Elsevier

Sleep Medicine Reviews

Volume 17, Issue 1, February 2013, Pages 65-74
Sleep Medicine Reviews

Theoretical Review
Tinnitus and insomnia: Is hyperarousal the common denominator?

https://doi.org/10.1016/j.smrv.2012.04.003Get rights and content

Summary

Tinnitus is an auditory sensation that is generated by aberrant activation within the auditory system. Sleep disturbances are a frequent problem in the tinnitus population. They are known to worsen the distress caused by the tinnitus which in turn worsens sleep quality. Beyond that, disturbed sleep is a risk factor for mental health problems and distressing tinnitus is often associated with enhanced depressivity, anxiety, and somatic symptom severity. Moreover there is evidence that therapies which alleviate tinnitus-related distress have a positive influence on sleep quality and help interrupt this vicious cycle. This suggests that distressing tinnitus and insomnia may both be promoted by similar physiological mechanisms. One candidate mechanism is hyperarousal caused by enhanced activation of the sympathetic nervous system. There is increasing evidence for hyperarousal in insomnia patients, and animal models of tinnitus and insomnia show conspicuous similarities in the activation pattern of limbic and autonomous brain regions. In this article we review the evidence for this hypothesis which may have implications for therapeutic intervention in tinnitus patients with comorbid insomnia.

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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