Exploding Head Syndrome

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Among sleep disorders, exploding head syndrome (EHS) is certainly in the running for most sensational name. Those who have it understand how frustrating it is, while those without it are often surprised to learn that the explosion refers to a sound within the head during sleep, rather than a physical explosion of the head itself.

EHS was first recorded in clinical literature in the late 1870s, but unfortunately little research has been done since then to capture the prevalence of the disorder, its causes, and possible treatment options.

Below we’ll review what exploding head syndrome is exactly, and how it interferes with sleep. Then we’ll provide our best recommendations for getting a better night’s sleep with EHS.

What is exploding head syndrome?

Exploding head syndrome is a type of parasomnia. Parasomnias are a category of sleep disorders that occur during the transitions between sleep and waking or between different stages of sleep. People with EHS hallucinate a sudden and alarmingly loud noise while they are falling asleep or when they are waking up.

EHS is not dangerous, but it can be unsettling at best or terrifying at worst. EHS interferes with the sleep of affected individuals on the day of an episode, but it can cause sleep deprivation in the long run if they begin to fear sleep itself as a result.

Symptoms of exploding head syndrome

During an instance of exploding head syndrome, the sleeper experiences an auditory hallucination as they are falling asleep or waking up. Common reported noises include gunfire, cymbals, fireworks, shouting, explosions, doors slamming, thunder, or electrical static. The sound itself may be heard from one ear or both, and some patients report it coming from inside their head (hence the “exploding head” in the name). The sound itself will last a few seconds at most.

In addition to the sound, people may see flashes of bright light or feel an electrical sensation or shock traveling from their torso to their head. Feelings of anxiety, including increased heart rate and heart palpitations, often accompany the sound. As a result, sufferers have a tougher time falling back asleep due to their heightened arousal.

In fact, even though the disorder itself is harmless and painless, the anxiety and fear of an episode occurring can create anxiety around going to sleep at all, contributing to insomnia and resulting daytime fatigue.

Fortunately, people with EHS tend to experience episodes less frequently as time goes on:

Causes of exploding head syndrome

Researchers still do not know what causes exploding head syndrome. They’ve explored potential culprits, including issues in the inner ear, seizures in the temporal lobe, or bleeding in the brain.

brainstem reticular formation and exploding head syndrome

Source: Psychlopedia

However, the leading theory posits that EHS, much like sleep paralysis, is caused by a glitch in the brainstem reticular formation. The reticular formation regulates your transitions between wakefulness and sleep, as well as your motor reflexes and muscle control.

During the transition between sleep and alertness, it’s common for people to experience hypnagogic jerks. That’s the scientific term for those involuntary spontaneous muscle spasms you sometimes experience while you’re falling or asleep or waking up. Researchers believe these jerks happen when there is a miscommunication among neurons in the reticular formation . Source: Psychlopedia

When you’re asleep, your brain puts your auditory and visual neurons to sleep, too. During REM sleep, your brain also paralyzes your muscles to prevent you from physically acting out your dreams. Sleep paralysis and EHS may occur when there is a misfire during this process, with neurons in the brain waking up before muscles and other parts of the body. People with sleep paralysis may experience hypnagogic jerks along with hallucinations, dreams, exploding head syndrome symptoms like bright lights or loud sounds, or sensations of falling. Meanwhile, in the case of exploding head syndrome, the part of the brain that processes sound may experience a boost while the alpha brain waves associated with drowsiness are suppressed.

Dr. Brian Sharpless, the lead researcher on the 2015 Washington State University study of EHS, described it thus:

“[Consider] the brain to be a computer. You go through a series of steps when you’re shutting down your computer, and your brain does the same thing. As you go to sleep, your auditory and visual neurons are normally inhibited. What we think happens during EHS is that instead of shutting down, these neurons fire all at once. When they do, they create a perception of sound, which is why sufferers hear the loud noises.”

Risk factors for exploding head syndrome

Although little understood, exploding head syndrome is not as rare as people think. Separate studies estimate between 10 to 18 percent of people experience EHS at least once in their lifetime.

Individuals with isolated sleep paralysis are twice as likely to experience EHS, and people with psychiatric disorders are slightly more likely than the general population to have EHS. Having high levels of emotional or physical stress are also associated with the disorder.

It’s generally been assumed that EHS is more common in women than in men, and in adults 50 years or older. However, a recent study of 211 undergraduate students found no differences between gender, raising the need for more studies to be done since this contradicted the commonly held assumption that it’s more prevalent among women and older adults.

Treatment for exploding head syndrome

While there is not yet an official treatment for exploding head syndrome, there are many things affected individuals can do to enjoy a better night’s sleep.

1. Talk to your doctor.

If you believe you have EHS, start keeping a sleep diary so you can track the frequency and description of your episodes to share with your doctor. During your appointment, they will ask you other follow up questions to ensure the hallucinations arenot related to another sleep or psychiatric disorder. For instance, individuals with PTSD may be roused by a bomb going off in a nightmare; this is distinct from EHS because the sounds associated with EHS are random and without context.

2. Recognize that it is a hallucination.

When you wake up from EHS, remembering that the sound is not real, and that it is harmless, can provide relief. In fact, some researchers believe getting the reassurance from your doctor can be enough for many to go into remission (see tip #1).

3. Maintain a healthy diet.

Eat a healthy diet of foods that promote sleep, like nuts, fish, leafy greens, and whole grains. Avoid heavy meals before bed, and limit your intake of caffeine, and anyoverly fatty, spicy, or sugary foods. Likewise, moderate your drug and alcohol use. These substances interfere with your ability to get quality sleep and contribute to sleep disturbances such as EHS.

4. Reduce stress.

Because of the association between stress and EHS, researchers advise sufferers to engage in stress-relieving activities like yoga, meditation, deep breathing exercises, and other relaxation techniques. Establish a calming bedtime routine that includes a warm bath or aromatherapy.

5. Follow good sleep hygiene.

Since lack of sleep can contribute to stress, do what you can to make sure you are getting at least 7 to 7.5 hours of sleep each night. Go to sleep and wake up around the same time every day. Keep your bedroom dark and quiet. Remove electronics from your bedroom and avoid using them in the hour before bed.

Additional resources

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