Exploding head syndrome

Exploding head syndrome
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Synonyms	Episodic cranial sensory shock, snapping of the brain, auditory sleep start
Pronounce
Field	Sleep medicine
Symptoms	Hearing loud noises when falling asleep or waking up
Complications
Onset
Duration	Short
Types
Causes	Unknown
Risks
Diagnosis
Differential diagnosis	Nocturnal epilepsy, hypnic headaches, nightmare disorder, PTSD
Prevention
Treatment	Reassurance, clomipramine, calcium channel blockers
Medication
Prognosis	Good
Frequency	~10% of people
Deaths

Exploding head syndrome (EHS) is a condition in which a person experiences unreal noises that are loud and of short duration when falling asleep or waking up. The noise may be frightening, typically occurs only occasionally, and is not a serious health concern. People may also experience a flash of light. Pain is typically absent.

Signs and symptoms

Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or waking up. They have a strong, often frightened emotional reaction to the sound, and do not report significant pain. Around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light. Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tinglings that ascends to the head before the auditory hallucinations occur. With heightened arousal, people experience distress, confusion, myoclonic jerks, tachycardia, sweating, and the sensation that they have stopped breathing and have to make a deliberate effort to breathe again.

The pattern of the auditory hallucinations is variable. Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime.

Causes

The cause of EHS is unknown. A number of hypotheses have been put forth with the most common being dysfunction of the reticular formation in the brainstem responsible for the transition between waking and sleeping.

Other theories into the causes of EHS include:

• Minor seizures affecting the temporal lobe
• Ear dysfunctions, including sudden shifts in middle ear components or the Eustachian tube, or a rupture of the membranous labyrinth or labyrinthine fistula
• Stress and anxiety
• Variable and broken sleep, associated with a decline in delta sleep
• Antidepressant discontinuation syndrome
• Temporary calcium channel dysfunction
• PTSD

Diagnosis

Classification

Exploding head syndrome is classified under other parasomnias by the 2014 International Classification of Sleep Disorders (ICSD, 3rd Ed.) and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake.

According to ICD-10 and DSM-5, EHS is classified as either another specified sleep-wake disorder or unspecified sleep-wake disorder.

Treatment

There is no high-quality evidence to support treatment. Reassurance may be sufficient. Clomipramine and calcium channel blockers have been tried, but more studies are needed to determine their effectiveness.

Epidemiology

While the frequency of the condition is not well studied, some have estimated that it occurs in about 10% of people. Females are reportedly more commonly affected.

History

The condition was initially described at least as early as 1876. The current name, "exploding head syndrome," came into use in 1988.

See also

• Sleep disorder
• Headache disorder
• Auditory hallucination

External links

• American Sleep Association: Exploding Head Syndrome

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