From the Guidelines
A comprehensive treatment plan for anxiety and insomnia related to tinnitus should prioritize cognitive behavioral therapy for insomnia (CBT-I) and cognitive behavioral therapy (CBT) as the first line of treatment, as recommended by the American Academy of Sleep Medicine and the American Academy of Otolaryngology—Head and Neck Surgery Foundation 1.
Key Components of Treatment
- CBT-I should focus on sleep hygiene, stimulus control, and relaxation techniques to address insomnia symptoms.
- CBT should be recommended to patients with persistent, bothersome tinnitus to address the psychological response to tinnitus.
- Sound therapy using white noise machines or smartphone apps can be used to mask tinnitus at night, making it easier to fall asleep.
- Progressive muscle relaxation and mindfulness meditation practiced for 10-15 minutes daily can significantly reduce anxiety related to tinnitus.
Medication Considerations
- Medications such as selective serotonin reuptake inhibitors (SSRIs) and non-benzodiazepine sleep aids may be considered for short-term use, but should not be the primary treatment approach.
- The use of medications should be carefully monitored and adjusted as needed to minimize potential side effects and maximize benefits.
Importance of Regular Follow-up
- Regular follow-up every 2-4 weeks initially is important to monitor treatment effects and adjust the treatment plan as needed.
- Continuing to work with an ENT specialist on the underlying tinnitus management is crucial to ensure comprehensive care.
Evidence-Based Recommendations
- The American Academy of Sleep Medicine recommends CBT-I as the treatment of choice for chronic insomnia disorder, with a strong recommendation based on high-quality evidence 1.
- The American Academy of Otolaryngology—Head and Neck Surgery Foundation recommends CBT for patients with persistent, bothersome tinnitus, with a recommendation based on randomized controlled trials (RCTs) 1.
From the FDA Drug Label
Zolpidem tartrate tablets are indicated for the short-term treatment of insomnia characterized by difficulties with sleep initiation. The FDA drug label does not answer the question.
From the Research
Treatment Plan for Anxiety and Insomnia Associated with Tinnitus
The treatment plan for anxiety and insomnia associated with tinnitus, currently being managed by an Ear, Nose, and Throat (ENT) specialist, may involve the following:
- Cognitive Behavioural Therapy for insomnia (CBTi) to address sleep disturbances and related anxiety and depression, as shown in studies 2, 3
- Mindfulness-Based Cognitive Therapy (MBCT) to reduce tinnitus severity, psychological distress, anxiety, and depression, as demonstrated in studies 4, 5
- A comprehensive audiologic evaluation to identify underlying hearing problems and rule out potentially dangerous causes of tinnitus, as recommended in study 6
- Sound therapy and tinnitus retraining therapy as potential treatment options, although evidence is inconclusive, as noted in study 6
- Medications such as melatonin, antidepressants, and cognitive training to help with sleep disturbance, mood disorders, and cognitive impairments, as suggested in study 6
Key Components of Treatment
The key components of treatment for anxiety and insomnia associated with tinnitus include:
- Addressing sleep disturbances through CBTi or other therapies
- Reducing tinnitus severity and related distress through MBCT or other interventions
- Identifying and addressing underlying hearing problems or other potential causes of tinnitus
- Providing education and support to help patients manage their symptoms and improve their quality of life
Benefits of Treatment
The benefits of treatment for anxiety and insomnia associated with tinnitus include:
- Significant improvements in insomnia, sleep quality, and related anxiety and depression, as shown in study 2
- Reduced tinnitus severity and related distress, as demonstrated in studies 4, 5
- Improved quality of life and increased confidence, as reported in study 3
- Enhanced ability to manage symptoms and cope with tinnitus, as suggested in study 6