How I classified a sleep disorder - in Israel. I was working with Dr Josef Attias in the Israeli medical corps at Tel Hashomer hospital in Tel-Aviv as a brain research of the auditory system and how to defend the auditory system from the stress of being in the military. A major problem for soldiers is that they can acquire tinnitus. A problem where a person afflicted will have a ringing in the ears sensation. At the time, Dr. Attias and his co-worker Dr. Zecharia Shemesh were trying to help tinnitus patients with self hypnosis as well as find a way to increase the immune system with vitamins that might help the auditory system to withstand high noise levels of stress. I was helping them as part of my reserve duties to do brain stem auditory testing or brain stem auditory evoked responses on different patients who came to the Noise Hazards research and Evoked Potentials Laboratory of the I.D.F. As I was also a registered polysomnographic technologist, R.Psg.T. and performed sleep research at the Technion Institute of Technology in Haifa , I knew something about sleep disorders. However, after I finished my master degree in neurosciences at the Technion I joined the staff at the sleep laboratory at Tel-Hashomer medical center which was across the street from the Noise Hazards Institute. Well while testing the patients brainstem auditory evoked responses BAER, I wondered if the tinnitus patients' ringing in their ears kept them awake. It was funny, I performed many sleep tests by now and never noticed a patient who came to the sleep center because of their ringing in their ears. So I began to ask the patients if they had any sleep disturbances. well to my surprise about half the patients said yes. This was unusual. I began to check the literature and although tinnitus patients would say on a general tinnitus questionnaire that they did have sleep disturbances they did not show up for a sleep test- nor were referred by a doctor either. So I decided to offer a specific dedicated mini sleep questionaire and after about 25 patients the picture showed that about half complained of moderate sleep disturbances. If this was the case, and since I worked in a sleep lab, I decided to check the polysomnographs at Tel Hashomer for any patient who came to the sleep center with a complaint or history of tinnitus and have a look at their results. Well the results were astonishing. out of 1000 records I checked only 10 patients had a main complaint of tinnitus, however, there were quite a few with another complaint as Sleep Apnea and tinnitus too. After going over their records I discovered that the patients who had tinnitus with another sleep problem had worse sleep results than people with tinnitus alone or sleep apnea alone. Thus, what was happenening now made sense. if you could not sleep well, then the ringing in the ears would keep you up longer. however, if you only had tinnitus, then it was in most patients not passing the threshold of severity to make it a reason to seek a sleep exam. Thus it became obvious that any patient with tinnitus was at risk of having a severe sleep disorder if it was combined with another sleep problem. After I published the results in Biological Psychiatry I notified the nosology committee at the sleep society and they acknolowedged my work (below). Years later I opened up a new book on sleep disorders classifications with noticed a new sleep disorder - tinnitus as a non-REM parasomnia and my paper referred to first as it was the very first objective physiological study of sleep records in tinnitus patients.
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