What is Exploding Head Syndrome?
Exploding head syndrome (EHS) is a harmless sleep condition where people experience the sensation of a loud noise while sleeping, causing them to wake up suddenly. These incidents usually happen during the transition from wakefulness to sleep or vice versa and typically last less than a second. Besides the perceived loud noise, people might also see flashes of light and have a certain level of distress, but they don’t usually experience any significant pain.
The sounds someone perceives can be described as various loud noises, such as explosions, gunshots, or thunder. These sounds can occur at different times and there may be long periods between each episode. This condition was first mentioned in a medical context in 1876 by an American neurologist named Silas Weir Mitchell. However, it was only officially recognized as a type of sleep disorder in 2005.
People who experience EHS may find it very scary, especially if they are not aware that it’s a harmless condition. Because of the intense sounds, some might worry about serious health issues like a stroke, brain tumor, or bleeding in the brain, leading them to seek medical help. However, EHS is often not diagnosed or reported because people might feel embarrassed about their symptoms, and some healthcare providers might not be familiar with the condition.
What Causes Exploding Head Syndrome?
The exact cause of Exploding Head Syndrome (EHS) isn’t yet known, but researchers have made a few educated guesses:
1. They think it might have something to do with delayed decrease of reticular formation activity. This is a fancy way of saying that our brain activity doesn’t slow down as quickly as it should when we’re transitioning from being awake to being asleep, and this results in increased activity in the neurons that are responsible for sensation.
2. There might be complex partial seizures happening within the temporal lobe of the brain, which is the area just above the ears that’s involved in processing senses and emotions.
3. There could be something wrong with the ear itself:
1. Dysfunction of the Eustachian tube (which connects the middle ear to the back of the nose and helps to control pressure).
2. Leaks in the perilymph (fluid in the inner ear).
3. Rupture of the round window membrane (a thin layer of tissue that separates the middle and inner ear).
4. Temporary malfunction of the cochlea (part of the inner ear) or its connections in the brain.
5. Sudden involuntary movement of the tympanum or tensor tympani (parts of the ear involved in hearing).
It may also be due to unusual attention processing during the transition from wake to sleep, altering the way we perceive sounds or visuals.
Some other possible causes might include an aura before a migraine, side effects from suddenly stopping certain types of antidepressants or anti-anxiety medications, or a gene mutation that causes temporary dysfunction in the calcium channels in our bodies.
Risk Factors and Frequency for Exploding Head Syndrome
Exploding head syndrome (EHS) is a condition that hasn’t been widely studied, so the exact number of people affected is unknown. It doesn’t affect one gender more than another, but some studies have found it tends to be more frequent in women. Starting off, it was thought to be uncommon and typically found in middle-aged women. However, newer studies show that EHS could be more common than people thought, affecting all ages. This includes as many as 16% of college students, according to one study.
Elderly people are more likely to report having EHS symptoms. This might be due to their worry about age-related brain issues. EHS also seems to be more common in people who have been diagnosed with sleep paralysis. In one study, nearly 37% of people who’ve experienced sleep paralysis also reported having EHS at least one time.
- There’s no one cause for EHS, but some people say they have more episodes when they can’t sleep or are very stressed.
- Other sleep-related issues, like vivid or scary dreams, nightmares, and being aware while dreaming may also happen at the same time as EHS.
Signs and Symptoms of Exploding Head Syndrome
The International Classification of Sleep Disorders has outlined several criteria for diagnosing Exploding Head Syndrome (EHS). These include:
- Hearing a sudden, loud sound in their head when waking up at night or during the transition stage between waking and sleeping
- Feeling a scary jolt following this sound
- Not experiencing significant pain with these episodes
Incidents of EHS are more commonly reported when individuals are transitioning from being awake to sleeping, rather than vice versa. Accompanying symptoms can include visual flashes of light, muscle twitching (hypnic jerks), and signs of fear like sweating, heart palpitations, and shortness of breath. Importantly, EHS episodes are not associated with substantial pain. If a person complains of pain, it’s likely linked to the shock or fear rather than EHS itself. Any report of pain warrants additional medical evaluation to rule out other potential diagnoses.
During the evaluation of EHS, healthcare providers should also investigate the presence of other sleep disorders, as well as any underlying medical and psychiatric conditions. For instance, sleep apnea often co-occurs with EHS. Similarly, there’s a notable connection between EHS, sleep paralysis, and insomnia. Sometimes, EHS can even act as a precursor to insomnia.
A psychological assessment may also be beneficial for detecting any underlying stress or anxiety issues. Notably, the physical examination of a person with EHS often appears normal compared to a standard neurological exam.
Testing for Exploding Head Syndrome
EHS, or Exploding Head Syndrome, is a condition that is diagnosed based on a set of guidelines called ICSD-3 criteria, rather than through any specific tests. When a doctor suspects EHS, they may conduct scans of the brain using a process called magnetic resonance imaging (MRI), or monitor brain activity using a procedure called an ambulatory electroencephalography (EEG). However, both of these tests will generally turn up normal results, which means they won’t show any unusual patterns or signs of epilepsy.
Another technique doctors might use is polysomnography, which is a type of sleep study used to monitor and record various physical activities while you sleep. For people with EHS, sleep duration and architecture (the way sleep is organized into different stages) are normal. The unusual symptoms of EHS are most likely to happen during the transition between being awake and falling asleep, or vice versa, and sometimes when waking up from a stage of sleep known as N2.
In one study, even though the patients felt like they were asleep during EHS episodes, their brain waves showed a pattern of alpha waves mixed with some theta activity, which are typically associated with relaxed alertness and light sleep, respectively. There weren’t any signs of epilepsy. Another study found additional oscillatory (wave-like) activity happening at the same time as the alpha waves during EHS episodes. These were different in how they were generated and in their frequency (how often they occur).
Treatment Options for Exploding Head Syndrome
The primary treatment for Exploding Head Syndrome (EHS), a benign sounding condition where a person ‘hears’ loud noises when falling asleep or waking up, involves educating the patient about the harmless nature of the syndrome. Sometimes, simply explaining the condition can help reduce the frequency of attacks. Also, treating anxiety can help, as anxiety may increase the frequency of episodes.
Additionally, it’s important to identify and deal with any stress triggers, adhere to a regular, healthy sleep pattern, and treat any other sleep disorders the patient may have. While verified treatments for EHS are lacking because there is not much research or clinical trials conducted on this topic, overall, if non-pharmacological measures aren’t enough and the condition is very distressing, some medications are reported to be effective in helping reduce the frequency and intensity of the symptoms.
The following types of medications have been found to be beneficial in certain cases: Clomipramine, an antidepressant, has entirely resolved symptoms for three patients. Amitriptyline, another antidepressant, has lessened the frequency of episodes in one patient and completely gotten rid of them in another person. Topiramate, a medicine primarily for seizures, lessened the intensity of the sound attacks. Duloxetine Hydrochloride, a medication used for depression and anxiety, reduced the number of episodes and their length for one out of two patients. And Nifedipine, a medicine to control high blood pressure, has also been found helpful. However, it is important to remember that the effectiveness of these medications can vary from person to person.
What else can Exploding Head Syndrome be?
When trying to diagnose exploding head syndrome, doctors will consider several possibilities that can present with similar situations:
- Nocturnal epilepsy: This happens during NREM sleep. But unlike exploding head syndrome, patients don’t remember what happened.
- Hypnic headaches: These are recurring headaches that interrupt sleep. They cause pain lasting from 15 minutes up to 4 hours. These headaches could happen on one or both sides of the head and occur for more than 10 days in a 3-month period. Unlike other headache syndromes, exploding head syndrome is more scary than painful. Any pain felt is usually a minor part of the complaint.
- Post-traumatic stress disorder and nightmare disorder: With exploding head syndrome, patients can’t remember any specific dream content.
Doctors will carefully study these conditions and conduct the right tests to reach the right diagnosis.
What to expect with Exploding Head Syndrome
Patients with EHS can expect a favorable outcome. In simpler terms, there are no reported long-term negative effects from this condition. Upon initial reassurance, the number and severity of episodes may gradually decrease. Over time, the condition may even disappear altogether.
Possible Complications When Diagnosed with Exploding Head Syndrome
There are no complications associated with EHS.
Preventing Exploding Head Syndrome
It’s important for patients to share any strange experiences they’ve had while sleeping. Often, they might avoid talking about these experiences because they’re worried about feeling embarrassed. However, sharing this information could be key to getting a proper diagnosis. Stress and uncontrolled worry are factors that could potentially cause Exploding Head Syndrome (EHS), a condition where a person might hear loud noises when falling asleep or waking up. Therefore, it’s beneficial for patients to talk about ways to manage stress and anxiety with their healthcare teams.
The doctors want to highlight that EHS is not a harmful condition. Many patients might feel anxious after having an episode, worrying they might have a serious illness. However, it’s vital to understand that EHS is a harmless condition, and having open discussions with your doctor can aid further in managing these experiences better.
