Theoretical ReviewTinnitus and insomnia: Is hyperarousal the common denominator?
Section snippets
Background
Sleep disturbances are the second most frequent comorbid condition among tinnitus patients.1 Tinnitus and insomnia tend to intensify one another, and successful tinnitus therapies often improve insomnia complaints.2 Studies exploring the relation between tinnitus and insomnia are sparse, however.1, 3, 4, 5, 6, 7
In this review, we put forward the hypothesis that hyperactivity of the sympathetic nervous system might promote the emergence of a distressing tinnitus and at the same time might be the
Tinnitus, insomnia and hyperarousal
Hyperarousal represents a state of increased psychological and physiological tension.76 On the behavioural level it is marked by anxiety, exaggerated startle responses, reduced pain tolerance, insomnia, fatigue, and accentuation of personality traits. As reviewed above, hyperarousal has been discussed as potential mechanism in the aetiology of insomnia (e.g.,*76, *85), but has not been considered as a potential tinnitus mechanism – with the exception of the neurophysiological tinnitus model by
Comordidity of tinnitus and sleep disturbances, results from a survey with 4705 respondents
We performed a cross-sectional survey in a population of 4705 persons with tinnitus who were all members of the German Tinnitus Association (Deutsche Tinnitus-Liga (DTL)116). Information about age and gender as well as measures of subjective tinnitus loudness and chronic somatic conditions was gathered. Tinnitus-related distress, depressive and anxious mood and somatic symptom severity were addressed with validated questionnaires,14, 117, 118 and clinically-relevant hyperacusis, i.e., the
Similarities of brain activation patterns between animal models of tinnitus and insomnia and implications for a neurocircuitry of hyperarousal
Animal models of tinnitus mostly concentrate on the auditory system, while only few studies suggest mechanisms beyond it.121, 122, 123 In gerbils, brain activation patterns were investigated after systemic application of a large dose of salicylate or exposure to loud noise, manipulations that reliably evoke tinnitus in animals and humans. Brains were screened for neurons containing the c-fos protein, a transcription factor widely used as a marker of neuronal activity. After salicylate
Conclusions
In our view, there exists strong evidence for characterizing distressing tinnitus and primary insomnia as expressions of physiological hyperarousal. Even though there are differences between the two conditions, the major one obviously being the presence of the phantom auditory percept tinnitus in the tinnitus condition, there are striking similarities in which hyperarousal appears to play a major role. Distressing tinnitus is often accompanied by insomnia, and even when occurring in separation,
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Objective multidisciplinary measurements of sleep disturbance and autonomic dysfunction as risk factors for chronic subjective tinnitus
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