Tinnitus at night: what the NHS and NICE say about sound, sleep and getting help

Tinnitus is hearing a sound that is not coming from outside: ringing, buzzing, hissing, humming, whooshing, throbbing, even music. During the day other sounds cover it. In a quiet bedroom at night there is nothing left to cover it, and many people notice it most when they are trying to fall asleep.

This article gathers what the NHS and the National Institute for Health and Care Excellence (NICE) say about tinnitus and sleep, as of 28 October 2026. It is general information and does not replace a GP or audiologist.

First, rule out the urgent cases

Most tinnitus is not serious. The NHS says it is not usually a sign of anything serious and may get better by itself. Some symptoms change that.

Go to A&E or call 999 if your tinnitus:

• started after a head injury;
• comes with sudden hearing loss, weakness in the muscles of your face, or vertigo.

The NHS adds: do not drive yourself, and take any medicines you use with you.

Ask for an urgent GP appointment if the sound beats in time with your pulse. This is called pulsatile tinnitus, and NICE recommends imaging for it.

NICE sets out the same picture for clinicians. People whose tinnitus comes with sudden neurological symptoms such as facial weakness, uncontrolled vertigo or a suspected stroke should be referred immediately. Anyone with tinnitus and hearing loss that came on suddenly, over three days or less, within the last 30 days should be seen within 24 hours.

See a GP (not urgent) if your tinnitus is regular or constant, is getting worse, or is affecting your sleep, concentration or mood. Sleep is on that list, so a few weeks of bad nights is reason enough to book.

What the GP does

The GP will look in your ears for treatable causes such as an ear infection or a build-up of earwax, and may check your hearing. You may be referred to a specialist.

The NHS lists several things tinnitus is often linked with: hearing loss, Ménière's disease, conditions such as diabetes, thyroid problems or multiple sclerosis, anxiety and depression, and some medicines, including certain chemotherapy drugs, antibiotics, anti-inflammatories and aspirin. Do not stop a prescribed medicine on your own. Ask the doctor who prescribed it.

Why the quiet makes it louder, and what the NHS suggests

The NHS self-help advice is direct on this point: do not try to have total silence. Soft music or other sound therapy can help distract you from the tinnitus. It also advises against focusing on the tinnitus, because that can make it worse, and suggests hobbies to take your mind off it.

Its other suggestions are aimed at sleep and stress:

• try relaxation, such as deep breathing or yoga;
• improve your sleep, for example with a bedtime routine and less caffeine;
• avoid stress, and avoid loud background noise;
• think about a support group.

Put those together and you get quiet background sound, not loud sound. The idea is to give the brain something else to hear. A gentle sound at a low volume does that without adding noise exposure.

Tinnitus UK, the charity the NHS refers to, has more self-help material and a free helpline on 0800 018 0527.

What the research says about sound therapy

This is where it gets less tidy. "Sound therapy" in research usually means devices: hearing aids, sound generators worn in the ear, or combination devices. The evidence on them is weak.

A 2018 Cochrane review (Sereda and colleagues) looked for randomised trials of these devices in adults. It found eight studies with 590 participants. None of them compared a device with a waiting list, a placebo or education alone, so the review could not say whether sound devices beat doing nothing. Where devices were compared with each other, both kinds were linked to a clinically meaningful drop in tinnitus severity, but the evidence was rated low quality. None of the studies measured sleep quality.

NICE reached a similar conclusion in its 2020 tinnitus guideline (NG155). On sound therapy, its committee "were unable to make recommendations for practice" and asked for more research instead.

That does not mean background sound at night is useless. It means nobody has run the trial that would show how much it helps. The NHS still lists it as self-help, and it is cheap and easy to stop if it does nothing for you.

Treatments with stronger backing

NICE is clearer about other options.

Psychological therapy for tinnitus-related distress. For adults whose tinnitus still affects their wellbeing and daily life after initial support, NICE recommends a stepped approach. Start with digital tinnitus-related CBT. If that does not help, move to group-based therapy (mindfulness-based cognitive therapy, acceptance and commitment therapy or CBT). After that comes individual CBT with a psychologist. The NHS says digital CBT is usually offered first.

Hearing aids if you have hearing loss. NICE recommends offering amplification devices to people with tinnitus whose hearing loss affects communication, and considering them when it does not. It says not to offer them to people with tinnitus and no hearing loss.

Tinnitus counselling and tinnitus retraining therapy. The NHS describes counselling as help to understand tinnitus and cope with it. Retraining therapy uses sound to help the brain notice the tinnitus less. It may be available on the NHS for severe or persistent tinnitus, though the NHS says it is not clear whether it works for everyone.

Not recommended: NICE says not to offer betahistine, a medicine for Ménière's disease, to treat tinnitus.

Sleep gets asked about. NICE tells clinicians to ask people with tinnitus whether it causes sleep problems and, if it does, to consider a questionnaire such as the Insomnia Severity Index and use the result in the care plan. If tinnitus is costing you sleep, say so at the appointment.

A practical night routine, within the guidance

Everything here comes from the advice above:

1. Keep a regular bedtime routine and cut down on caffeine.
2. Do not aim for a silent room. Play a soft, steady sound or quiet music at a low volume.
3. Use something relaxing before bed, such as slow breathing.
4. If you lie awake listening to the tinnitus, shift your attention to something else instead of monitoring it.
5. If it keeps affecting your sleep, see your GP and mention the sleep problem by name.

Nanu, a sound app for the bedroom

At X MAXIMUS LABS we make Nanu, a white noise app for iPhone. It has 21 sounds made on the iPhone itself and looping without a seam: white, pink and brown noise, rain, ocean, stream, wind, fan and others. It keeps playing with the screen off, and a timer runs from 15 minutes to 10 hours, or until a set time, with a gentle fade-out. No ads, no account and no tracking.

Free: every sound, for up to 30 minutes at a time, with 15- and 30-minute timers. Nanu Plus adds all-night playback, longer timers, stopping at a set time, and mixes of up to four sounds. It comes as a monthly or yearly subscription (the yearly plan starts with 3 free nights) or a one-time purchase; the App Store shows the price in your currency.

Nanu is not a medical device and not a tinnitus treatment, and none of the studies in this article tested it.

Nanu on the App Store · Questions: info@xmax.es · Privacy

Sources

• NHS, 'Tinnitus', reviewed 12 January 2024. nhs.uk
• NICE (2020). Tinnitus: assessment and management (NG155), published 11 March 2020, recommendations 1.2, 1.3.5, 1.4.9 and 1.5. nice.org.uk
• Sereda, M., Xia, J., El Refaie, A., Hall, D. A. and Hoare, D. J. (2018). 'Sound therapy (using amplification devices and/or sound generators) for tinnitus'. Cochrane Database of Systematic Reviews, 12, CD013094. PubMed 30589445