If you talk to enough people who have chronic tinnitus, one thing becomes clear quickly: It’s a challenge to get a good night sleep when you live with constant ringing in your ears.

In the dark stillness and quiet of the bedroom, tinnitus takes center stage night after night, and it can quickly turn your life into a living nightmare.

Note: If you have not read Part 1 of my Sleeping Well With Tinnitus series—Tinnitus keeping you up at night? Try these 11 tips—I encourage you to pause here to read it first, as it covers important basic strategies such as sound masking, brainwave entrainment, and improving sleep hygiene.

I should know: I’ve lived with loud tinnitus for the last 13 years, and when it first started, I nearly stopped sleeping entirely. And as someone who now coaches others to live with the condition, I know sleep disturbances are often one of the most challenging and frustrating aspects of living with tinnitus, because it creates a vicious cycle where a lack of sleep only worsens the condition, making sleep even more difficult the next night.

The good news? This is a solvable problem.

Getting better sleep is not only possible but essential to the habituation process, which is key to finding lasting relief from tinnitus.

Whether your challenge is falling asleep, staying asleep, or both, with the right tools, strategies, and a little bit of effort, you can fix your sleep issues–no matter how severe your tinnitus may seem right now.

In this article, I’ll introduce six new tools and techniques to help you improve your sleep with tinnitus, based on my experience of having the condition and helping others.

Ujjayi Breathing – The best breathing technique for falling asleep you’ve never heard of

This yoga breathing technique is not widely known, but it is one of the most powerful techniques for falling asleep that I have ever come across. In my experience, it can induce a feeling of sedation and sleepiness much faster and more effectively than any other breathing technique.

Ujjayi breathing involves deep, slow breaths through the nose, where the back of your throat is gently constricted to create a soft, ocean-like–or more accurately snoring-like–sound.

The rhythmic sound helps to both focuses your attention away from external distractions (like tinnitus) and sends a signal to your nervous system that it’s time to relax.

There is a small learning curve to this technique as it can be somewhat confusing to learn to breathe through the throat constriction. But once you get it, it’s easy.

1. Find a comfortable position in bed where you are most likely to be able to fall asleep.
2. Inhale deeply through your nose, feeling your belly rise, for a count of 4 seconds, slightly constricting the back of your throat.
3. Exhale slowly through your nose for a count of 4-6 seconds, maintaining gentle constriction to create the same oceanic sound.
4. Focus on the soothing rhythm of your breath and repeat until you feel yourself drifting off. (I usually feel the effects within 10-15 breaths, but I recommend continuing for 5-10 minutes.)

Helpful guided instructions can be found here.

Cognitive shuffling technique for rapid sleep induction

Cognitive shuffling is a sleep induction technique developed by Canadian cognitive scientist Dr. Luc Beaudoin. It’s designed to gently shuffle your thoughts in a way that prevents rumination and anxiety – two big factors that can make it more difficult to fall asleep with tinnitus.

The goal is to engage your mind just enough to distract it from racing thoughts or the constant noise of tinnitus, without triggering stress or focus that might keep you awake. These are the basic steps:

1. Start by choosing a random simple word with at least five different letters, such as “train.”
2. Begin with the first letter "T" and think of a word that starts with the letter T. For this example, “typewriter" could be your first word. Picture a typewriter in your mind, or even better, imagine a scene involving a typewriter.
3. Then think of another word that begins with the letter T and bring up a mental image of that word as well. Keep going until you run out of words that begin with the letter T.
4. Go to the next letter in "Train" - "R", and now think of words that begin with the letter R. Bring up a mental image or scene for each R word, as you think of as many as you can.
5. Continue going through the letter of the word you’ve selected, moving at your own pace. Just keep going until you fall asleep.

Helpful tips: Inhale deeply as you think of the next word. Exhale slowly as you bring up the mental image for that word. If negative thoughts enter your mind, simply come back to the exercise and begin again.

CBTi – Retraining your mind for better sleep

Cognitive behavioral therapy for tinnitus is an effective tool for reducing anxiety related to chronic symptoms. Similarly, CBT for insomnia (CBTi) is an effective, evidence-based, and drug-free approach to treating chronic sleep problems.

With CBTi, the goal is to address the root causes of your insomnia by helping you change negative thought patterns and behaviors that interfere with your ability to sleep.

CBTi focuses on two primary areas of concern: cognitive restructuring and behavioral interventions.

Cognitive restructuring involves helping patients to identify, challenge, and reframe negative and distorted thoughts and beliefs about sleep, such as “I will never be able to sleep when my tinnitus is this loud!”

Cognitive restructuring techniques can help to reframe these thoughts into something more realistic and positive such as, “Even with tinnitus this loud, I can learn techniques to sleep better.” This can help to reduce anxiety and improve your mindset around sleep.

On the behavioral side of things, CBTi emphasizes establishing good sleep habits through techniques and strategies such as:

• Stimulus control: Strictly associating your bed with going to sleep
• Sleep restriction: Limiting the time spent in bed to increase sleep drive
• Relaxation training: Mindfulness training, breathing exercises, and muscle relaxation techniques
• Sleep hygiene training: Maintaining a consistent sleep schedule, improving your sleep environment, and other lifestyle changes to improve sleep quality

CBTi training can take time to see results, but it’s a highly effective option for tinnitus sufferers. If you want to try CBTi, here are some excellent apps and resources:

• International Directory of CBTi Providers
  • US telehealth providers of CBTi can be found here
• Apps for CBTi: Sleepio, Sleep Reset, Stellar Sleep, CBT-i Coach

Supplements I’ve found useful

Disclaimer: I am not a doctor or medical professional. Always consult with your doctor before trying any new medication or supplement.

Magnesium – An important mineral for stress management

Magnesium is a crucial mineral for many bodily functions, including stress and sleep regulation. For tinnitus sufferers, the calming effects of magnesium are especially helpful, as low levels of magnesium are linked to poor sleep quality and increased levels of stress, both of which can increase tinnitus distress. By boosting your magnesium levels through supplementation, you support the body’s natural ability to relax, possibly making it easier to both fall asleep and stay asleep. Look for magnesium supplements with high bioavailability, like magnesium glycinate, aspartate, malate, threonate, or orotate, and typical doses range from 400-800mg daily, best taken in the evening.

Note: Magnesium supplements should not be taken by anyone with compromised kidney function. They also should not be taken with calcium supplements or dairy products, as magnesium can interfere with calcium absorption.

Valerian Root – An ancient natural remedy for better sleep

Valerian root has been used for thousands of years as a natural remedy to address anxiety, nervousness, and sleep issues. Today, it is most commonly used to improve sleep quality and can be very effective for people suffering from tinnitus-related insomnia as it can help to induce drowsiness while also reducing anxiety and tension, both of which can heighten awareness of tinnitus. Valerian root is not considered habit-forming and is widely available in tinctures, capsules, and extracts. I personally prefer valerian root extract tinctures, such as this one offered by Maxx Herbs, which allows for much more precise dosing.

Note: Valerian root may negatively interact with alcohol, as well as with many common prescription and over-the-counter medications.

Cannabinol (CBN) – The best cannabinoid for better sleep

Cannabinol (CBN) is a non-intoxicating cannabinoid derived from the cannabis plant, known for its mild sedative properties, which has made it an increasingly popular natural sleep aid. Unlike THC (the active ingredient in marijuana), CBN won’t make you feel high, but its calming effects can help tinnitus sufferers improve sleep quality. CBN products, such as tinctures, capsules, and gummies, are widely available and often combined with CBD to enhance relaxation without intoxication. Many people – myself included – find CBN highly effective as an occasional sleep aid, but it doesn’t work for everyone, and individual results will vary. It’s always important to start with a low dose and increase gradually.

Note: CBN may interact with common prescription and over-the-counter medications. Consuming CBN may also trigger a false positive result for THC on drug tests. Hemp-derived CBN products are federally legal in the US under the 2018 Federal Farm Bill, but always check all local and state laws before purchasing.

Final thoughts

Tinnitus can be an overwhelmingly difficult problem, even when you’re getting adequate sleep. But when your ringing keeps you up at night, it becomes a much bigger challenge, and it can be hard to break out of the vicious cycle.

Improving your sleep habits is an essential part of managing tinnitus distress and finding relief. And while not every idea in this post will work for every tinnitus patient, I hope you will explore some of these strategies and tools.

No matter what your tinnitus sounds like, you are closer to a good night sleep than you realize. With the right strategies in place, restful, restorative sleep is always within reach.