen into your bedroom. You also have to ensure your phone is charging all night.

Consider Hearing Aid Rehabilitation

Hearing aids have been shown to make a dramatic difference in the lives of people with hearing loss. Not only do they help restore some amount of hearing, but they can also improve sleep problems and related issues. (See “Hearing Aids and Sleep” above for more information.)

However, only 20% of adults who would be helped by hearing aids use them. If you have hearing loss and struggle with insomnia or another sleep disorder,  hearing aid rehabilitation could be the right treatment choice.

Hearing aid rehabilitation starts with a hearing test. (You may also require a medical examination to ensure the cause of your hearing loss doesn’t need medical treatment.) Once the audiologist or hearing aid dispenser understands your form of hearing loss, they will suggest potential hearing aids.

Modern hearing aids come in a wide range of styles and at many price points. When choosing one, it might be helpful to consider these questions suggested by the FDA:

  • Are the benefits and features of higher-priced styles worth the cost to me?
  • Does the manufacturer offer a trial and adjustment period?
  • What are the terms of the warranty?
  • How are repairs covered, and will loaner aids be provided during repairs?

Adjusting to hearing aids can take time. Not only will you have to get used to the physical sensation of the aids, but you will also have to retrain your brain to adjust to sounds you otherwise could not hear.

Still, the process is well worth the effort. Most hearing aid users are satisfied or very satisfied with their aids, regardless of the technology or version they use.

Conclusion

Although not all links between sleep and hearing loss are fully understood, it is clear that they impact each other.

It’s easy to become overwhelmed by hearing loss, particularly if you aren’t sleeping well. However, effective treatments are available which can increase your quality of life. Worsening hearing loss often means sleep loss as well, but treating hearing problems can help ensure a good night’s sleep. Likewise, treating sleep dysfunction can make it easier to cope with hearing problems.

Further information on hearing loss:

Additional Tuck Resources

If you want to learn more about sleep disorders and how to sleep well, visit our other Tuck articles at the links below: