Sounds for tinnitus at night: how to choose and set them up
What the evidence says about sound for tinnitus at night: masking vs. the mixing point, which sounds to try, speaker vs. earbuds, timers, and when to see a doctor.
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This article is general information, not medical advice. If sleep, hearing or a health problem worries you, talk to a doctor or audiologist.
Silence makes tinnitus louder. Not literally, but in a quiet bedroom the ringing, hissing or humming has nothing to compete with, so it becomes the only thing to listen to. A soft, steady sound at night gives your hearing something else to rest on. For many people that is enough to fall asleep without fixating on the noise in their ears.
The short version: pick a broadband sound you find pleasant (rain, a river, pink noise or a fan are good starting points), play it from a speaker near the bed, and set the volume low, at or just below the level where it starts to blend with your tinnitus. You don’t need to drown the tinnitus out. Sound does not treat or cure tinnitus, and the evidence for sound therapy is weak, so think of it as a comfort tool. If your tinnitus is new, in one ear, pulsing in time with your heartbeat, or came with sudden hearing loss or dizziness, see a doctor first.
Below is what the guidelines and research actually say, and how to set things up.
Sound enrichment, masking and the mixing point
These three terms get mixed up, and the difference affects how loud you set the sound.
Sound enrichment means adding background sound to a quiet environment so the tinnitus has less contrast. The NHS puts it simply in its tinnitus advice: don’t have total silence, because soft music or sounds may distract you from the tinnitus.
Masking means playing a sound loud enough that you no longer hear the tinnitus at all. It gives immediate relief, but it needs more volume, and covering a loud tinnitus can mean a sound level that is not great to sit in for eight hours.
The mixing point comes from tinnitus retraining therapy (TRT), the approach developed by Pawel Jastreboff. It is the level at which the external sound starts to mix with the tinnitus without covering it. The idea in TRT is that your brain can only get used to (habituate to) a sound it can still hear, so you set the sound slightly below the tinnitus, not above it.
That idea has been tested. A 2012 randomized trial in Ear and Hearing (Tyler and colleagues, University of Iowa) assigned 48 people with tinnitus to counseling alone, counseling plus noise generators set to fully mask the tinnitus, or counseling plus noise generators set near the mixing point. After about 12 months, all three groups improved on average on a tinnitus questionnaire (17%, 32% and 36% reductions), and the differences between groups were not significant. The authors concluded that a focus on the mixing point is not required for habituation. It was a small trial, so it does not settle the question, but it suggests you don’t need to agonize over the exact level.
In practice that leaves a sensible middle ground for bedtime: a low, comfortable level where the sound and the tinnitus blend, so the ringing stops being the most prominent thing in the room.
What the guidelines and research say
NICE guideline NG155
The UK’s National Institute for Health and Care Excellence published its tinnitus guideline, NG155, in March 2020. On sound therapy, the committee was unable to make any recommendation for practice. Their reasoning: there are many types of sound therapy and not enough evidence for any particular one. Instead they recommended more research on sound therapy combined with tinnitus support.
NICE was clearer on two related points. Amplification devices (hearing aids) should be offered to people with tinnitus whose hearing loss affects their ability to communicate, and considered for those with hearing loss but no communication difficulties. And clinicians should ask people with tinnitus whether it causes problems sleeping, and consider screening with a questionnaire such as the Insomnia Severity Index. For tinnitus-related distress, NICE recommends psychological therapies in steps, starting with digital cognitive behavioral therapy (CBT).
The takeaway: sleep problems are taken seriously, hearing aids matter if you have hearing loss, and sound therapy is accepted as part of self-help but not proven on its own.
The Cochrane review
A 2018 Cochrane review led by Magdalena Sereda at the University of Nottingham looked at sound therapy using hearing aids, sound generators or combination devices. It included 8 studies with 590 participants. None of them compared a device with no device, a placebo or a waiting list, so the review could not say whether sound therapy works better than doing nothing. Comparisons between device types found no clear winner, and the quality of the evidence was rated low. People using each type of device did report meaningful improvement, but without a proper control group it is hard to separate that from time, counseling and placebo.
Note also what was studied: ear-level devices fitted by audiologists, not bedside speakers or phone apps. Nobody has run a good trial of “rain sounds at night for tinnitus.”
What patient organizations suggest
The American Tinnitus Association describes sound therapy as using pleasant or calming sounds that diminish the presence of tinnitus, and offers a free masking sound library. Its list is a good hint at what works for people: spring rain, rivers, fountains, a waterfall, shower sounds, wind, pink noise, brown sound, white noise and even a cat purring. Mayo Clinic’s tinnitus page similarly mentions white noise machines with pillow speakers for sleep, and notes that fans, humidifiers and air conditioners in the bedroom may make tinnitus less bothersome at night.
Choosing a sound
Match the sound to the pitch of your tinnitus
There is no strong evidence on this, but it is a common practical rule: a sound blends with tinnitus more easily when it has energy in the same frequency region. Tinnitus comes in different pitches, and the NHS lists ringing, buzzing, whooshing, humming, hissing and throbbing.
| Your tinnitus sounds like | Try first | Why |
|---|---|---|
| High-pitched ringing or whine | Rain, a river, white noise, blue noise | Plenty of energy in the upper frequencies where the ringing sits |
| Hissing or a “steam” sound | Pink noise, steady rain, shower | Broadband with a softer top, blends with a hiss |
| Mid-pitched tone or buzz | Green noise, fan, ocean waves | More energy in the middle of the range |
| Low hum or rumble | Brown noise, airplane cabin, heavy rain | Weighted toward the bass |
If you have had a hearing test, an audiologist can estimate the pitch and loudness of your tinnitus, which makes this easier. Otherwise, experiment: play two or three sounds at the same low level and notice which one makes the tinnitus fade into the background soonest.
Why nature sounds often feel better than static
Static is good at covering tinnitus, but many people find hours of hiss tiring or even irritating, and a sound you dislike keeps you alert. Rain, water and wind carry the same broadband energy with some natural variation and no association with a broken radio. A small 2017 fMRI study in Scientific Reports found that listening to natural soundscapes, compared with artificial ones, went along with higher parasympathetic (rest-and-digest) activity. It involved 17 healthy, awake volunteers, so it says nothing direct about tinnitus, but it fits what many people report: the most effective sound is often simply the one you like hearing. Our rain sounds guide covers why rain works for so many people, and the noise colors guide explains white, pink and brown noise.
Avoid sounds with sudden events (loud thunder cracks, birds, dripping) and anything with words or melody you will want to follow. Steady and boring is the goal.
Volume: lower than you think
Set the level lying down with the lights off, and aim for blending, not drowning. Loud sound is a known risk for hearing, and NICE lists exposure to loud noise among the things that can make tinnitus worse, while the NHS advises avoiding loud background noise. If you notice your tinnitus seems louder or more irritated after a night with sound, turn it down. Our article on whether white noise is safe covers safe levels in more detail.
Bedside speaker, pillow speaker or earbuds
| Option | Pros | Cons |
|---|---|---|
| Bedside speaker or phone across the room | Nothing touching your ears, sound feels like part of the room, easy to keep at a low level | Your partner hears it too; less effective if you sleep with one ear in the pillow |
| Pillow speaker (thin speaker under the pillowcase) | Sound stays close to your head at a low level, partner hears less | Can shift during the night; a cable if wired |
| Sleep earbuds or headband headphones | Very private, work when sharing a room or traveling | Pressure and heat in the ear over a whole night, battery life, and the sound is close to the eardrum so volume needs extra care |
For most people a bedside speaker is the simplest start. Pillow speakers suit people who share a bed. Earbuds are useful when nothing else works or when traveling, but keep the volume especially low and give your ears a break if they feel sore.
A note on earplugs: if you live somewhere noisy, earplugs may help with outside noise, but blocking sound tends to make tinnitus more noticeable.
Timer or all night
If your problem is falling asleep, a timer of 30 to 60 minutes is enough, with a gentle fade so the room doesn’t fall silent with a jolt. If you tend to wake at 3 a.m. and the tinnitus is the first thing you hear, keep the sound on all night at a low level so it is still there when you surface.
In Noctune (coming soon to iPhone and Android) the sleep timer runs from 5 minutes to 10 hours (or until a time you choose) and fades the sound out slowly over the last tenth of the timer. Each sound also has a tone control (darker or brighter) and you can mix sounds, which helps when you are hunting for the blend that sits best with your tinnitus. Green, blue and violet noise cover the middle and high bands specifically; you can see all 32 sounds here.
When to see a doctor or audiologist
Sound is a self-help tool, not a diagnosis. The NHS advises seeing a GP if you have tinnitus regularly or constantly, if it is getting worse, or if it bothers you, for example by affecting your sleep or mood. Seek help faster in these cases, based on NHS advice and NICE guideline NG155:
- Tinnitus that beats in time with your pulse (pulsatile tinnitus): ask for an urgent appointment.
- Tinnitus with sudden hearing loss, weakness in the face, or a spinning sensation (vertigo): emergency care now.
- Tinnitus after a head injury: emergency care now.
- Tinnitus in one ear only, or with hearing loss in one ear: get it checked, NICE lists these as reasons for specialist referral.
- Distress that stops you doing your usual daily activities: see your doctor soon (NICE suggests specialist assessment within 2 weeks).
- Thoughts of harming yourself: seek help immediately.
An audiologist can test your hearing (tinnitus often comes with some hearing loss, and hearing aids can help with both) and can guide sound therapy properly. Treatments with the best evidence for tinnitus distress, such as CBT, come through healthcare, not an app.
Questions
What is the best sound to mask tinnitus?
There is no single best sound, and studies have not found one type of sound therapy to be better than another. A broadband sound such as rain, a river, pink noise or a fan is a good start, and many people find it blends best when it has some energy near the pitch of their tinnitus.
Is white noise good for tinnitus?
White noise can make tinnitus less noticeable in a quiet room, and Mayo Clinic lists white noise machines among the options for nighttime. Many people find pure white noise harsh over hours, so softer sounds like pink noise or rain are often easier to live with.
Should the sound be louder than my tinnitus?
It doesn't need to be. Tinnitus retraining therapy suggests setting it so it just starts to blend with the tinnitus, and a small trial found partial and total masking gave similar results. Keep it at a comfortable, low level and never loud.
Can sound therapy cure tinnitus?
No. Sound can make tinnitus less noticeable and make quiet rooms easier, but it does not cure tinnitus, and the research on sound therapy is low quality. Talk to a doctor or audiologist about your tinnitus, especially if it is new, in one ear or pulsing.
Sources
- NICE guideline NG155, “Tinnitus: assessment and management”, recommendations, 2020: https://www.nice.org.uk/guidance/ng155/chapter/Recommendations
- NICE guideline NG155, rationale on sound therapy, 2020: https://www.nice.org.uk/guidance/ng155/chapter/Rationale-and-impact
- Sereda et al., “Sound therapy (using amplification devices and/or sound generators) for tinnitus”, Cochrane Database of Systematic Reviews 2018: https://pubmed.ncbi.nlm.nih.gov/30589445/
- Tyler et al., “Tinnitus retraining therapy: mixing point and total masking are equally effective”, Ear and Hearing 2012: https://pubmed.ncbi.nlm.nih.gov/22609540/
- NHS, “Tinnitus”: https://www.nhs.uk/conditions/tinnitus/
- American Tinnitus Association, “Sound therapy” and masking sound library: https://www.ata.org/about-tinnitus/sound-therapy/
- Mayo Clinic, “Tinnitus: diagnosis and treatment”: https://www.mayoclinic.org/diseases-conditions/tinnitus/diagnosis-treatment/drc-20350162
- Gould van Praag et al., “Mind-wandering and alterations to default mode network connectivity when listening to naturalistic versus artificial sounds”, Scientific Reports 2017: https://www.nature.com/articles/srep45273
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