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Posts: 11
Hi Dr. Nagler--

Love this resource - I read it every day and truly, truly appreciate the insight and time you give all of us! 

My question surrounds sleep.  In my case, as it appears to me, it seems that when I am extremely tired or have gone a few days without the proper hours of sleep because of work travel etc, it seems like my T is especially higher. At night before bed I notice this as well.

I am wondering if that may be tied to the signal of my T coming originating from my brain...meaning the signal is actually stronger when a person is tired due to other issues in the central nervous system.  Or is it that when I am **not tired I actually have a lower T rating and therefore it seems to me that the T is in fact lower.

I hope my question makes sense.  I really try to follow your advice and not dwell on the things I can't control - like T...but I do have a curious fascination with all of this and love to learn about the science of T that may be known.

Thank you as always for your gift of time and knowledge to everyone here!!

Be well.


Dr. Nagler

Posts: 1,764
Hi Jeff -

Thank you for your kind words regarding my efforts and this board. I appreciate it.

Regarding your interesting question, I'd like to tell you that science has a clear understanding of what makes tinnitus loud and what makes it not-so-loud. But if I told you that, I'd be lying. What follows, then, is more along the lines of "how I have come to see it" than something written in stone. (And since you follow this board closely, you will likely recognize that I am paraphrasing some of my response from a previous post.)

So ...

Tinnitus loudness may be viewed is a function of (1) the strength of the electrochemical tinnitus signal itself wherever in the auditory system that signal originates and (2) the brain’s influence upon that signal. Tinnitus is not the electrochemical signal itself; tinnitus is the end product of the signal and the brain’s influence upon it. I strongly doubt that your sleep pattern influences the strength of your tinnitus signal at its point of origin. But if you want to be certain, then you can ask an audiologist with experience in tinnitus loudness matching to perform a loudness match when you are well-rested and again when you are fatigued. The tinnitus loudness match (in dB) is felt to be a reflection of strength of signal at origin. There is, however, a second sort of loudness measurement, the tinnitus loudness rating, which is basically how loud your tinnitus sounds to you (on, say, a 1 to 10 scale) at any given point in time. And the tinnitus loudness rating is a reflection of both the strength of signal at origin and the brain's influence upon it. What you are describing in your post is an increase in your tinnitus loudness rating due to fatigue. The same occurs with stress and anxiety. But I do not believe that any of it represents an increase in your tinnitus loudness match. We are thus talking about the brain's influence upon your tinnitus signal rather than the strength of that signal at its point of origin.

There are numerous factors that affect the brain's influence upon the tinnitus signal. Prominent among those factors are the limbic (emotional) elements and the autonomic ("fight or flight") elements. It is the autonomic elements in particular that are felt to play a role in sleep. Anyway, these limbic and autonomic elements tend to feed upon themselves, and you have very little conscious control over them because they represent an internally-reinforced conditioned reflex. That is why, in my opinion, purposely focusing on trying to "get quiet" is more often than not a fruitless endeavor.

Hope this helps.

Dr. Stephen Nagler
Atlanta Tinnitus Consultants, LLC


The best way to find yourself is to lose yourself in the service of others.
- Mahatma Gandhi

No bird ever soared in a calm. Adversity is what lifts us.
David McCullough quoting Wilbur Wright
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