1. Aintree Tinnitus Support Group Registered with the BTA AIN1314 – 20% discount on BTA membership

2. The Terms of Reference of Aintree Tinnitus Support Group To provide additional information and support to patients, and their significant others, living with tinnitus It is not a substitute for an individual management plan and individual medical advice cannot be given at the meetings

3. Boundaries Not a substitute for individual assessment Unilateral, pulsatile and distressing tinnitus should be investigated Respect confidentiality Respect any shared experiences Unable to answer specific questions

4. Tinnitus and Sleep Management Gaynor Chittick Chief Audiologist Aintree Tinnitus Support Group September 2015

5. Sleep problems are common Over 40% of adults report difficulty sleeping Over 30% of pre school children Over 25% of the elderly

6. Sleep onset problems are more common in young adults and sleep maintenance problems are more common in the elderly Twice as common in women More common in housewives, unemployed, separated, widowed and living alone Shift workers – sleep still impacted >10yrs later

7. Insomnia Subjective complaints of poor sleep Sleep onset or maintenance problems Delayed sleep by at least 30 minutes 3 or more nights per week Duration of more than 6 months Affects day time functioning

8. Causes of insomnia Biological factors Psychological factors Use of drugs Disturbing environment and bad habits Conditioning

9. Why do we need sleep? Possibly restores or preserves energy Deliberate sleep deprivation Effects are reversed by relatively short amounts of sleep

10. What controls sleep? Sleep pressure & Circadian rhythm Melatonin

11. The Sleep Cycle

12. Tinnitus Cycle

13. Suggestions for managing your sleep better

14. Environment Keep it dark Reserve your bed for bedroom activities Bedroom temperature (18-21 degrees C) Body temperature Clear clutter Get rid of gadgets Bed Sound enrichment

15. Lifestyle Manage day time stress and worries Avoid meals just before bedtime Avoid late night use of technology Avoid napping

16. Diet & Exercise Avoid Caffeine late at night Avoid alcohol Eat healthily Nicotine Exercise for 40 minutes 4 times per week or 30 minutes daily

17. Bed time Routine Relax and unwind Go to bed when sleepy Have a hot bath Get up at the same time every day Use Sound enrichment Do not worry about your sleep Do not spend too long in bed Relaxation Exercises/Visual imagery

18. Regulate your sleep – wake cycle Increase light exposure during the day. Spend more time outside. Keep curtains open. Use a light therapy box. Boost melatonin production at night Turn off the TV & Computer. Don’t read from a backlit device. Change your light bulbs and keep your bedroom dark

19. Sleep restriction Insomniacs spend an excessive amount of time in bed It is useful to estimate how much sleep you actually get and then spend only that amount of time in bed. Keep to the plan for 4 weeks

20. Know when to see your doctor Persistent day time fatigue Loud snoring with pauses in breathing Frequent morning headaches Falling asleep at inappropriate times Any other concerns

21. Thank you