Why does tinnitus get worse with stress and anxiety? Learn when to see an ENT doctor, how to sleep with ringing in the ears and how to make peace with it.
During the day, amid the crowds, the traffic and the television, you can hardly hear it. But at night, when you switch off the lights and lay your head on the pillow, that thin sound is there again: a high-pitched ringing, a buzzing, like the hum of a distant electricity substation. The more you listen, the louder it seems to get. Sleep slips away and the mind asks: "Will this never go away?" Tinnitus and stress are symptoms that feed each other. In tense periods the ringing is heard more loudly; and the ringing turns into a source of stress in its own right. In this article I explain what tinnitus is, when you should see an ear, nose and throat (ENT) doctor first, why anxiety magnifies this sound, how you can sleep more easily at night and ways to make peace with the sound.
What Is Tinnitus?
Tinnitus is the medical name for ringing in the ears: hearing a sound in the ear or inside the head when there is no real external source of sound. People describe this sound in very different ways:
- A high-pitched ringing or whistling
- Buzzing, like a bee or a cricket
- Humming, like wind or the sea
- Hissing, like steam
- A sound that beats in time with the pulse
Brief episodes of ringing are very common. Many people have experienced the ringing left in their ears after leaving a loud wedding or concert. In some people, however, the ringing lasts for weeks, months or years.
Tinnitus is not the name of a disease but a symptom. It can accompany changes in the hearing system, noise damage, age-related hearing loss, earwax, middle ear problems, some medications and other medical conditions. In many people, no clear cause is found. The important point is this: not everyone with constant ringing is bothered by it to the same degree. Some notice the sound but carry on with their lives; for others, their sleep, work and enjoyment become shaped around this sound. Psychological factors play a large part in this difference.
ENT First: Which Ringing Should Be Assessed Straight Away?
Before moving on to the psychological side of tinnitus, it is necessary to emphasise the importance of a medical assessment. In the following situations, see an ENT doctor without losing time:
- Ringing that comes with sudden hearing loss or a blocked feeling in one ear: Early treatment matters in sudden hearing loss; rather than waiting days, you should be assessed the same day or as soon as possible.
- Ringing in one ear only that is constant and getting worse
- Ringing that beats in time with your pulse
- Ringing accompanied by severe dizziness, unsteadiness or nausea
- Ringing that starts with ear pain or discharge, or after a blow to the head
If the ringing comes with symptoms such as drooping of the face, speech problems, weakness in an arm or leg or a sudden and very severe headache, this is an emergency; call 112 (emergency services).
For ringing that has been going on for a long time, it is also important to have a hearing test and an ear examination. Sometimes simply removing earwax or using a hearing aid can noticeably change how the ringing is perceived.
Tinnitus and Stress: Why Does the Sound Get Louder with Anxiety?
Our brain receives countless sounds at every moment, but we consciously notice very few of them. The hum of the fridge, distant traffic, our own breathing... The brain labels these as "unimportant" and pushes them into the background. This filtering allows us to focus on what matters.
In tinnitus, the problem is often less the sound itself than how the brain labels it. If the sound, when first heard, comes with thoughts such as "What is this? Is there something in my ear? Am I going deaf?", the brain marks it as a threat. A sound marked as a threat is not pushed into the background; on the contrary, it is constantly monitored. Just as a mother hears her own baby crying straight away even in a noisy room, the anxious brain picks out the ringing from among all the other sounds and brings it to the front.
Stress strengthens this process in several ways:
- Being on alert: A nervous system under stress is more sensitive to danger signals, and the ringing is perceived as one of these signals.
- Attention turning inwards: Anxious people scan their bodies more often; this scanning leads them to notice the ringing more often.
- Sleeplessness: A brain that sleeps too little is less tolerant of disturbing stimuli.
- Muscle tension: Tension in the jaw and neck muscles can affect the intensity of the ringing in some people.
Many people say the ringing is "louder" on stressful days. Even if the volume of the sound stays the same when measured, the loudness and the discomfort the person perceives genuinely increase. This is one of the clearest signs of the relationship between tinnitus and stress.
The Tinnitus and Stress Cycle: Hearing, Listening, Worrying
Many people living with ringing in the ears describe a similar cycle:
- In a quiet moment, the ringing is noticed.
- The mind immediately interprets it: "Here it is again. It will never go away. How can anyone live like this?"
- These thoughts create anxiety, anger or helplessness.
- The emotional reaction leads the brain to mark the ringing as an even more important signal.
- The person starts listening to the ringing and testing it: straining to hear it in a quiet room, comparing the two ears, covering and uncovering their ears.
- The sound is heard more clearly, and the cycle starts again.
Avoidance behaviours can also be added to this cycle. Some people run from silence and keep the television or radio on non-stop. Others become extremely afraid of noise and start using earplugs even in everyday settings. Keeping the ears blocked all the time can make the brain more sensitive to outside sounds and make ordinary sounds feel disturbing. If you experience intense anger or disgust at particular sounds, this may be a different picture; we have covered this topic in the article on misophonia.
Even if the sound does not change, when the meaning you give it changes, living with that sound can become an entirely different experience.
Why Is It Worse at Night? Sleep and Ringing
The most common complaint of people with tinnitus is sleep. There are understandable reasons for this: at night, outside sounds decrease and there is no background left to mask the ringing. Lying down in bed is also a moment when thoughts put off amid the rush of the day come back.
Let's say you are in your late fifties, newly retired after many years of working in a noisy printing works. While you were working, you hardly noticed the ringing. Now you live in a quiet housing complex, in a flat with no one living above you. At one in the morning you wake up and start listening to that high-pitched sound. The emptiness that retirement has brought, the loneliness of your son having moved to another city and the question "Am I going deaf?" all descend on you at the same hour. You get up tired in the morning and are more tense during the day; the next night the ringing seems even louder.
In this fictional example, the ringing has merged with the sound of a major change in life, of loneliness and of anxiety. If the thoughts that go round and round in bed at night feel familiar, the article on thoughts that come when you lie down may also help.
Steps You Can Take to Make Peace with the Sound
The suggestions below can be applied after an ENT assessment, in addition to your doctor's recommendations. The aim is not to make the sound disappear completely but to reduce the weight it carries in your life.
Fill the silence a little
Completely silent settings bring the ringing to the fore. At night, turning on a fan, the sound of rain or nature sounds at a low level in the room can help. An important detail: keep this background sound not so loud that it masks the ringing completely, but at a level where both can be heard together. In this way, the brain can learn to reclassify the ringing as "an unimportant sound" among the other sounds.
Notice the habit of listening
Notice how many times a day you "check" the ringing. When you catch behaviours such as going into a quiet room to strain to hear it, covering your ears to listen to the sound or comparing the two ears, gently bring your attention back to what you are doing at that moment.
Reframe your thoughts
Saying "This sound is unpleasant, but it is not dangerous; my doctor has assessed it" instead of "This sound is ruining me" reduces the threat that the sound carries. This is not fooling yourself; it is reminding yourself of a realistic perspective.
Build relaxation into your day
Progressive muscle relaxation, slow breathing exercises and short walks lower the nervous system's general level of alertness. A tense body and mind react more strongly to the ringing.
Protect your ears, but do not overdo it
Using ear protection in very loud settings, such as wedding halls, concerts and building sites, protects your hearing. However, keeping your ears constantly blocked against everyday sounds at normal levels can have the opposite effect. When listening to music through headphones, keep the volume at a moderate level and take breaks during long use.
Do not let your life shrink around the ringing
Write down on a piece of paper the things you have given up since the ringing started: perhaps you no longer go out for coffee with friends, no longer attend a course you used to love, or avoid playing with your grandchildren. Choose one small activity from this list and try it again this week. As activities that bring enjoyment and draw attention outwards increase, the ringing can shift from the centre of your life towards its edges.
Keep your sleep routine
Going to bed and getting up at the same time every day, cutting down on caffeine in the afternoon and using the bed only for sleep strengthen sleep. When you cannot sleep, rather than tossing and turning in bed listening to the ringing, get up, occupy yourself with something calm in dim light and go back when you feel sleepy.
When Should You Seek Professional Help?
The medical assessment of ringing is the job of the ENT doctor and the audiologist. After the medical assessment, working with a mental health professional can be helpful in the following situations:
- If your sleep has been noticeably disrupted by the ringing
- If you think about the ringing constantly during the day and check the sound
- If you have begun to avoid quiet settings or social activities
- If the ringing is accompanied by intense anxiety, anger, helplessness or low mood
- If the thought "I can't live with this sound" often comes to mind
Some people may experience deep hopelessness together with ringing that lasts a long time and disrupts sleep. If thoughts of harming yourself or ending your life are going through your mind, do not carry them alone; share them with someone close to you and with a mental health professional. In an emergency, call 112.
Whether medication is needed is decided by a psychiatrist.
How Is Tinnitus Addressed in Therapy?
The aim of psychological approaches to tinnitus is not to silence the sound but to reduce the distress it creates and its impact on life. Cognitive behavioural approaches are known to be helpful in reducing tinnitus-related distress and sleep problems.
Cognitive Behavioural Therapy (CBT): Catastrophic thoughts about the ringing ("It will never go away", "I'll go mad", "I'll go deaf") are examined together with the doctor's findings. As the threat the sound carries decreases, the importance the brain gives it can decrease too. Checking and avoidance behaviours are changed gradually.
Attention work: The person practises being able to shift their attention flexibly from the ringing to other stimuli. The aim is not to stop hearing the sound but to prevent it from settling at the centre of attention.
Acceptance-based work: Rather than fighting the ringing, accepting it as a background sound and turning towards valued activities brings relief to many people.
Sleep-focused work: Sleep routine, pre-bed routines and what to do on waking at night are worked on.
Underlying stress and life changes: Issues such as retirement, loss, loneliness or work stress experienced during the period when the ringing became prominent are also addressed in therapy.
You can find details of working with anxiety-related physical symptoms on the anxiety and panic page; sessions can be carried out face to face or online.
Frequently Asked Questions
Can stress alone cause tinnitus?
Rather than being the only cause that starts the ringing, stress makes existing ringing more noticeable and more disturbing. Some people say their ringing first began during a very stressful period. In every case, an ENT assessment should be carried out first.
Does tinnitus go away over time?
Some ringing, especially after noise or due to a temporary cause, eases by itself. With long-lasting ringing, even if the sound continues, many people get used to it over time and the discomfort decreases markedly. Anxiety slows this process of habituation, while psychological support can speed it up.
Does listening to music through headphones make ringing worse?
Listening to loud music for long periods can damage hearing and make ringing worse. It is important to keep the volume at a moderate level and to take breaks. Calm music listened to at a low level, on the other hand, helps some people draw their attention away from the ringing.
Should I worry if I only hear ringing in a quiet room?
Hearing a slight ringing or humming in very quiet settings is something many people experience. If the sound does not bother you and there is no change in your hearing, it usually needs no concern. Still, if you want to be sure, you can have an ear examination.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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