How to Implement

Sound Selection:

• White noise: Broadband sound covering all frequencies—effective for high-pitched tinnitus
• Pink noise: Lower frequencies emphasized—often reported as more pleasant for sleep
• Brown noise: Deep, rumbling sound—helpful for low-frequency tinnitus
• Nature sounds: Rain, ocean waves, forest sounds—psychologically calming with acoustic masking
• Notched sound therapy: Specialized sounds with your specific tinnitus frequency removed—may enhance habituation

Volume Guidelines:

• Partial masking approach: Set volume to 50-60% of your perceived tinnitus loudness. You should still hear tinnitus faintly through the therapeutic sound.
• Mixing point: The sound should blend with tinnitus rather than compete with it—creating acoustic "camouflage" rather than overwhelming coverage.
• Comfort priority: If a sound feels irritating or too loud, lower it. Effective therapy should feel relaxing, not intrusive.

Delivery Methods:

• Sleep-specific apps: Dedicated tinnitus sound therapy apps (like Acouphènes HQ) with all-night playback and smart timers
• Bedside sound machines: Physical devices with pre-programmed sounds—reliable but less customizable
• Pillow speakers: Small speakers placed under or in pillow—privacy for partners, though audio quality varies
• Headband speakers: Soft fabric headbands with flat speakers—comfortable for side sleepers

How to Implement

Typical Ramp Protocol:

• Starting volume: 60-70% of tinnitus loudness when lying down
• Ramp duration: 30-60 minutes (align with typical sleep onset time)
• Target volume: 30-40% of initial volume—enough to break silence without being prominent
• Hold duration: Maintain target volume for remainder of night or until scheduled wake time

Technical Setup:

Most sound therapy apps (including Acouphènes HQ) include gradual volume reduction features. Configure settings before bed:

1. Set initial volume comfortably loud enough to notice but not overwhelming
2. Configure 45-minute ramp-down to 35% of starting volume
3. Enable all-night playback at reduced volume
4. Optional: Set gentle fade-out 30 minutes before wake alarm

Individual Calibration:

Optimal ramp parameters vary between users. Experiment systematically:

• If you're still awake after the ramp completes, extend ramp duration to 60-90 minutes
• If reduced volume feels too quiet and tinnitus becomes prominent, raise target volume to 45-50%
• If you wake during night and tinnitus feels loud, the target volume may be too low

How to Implement

Basic 90-Minute Protocol:

1. Start sound therapy at comfortable volume when lying down to sleep
2. Set timer for 90 minutes of consistent playback
3. After 90 minutes, sound either continues at reduced volume or gradually fades out

Extended Cycle Options:

• One cycle (90 min): Minimum recommended—gets you through to deep sleep
• Two cycles (180 min / 3 hours): Often optimal—covers vulnerable transition periods
• Three+ cycles (270+ min): For severe tinnitus—essentially all-night playback

Combination Approach:

Many users combine cycle timing with volume ramping:

• Minutes 0-90: Full volume, maintain consistently through first cycle
• Minutes 90-180: Gradually taper to 40% volume during second cycle
• Minutes 180+: Maintain low volume or gentle fade-out

Waking Considerations:

If you naturally wake after 4-6 hours (common for tinnitus sufferers), having sound therapy available for "second sleep" helps you return to sleep without prolonged tinnitus awareness. Keep controls accessible on bedside table.

How to Implement

Simple Multi-Source Setup:

• Primary source: Bedside sound therapy app (phone/tablet) with tinnitus-specific sounds
• Secondary source: Small fan or air purifier across room—adds physical air movement and white noise
• Optional third source: Hallway white noise machine with door slightly ajar—reduces household sounds that might startle

Layering Approach:

Combine different sound characteristics for richer masking:

• Base layer: Deep brown noise or distant thunder (low frequencies)
• Mid layer: Rain sounds or pink noise (mid frequencies)
• Accent layer: Soft wind chimes or high-frequency white noise (high frequencies—if tinnitus is high-pitched)

Physical Room Modifications:

• Soft furnishings: Curtains, rugs, upholstered furniture absorb sound reflections, preventing harsh echoes that can emphasize tinnitus
• Window treatments: Heavy curtains block external noise variability (car horns, sirens) that can trigger attention shifts to tinnitus
• Door positioning: Slightly open door allows ambient house sounds to gently penetrate without sudden intrusions

Partner Considerations:

If sharing a bed with someone who doesn't need sound therapy:

• Use directional speakers aimed at your side of bed
• Consider pillow speakers or sleep headband speakers for isolated listening
• Many partners report they also benefit from consistent background sound
• Compromise on volume—slightly lower than ideal is better than relationship conflict

How to Implement

90-Minute Pre-Sleep Protocol:

T-90 minutes (9:00 PM for 10:30 PM bedtime):

• Dim household lights to 30-50% brightness (signals melatonin production)
• Shift from stimulating activities (work emails, news, intense exercise) to calming activities
• Turn off screens or enable blue-light filters on essential devices

T-60 minutes:

• Begin physiological relaxation: warm shower or bath (temperature drop afterward promotes sleep)
• Practice 10 minutes of slow breathing (4-second inhale, 6-second exhale—activates vagus nerve)
• Light stretching or gentle yoga focusing on neck, shoulders, jaw (areas that hold tension)

T-30 minutes:

• Prepare bedroom environment: sound therapy device ready, temperature cool (65-68°F optimal), minimal light
• Journaling: write down three things from the day and tomorrow's top three priorities (reduces "task-oriented" thoughts at bedtime)
• Avoid tinnitus monitoring—don't check if it's still there, don't rate loudness

T-0 (bedtime):

• Lie down, activate sound therapy
• Progressive muscle relaxation: systematically tense and release each muscle group from toes to head
• If mind stays active, use "cognitive shuffle" technique: visualize random objects alphabetically (apple, balloon, camera...) to occupy default mode network without emotional engagement

Critical Elements:

• Consistency: Perform the routine at the same time nightly—establishes conditioned sleep response
• No clock-watching: If you can't sleep after 20-30 minutes, get up and do something calm in another room until sleepy—prevents bed-anxiety associations
• Avoid sleep aids initially: Allow the protocol 2-3 weeks to work before adding supplements or medication (unless advised by doctor)

How to Implement

Elevation Methods:

• Wedge pillow: Gradual 7-10 degree incline from waist to head—more comfortable than stacked pillows, maintains neck alignment
• Adjustable bed base: Elevate head section 15-30 degrees—expensive but most comfortable long-term solution
• Bed risers: Place risers under legs at head of bed frame—creates whole-bed incline (also helps with acid reflux if relevant)
• Extra pillows: Stack 2-3 pillows—least expensive but can create neck strain if not properly supportive

Optimal Positioning:

• Target angle: 10-15 degrees is often reported as optimal—noticeable benefit without sleep discomfort
• Gradual adjustment: If you normally sleep flat, increase elevation by 5 degrees every few nights to adapt
• Side sleeping considerations: Ensure your entire upper body is elevated, not just your head, to avoid neck kinks

Individual Response:

Try elevation for 1-2 weeks before deciding effectiveness. Response indicators:

• Positive: Tinnitus feels less prominent when first lying down, easier to fall asleep
• Neutral: No noticeable change in tinnitus but sleep quality unaffected—can continue if comfortable
• Negative: Neck or back discomfort, sleep quality worsens—discontinue and try alternative strategies

Note: Elevation primarily helps vascular/pulsatile tinnitus. If your tinnitus is high-frequency ringing from noise exposure, elevation may provide minimal benefit. Still worth testing given low risk.

How to Implement

Core Principle: Same Bedtime and Wake Time Every Day

Yes, including weekends. Circadian rhythm doesn't recognize social schedules.

Establishing Your Schedule:

1. Calculate sleep need: Most adults need 7-9 hours. Determine your personal requirement based on when you naturally feel rested (before tinnitus disrupted sleep).
2. Set non-negotiable wake time: Choose based on work/life requirements. Set alarm for this time every day.
3. Back-calculate bedtime: Subtract sleep need plus 30-minute wind-down from wake time. Example: 6:30 AM wake time - 8 hours sleep - 30 min wind-down = 10:00 PM bedtime.
4. Implement gradually: If your current schedule differs significantly, shift by 15-30 minutes every few days until reaching target schedule.

Schedule Maintenance:

• Weekend consistency: Maximum 1-hour variation from weekday schedule—more disrupts circadian rhythm
• Nap restrictions: If you must nap, limit to 20-30 minutes before 3 PM
• Light exposure timing:
  • Morning: Get bright light (ideally sunlight) within 30 minutes of waking—reinforces wake signal
  • Evening: Dim lights 2-3 hours before bed—prepares body for sleep
  • Night: If you wake, avoid bright lights (use dim red lights if necessary)

Difficult Nights Protocol:

Even with tinnitus, maintain schedule:

• If you can't sleep, get up after 20-30 minutes of lying awake
• Do something calm in another room (reading with dim light, gentle stretching)
• Return to bed when sleepy
• Critical: Wake at scheduled time even if you slept poorly—this maintains circadian rhythm and increases sleep pressure for next night

Timeline for Results:

Circadian rhythm entrainment takes 2-4 weeks of consistent scheduling. Initial period may feel difficult, especially if you're sleep-deprived. Most users report that sleep quality begins improving in week 2-3 as rhythm stabilizes.