Does Sleep Apnea Cause Ringing Ears?

Do you wake up with a distinct whining sound in your ears? Or worse, do you go to bed with whooshing, roaring sounds in your ears that make it hard to fall asleep?

If you have a sleep-related breathing disorder like obstructive sleep apnea (OSA) and you’re not treating it, this may be one result.

What causes tinnitus?

Ringing ears, clinically known as tinnitus, describe the experience of hearing sounds that aren’t caused by an external source.

Ringing is only one of the sounds. Tinnitus can also be a high-pitched humming or buzzing sound. Some people describe the sound they hear as the pealing of church bells or roaring static or even a pulsing sound to match your heartbeat.

(Curious what tinnitus can sound like? Listen to these tinnitus examples from the Hear-It.org website).

Ringing ears can be deafening. They can also occur as a constant background noise. Some people with ringing ears aren’t bothered too much by them, but others find the noise oppressive and a major cause for sleep loss, mood swings, or noticeable disruptions to daily life.¹

What is actually happening when ears ring?

Tinnitus starts in the inner ear, specifically the cochlea: the snail-shaped, fluid-filled tube found in the inner ear. The ringing one experiences with tinnitus usually happens as the result of damage to or loss of hair cells both inside and outside the cochlea.

These cells aren’t actually made of hair! They’re sensory receptors chiefly designed to produce, tune, intensify, and manage the frequency and intensity of sound. They quite literally turn sounds you hear into signals which are sent to the brain by way of the auditory nerve.²

Damage to these cells – by whatever cause – can lead to ringing ears.

Chief causes of ringing ears

The Mayo Clinic cites the following as the most common causes of ringing ears:¹

• Damage to the inner ear
• Infection or blockage of the ear canal
• Head or neck injury
• Medication side effects

However, other kinds of conditions or injuries can also lead to tinnitus. This includes OSA.

Can sleep apnea cause tinnitus?

Although research is limited, studies have confirmed links between untreated OSA and hearing impairment. Specifically, researchers identified 2 factors related to this apnea and ear health: ischemia and inflammation.^3,4

Ischemia

Ischemia is reduced blood flow, something that occurs as a result of OSA. When an apnea takes place, the cochlea receives limited or delayed blood flow. This reduction in blood flow can cause damage to the cochlear hair cells if it lasts more than 15 minutes. Damage to these cells can cause ringing ears.

Inflammation

The cochlea is sensitive and requires a constant blood supply to function adequately. When reduced blood flow occurs in the ear, such as what happens with apneas, the hair cells will swell up, leading to impairment linked to tinnitus.

Damage to the inner ear can also be caused by other features of untreated OSA, such as the loud vibrations that result from snoring and depleted oxygen levels in the bloodstream (hypoxia) caused by long pauses in breathing.^5,6

Is CPAP the solution?

Maybe. A research review published in 2020 suggests that continuous positive airway pressure (CPAP) may have both positive and negative impacts on tinnitus.⁷

CPAP may benefit someone with OSA who also has tinnitus by:⁸

• Preventing periods of low blood oxygen
• Improving sleep quality (poor sleep quality is linked to ringing ears)
• Masking the sound of ringing ears through the CPAP machine’s white noise

However, CPAP use may complicate issues with tinnitus by:

• Introducing increases in middle ear pressure which could affect hearing
• Damaging the organs of the ear due to rapid, excessive changes in pressure during CPAP use (rare)
• Leading to vertigo (very rare)

The likelihood of these complications remains so rare that – in the big picture – it’s a better bet to treat your OSA, which may also take care of your tinnitus.

What should you do if you have ringing ears?

As always, your best approach is to visit your doctor if you suspect your ringing ears may be linked to undiagnosed sleep apnea.

You may also want to mention your concerns about ringing ears to your sleep specialist if you already have an OSA diagnosis and are using CPAP. They might decide to adjust your pressure settings to prevent or minimize problems with tinnitus.

Do you experience tinnitus and sleep apnea? Share your story or comment below!