Cognitive–behavioral factors in tinnitus-related insomnia

Gemma Barry, Elizabeth Marks

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Background: A significant proportion of individuals with distressing tinnitus also report insomnia. Limited, but emerging, evidence suggests that tinnitus-related insomnia cannot be explained only by the presence of tinnitus and that sleep-related cognitive–behavioral processes may play a key role in exacerbating tinnitus-related insomnia. Objectives: This study aimed to assess whether sleep-related cognitions and behaviors believed to maintain insomnia disorder are present in individuals with tinnitus-related insomnia. Methods: This between-groups study recruited 180 participants online for four groups: tinnitus-related insomnia (N = 49), insomnia disorder without tinnitus (N = 34), tinnitus sufferers who are good sleepers (N = 38), and controls (N = 59). They completed questionnaires assessing insomnia severity, sleep-related cognitions and behaviors, sleep quality, anxiety, and depression. People with tinnitus completed a measure of tinnitus severity and rated the loudness of their tinnitus on a subjective measure. Results: Linear regression demonstrated that group significantly predicted sleep related thoughts and behaviors, and sleep quality. Pairwise comparisons showed that the tinnitus-related insomnia group had significantly greater insomnia-related thoughts and behaviors and significantly worse sleep quality than tinnitus-good sleepers. No differences were seen between the tinnitus-related insomnia and the insomnia groups. The tinnitus-related insomnia group had significantly higher depression, anxiety, and tinnitus distress than tinnitus-good sleepers. Conclusion: Findings suggest that tinnitus-related insomnia may be maintained by cognitive–behavioral processes similar to those found in insomnia disorder. Such processes are more important than tinnitus severity when understanding sleep disturbance. People with tinnitus-related insomnia may benefit from treatments such as cognitive–behavioral therapy for insomnia.

Original languageEnglish
Article number983130
JournalFrontiers in Psychology
Publication statusPublished - 17 Mar 2023

Bibliographical note

Funding Information:
This research took place as part of a doctoral undertaking (), so it was supported by the University of Bath.

Funding Information:
The authors are indebted to the participants of this study who agreed to give their time to support this project. The authors are grateful to the charities who supported us in recruitment, most notably the British Tinnitus Association. An earlier version study has been published online as part of the second author’s thesis.

Data availability statement
The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.


  • behavioral
  • CBT
  • cognitive
  • insomnia
  • sleep
  • sleep disorder
  • tinnitus

ASJC Scopus subject areas

  • General Psychology


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