How Tinnitus Contributes to Sleep Apnea in Veterans

Sleep apnea is a condition that causes a person to stop breathing for short periods during sleep. One type—obstructive sleep apnea (OSA)—happens when the muscles in the throat relax too much during sleep, causing the airway to narrow or close. For veterans dealing with both tinnitus (a constant ringing or buzzing in the ears) and obesity, there’s growing evidence that tinnitus plays a key role in causing or worsening OSA.

According to Dorland’s Medical Dictionary, sleep apnea is “the collapse or obstruction of the airway with the inhibition of muscle tone that occurs during REM sleep”—the phase of sleep when most dreaming happens. During REM, the body becomes temporarily paralyzed (except for eye movement), and this includes the muscles that normally keep the airway open.

For people who are overweight, fat deposits around the throat already narrow the airway. When REM sleep kicks in and the muscles—including the tongue—are paralyzed, the tongue can fall backward and block the airway entirely. That’s when a person stops breathing.

What Does Tinnitus Have to Do With It?

Emerging research and expert opinion suggest that tinnitus can play a major role in this process. In veterans—especially those who are obese—tinnitus may interfere with the brain’s ability to regulate sleep and muscle tone. This disruption can make it more likely for the airway to collapse during sleep.

In simple terms, both factors are needed: a narrowed airway and relaxed throat muscles. Obesity creates the narrowing, but it’s the REM-related muscle paralysis—possibly worsened by tinnitus—that allows the airway to fully collapse.

VA Disability and Sleep Apnea: The Legal Standard

Under VA rules, a veteran can qualify for disability benefits if a service-connected condition—like tinnitus—is a substantial factor in causing another health problem, like sleep apnea. Even if other factors like obesity are also involved, the VA must consider whether the service-connected condition contributed meaningfully to the development of the illness.

The legal precedent says that if a condition like tinnitus was a “substantial factor” and the problem “would not have happened without it,” then it should be recognized. This principle comes from court cases like Shyface v. Secretary of Health & Human Services and VA legal opinions such as VAOPGCPREC 6-2003.

Current Scientific Understanding

Today, the medical community widely agrees that OSA isn’t caused by just one issue. It takes both a narrowed airway and neuromuscular dysfunction—meaning the throat muscles don’t work properly during sleep. A key study in the journal Chest explained that only about one-third of sleep apnea severity can be explained by physical narrowing of the airway. The remaining two-thirds is due to how the brain controls the muscles that keep the airway open.

This is especially important for veterans, who often suffer from service-related conditions like PTSD, depression, and tinnitus. These are much more common among veterans than in the general public and are known to affect sleep quality and brain function.

Why the VA Got It Wrong

When reviewing this case, the VA only looked at sleep apnea causes in the general population—where obesity and aging are the main culprits. But veterans are not the general public. In the VA system, many cases of sleep apnea are linked to mental health conditions and neurological issues, including tinnitus.

Tinnitus is more than just an annoying sound—it can interfere with sleep regulation, increase stress, and contribute to physical changes in the brain that affect how breathing is controlled during sleep. That’s why it should be recognized as a contributing cause of sleep apnea in veterans.

Conclusion

Veterans with tinnitus, especially those who are also overweight, face a unique set of challenges when it comes to sleep health. The science now supports the view that tinnitus isn’t just a side issue—it can be a substantial factor in causing sleep apnea. And when that’s the case, VA disability law says it should be taken seriously and recognized accordingly.