Can Naps Make Tinnitus Worse?

For many people with tinnitus, sleep is a double-edged sword. A good night’s rest can make the sound seem quieter and more manageable. But for others, waking from a nap or a restless night brings a sudden surge — the ringing feels louder, sharper, or somehow “reawakened.”

This pattern has long puzzled patients and clinicians alike. Why would sleep — our brain’s primary restorative process — sometimes worsen a symptom rooted in neural hyperactivity? Until recently, the connection between sleep and tinnitus was largely anecdotal. That’s beginning to change. Recent research has begun to clarify these dynamics, examining how sleep architecture, breathing patterns, and even naps can modulate tinnitus perception (Attanasio et al., 2013; Guillard et al., 2024; Vanneste et al., 2010; Guillard et al., 2023; Awad et al., 2024; De Maistre et al., 2024; Jastreboff et al., 1996).

Below, I’ll walk through what this emerging science shows, what it might mean for patients, and how clinicians can start thinking differently about the sleep–tinnitus connection.

The Sleep–Tinnitus Link: What We Already Knew

Sleep disturbance is among the most common complaints in chronic tinnitus. In some studies, over 70% of tinnitus patients report poor sleep quality, and a significant subset meet criteria for clinical insomnia (Gallo et al. 2023). Earlier research showed that compared to controls, tinnitus patients often experience altered sleep architecture — more time in light sleep (N1/N2) and less in restorative deep (N3) or REM sleep (Attanasio et al., 2013, Guillard 2023).

Yet while we’ve known that tinnitus and poor sleep frequently coexist, causality has remained murky. Does tinnitus disrupt sleep? Or does poor sleep make tinnitus worse? The answer, it seems, may be “both.”

When Naps Make It Louder: The First Objective Data

A 2025 study led by researchers in Germany tackled a phenomenon many patients describe but few clinicians have measured: tinnitus worsening after naps. In this experiment, 37 participants who routinely noticed louder tinnitus following naps underwent 197 polysomnographically monitored nap sessions (Guillard et al., 2025). The team found that tinnitus loudness — measured via minimum masking level — significantly increased after naps in most participants.

Interestingly, the magnitude of tinnitus worsening correlated best not with how long the nap lasted, but with snoring duration and the number of apnea events recorded during the nap. In other words, sleep-disordered breathing — even during short naps — seemed to influence tinnitus modulation.

The study did not find consistent links between tinnitus change and jaw or neck muscle tension, suggesting that the post-nap flare was not primarily somatosensory. The implication is that the tinnitus exacerbation noted by some after a nap may be mediated by physiologic changes like decreased oxygen levels or an increased stress response provoked by snoring and sleep apnea

Sleep-Related Subgroups: “Sleep-Modulated Tinnitus”

Parallel analyses from large tinnitus registries have identified a distinct sleep-modulated subgroup — individuals whose tinnitus reliably changes after naps or nighttime sleep (Guillard et al., 2024). Roughly one in three patients reports this phenomenon, and most of them experience worsening rather than relief.

These individuals also tend to have more variable tinnitus and a greater sensitivity to other modulatory factors such as stress.

Mechanisms: How Sleep Might Modulate Tinnitus

Several hypotheses are emerging to explain how sleep interacts with tinnitus:

• Local Wakefulness: Even when we appear asleep, the brain doesn’t shut down uniformly. Regions responsible for tinnitus — auditory cortex, limbic circuits, and parts of the thalamus — may remain hyperactive, producing a state of “local wakefulness.” This persistent activity could prevent full restorative sleep, perpetuating a vicious cycle.
  
  

• Hyperarousal and Stress Pathways: The same limbic–autonomic networks that contribute to tinnitus distress are also central to insomnia, stress, and anxiety. Hyperactivation of these circuits may simultaneously cause sleep disruption and amplify tinnitus.
  
  

• Respiratory and Vascular Factors: Intermittent hypoxia from sleep apnea or even mild snoring could influence cochlear or brainstem oxygenation, transiently altering the activity in auditory centers. The correlation between apnea events and tinnitus loudness in nap studies lends weight to this theory.
  
  

• Sleep-Stage Gating Effects: Slow-wave sleep (SWS, primarily in N3) is characterized by global neuronal downscaling and delta oscillations that may temporarily suppress phantom auditory activity. When SWS is truncated or fragmented, tinnitus suppression mechanisms may fail.
  
  

These models aren’t mutually exclusive — they likely interact within a shared physiological framework linking sleep, arousal, and sensory gating.

Practical Implications for Patients

For patients, these findings reinforce something I emphasize often in clinic: treat your sleep as part of your tinnitus care plan.

Some practical takeaways:

• Screen for sleep apnea — especially if you snore, feel unrefreshed, or notice tinnitus worsening after naps. Continuous positive airway pressure (CPAP) therapy can indirectly stabilize tinnitus by improving oxygenation and sleep quality.
  
  

• Prioritize deep and REM sleep by maintaining regular bedtimes, limiting caffeine/alcohol late in the day, and reducing late-night screen exposure.
  
  

• Be cautious with naps if you notice consistent post-nap worsening; short naps (< 20 min) earlier in the day are less likely to disturb circadian rhythm.
  
  

• Track your sleep–tinnitus relationship. Many patients find it enlightening to record sleep hours and tinnitus severity daily. Patterns often emerge that guide behavioral adjustments.
  
  

• Address comorbid anxiety and stress, which aggravate both insomnia and tinnitus perception.
  
  

Clinicians, meanwhile, should consider adding sleep questionnaires (e.g., PSQI, STOP-BANG) to tinnitus assessments. Treating underlying sleep disorders may yield improvements even without direct auditory interventions.

Limitations and Caution

The evidence, while growing, still has caveats. Many studies are small, observational, and reliant on subjective tinnitus reports. Objective measures (like tinnitus loudness matching) are difficult to standardize across nights. Moreover, not all tinnitus sufferers are affected — the sleep-modulated subgroup may represent a specific phenotype with unique neurophysiology (Guillard et al., 2024). Longitudinal interventional trials — where sleep quality is deliberately improved — remain scarce.

Nonetheless, the convergence of findings from PSG, surveys, and case studies suggests that the relationship is real and clinically meaningful.

Closing Thoughts

As both a clinician and someone deeply engaged in tinnitus research, I’ve seen how profoundly sleep influences perception. For some, the ringing fades with rest; for others, it flares. These fluctuations are not random — they reflect how dynamically the auditory system interacts with the rest of the brain.

The takeaway is hopeful: by better understanding sleep’s role, we can move beyond coping toward targeted, personalized tinnitus care — care that treats not just the ear, but the entire human system that surrounds it.

References

• Attanasio, G., Russo, F.Y., Roukos, R., Covelli, E., Cartocci, G., & Saponara, M. (2013). Sleep architecture variation in chronic tinnitus patients. Ear and Hearing, 34(4), 503–507.

• Guillard, R., Philippe, V., Hessas, A., Faraut, B., Michiels, S., Park, M., Congedo, M., Londero, A., & Léger, D. (2024). Why does tinnitus vary with naps? A polysomnographic prospective study exploring the somatosensory hypothesis. Hearing Research, 455, 109152.

• Guillard R, Korczowski L, Léger D, Congedo M, Londero A. REM Sleep Impairment May Underlie Sleep-Driven Modulations of Tinnitus in Sleep Intermittent Tinnitus Subjects: A Controlled Study. Int J Environ Res Public Health. 2023 Apr 14;20(8)

• Guillard R, Philippe V, Hessas A, Faraut B, Michiels S, Park M, Congedo M, Londero A, Léger D. Why does tinnitus vary with naps? A polysomnographic prospective study exploring the somatosensory hypothesis. Hear Res. 2025 Jan;455:109152.

• Gallo KEB, Corrêa CC, Gonçalves CGO, Correia Baran JB, Marques JM, Zeigelboim BS, José MR. Effect of Tinnitus on Sleep Quality and Insomnia. Int Arch Otorhinolaryngol. 2023 Mar 22;27(2):

• Vanneste, S., Plazier, M., van der Loo, E., van de Heyning, P., Congedo, M., & De Ridder, D. (2010). The neural correlates of tinnitus-related distress. NeuroImage, 52(2), 470–480.

• Guillard, R., Philippe, V., Michiels, S., Faraut, B., Park, M., Congedo, M., Londero, A., & Léger, D. (2023). REM sleep impairment may underlie sleep-driven modulations of tinnitus in sleep-intermittent tinnitus subjects: A controlled study. International Journal of Environmental Research and Public Health, 20(8), 5509.

• Awad, M., et al. (2024). Association between sleep characteristics and tinnitus severity: A polysomnographic study. Journal of Clinical Sleep Medicine, 19(5), 1234–1242.

• De Maistre, R., et al. (2024). Sleep-induced tinnitus modulation: A longitudinal case report study. Tinnitus Journal, 1(1), 30927.

• Jastreboff, P.J., Gray, W.C., & Gold, S.L. (1996). A neurophysiological approach to tinnitus patients. American Journal of Otology, 17(2), 236–240.