Dr. Nagler, in all of the years of being in the tinnitus field, and the numerous conferences you have been to etc.
Is there one theory that stands out among others regarding why T can be perceived as very low for 5-7 days, then high for 5-7 days, almost like a cycle. This is how my brain reacts to T
Gary, please allow me to make a slight clarification before giving you an answer that will surely frustrate you. The clarification is that you are not describing how your brain
reacts to tinnitus, but rather how your brain
perceives tinnitus. As far as the answer to your question goes, I'm afraid that the answer is no - there is not any one theory that stands out among the others. That doesn't stop folks from wondering, though. For me, after wondering throughout the first year or so of my own tinnitus odyssey, I gave up trying to figure it out and came to the conclusion that the only predictable thing about tinnitus is its unpredictability. That goes for the types of patterns you describe as well. It is quite rare that the patterns persist longer than six months or so. They just seems to change over time - sometimes gradually and sometimes abruptly. That's one of the reasons I eventually came to the conclusion that reaction is far more important than perception in the search for relief.
Then there is what I call the sleep phenomenon, when I awake in the morning, if T is high it will stay that way all day, and not go into a low cycle until I awake the next morning. Mine never gets lower once I awake. However, if I am having a low day and nod off for thirty minutes I wake up with it being very high, this has happened four time now, so no naps for me on a low day. Has this ever been brought up to you before.
Lots of theoretical and speculative possibilities here, Gary. Dr. Jastreboff feels that the issue is one of neurotransmittors being somewhat dependent on the amount sleep - especially REM sleep. I am partial to another view that focuses on the role of the reticular formation in increase of tinnitus perception after a nap. The reticular formation is a primitive structure in the brain stem. It is, if you will, a vital sign monitor. When you wake from a nap or from sleep, the RF checks to see whether or not you are alive. It looks for heartbeat, respiration, blood pressure, temperature - basic bodily signs. It does not care whether or not these signs are good or bad, just that they are present. In a person suffering from intrusive tinnitus, the RF views the tinnitus as part of "normal" body function - so upon waking, the RF checks to see whether or not tinnitus is present. If it doesn't immediately find the tinnitus, the RF seeks it with a vengeance - - especially in the post-nap state, when there has been inadequate REM sleep and when, therefore, the RF is already on "high alert" that something might not be quite right. Theoretically - very theoretically - this RF hyperactivity in seeking tinnitus after napping results markedly augmented tinnitus perception.
Going back to this reaction/perception clarification to which I referred earlier, perhaps you can now see why I focus on reaction so much - because if you do not react to your tinnitus, what difference does it make how loud it might be at any point in time ... or why!!
Hope this helps more than confuses.
Dr. Stephen Nagler
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