What is Exploding Head Syndrome?

Exploding head syndrome is a rare parasomnia, a sleep disruption that occurs when the body is transitioning from REM to non-REM sleep. The condition is rare and not very well studied. Although the name indicates otherwise, there are no painful or physical manifestations of exploding head syndrome, only auditory hallucinations. Women have a higher chance of experiencing it than men, and though it is most common in people over age 50, there are reported cases of the condition affecting children as young as tent cases have been reported in children as young as ten.

Auditory Hallucinations

Exploding head syndrome (EHS) is a sleep-related disorder because it usually occurs when someone is falling asleep or starting to wake up. It is also called “episodic cranial sensory shock.” The person perceives a loud noise that sounds like a bomb or gunshot. This sound is not real, and no one else can hear it. It is not painful, though it can induce significant fear and anxiety.

Sensory Signs and Symptoms

Auditory hallucinations are the main symptom of exploding head syndrome but there are other symptoms as well. Some people report seeing bright flashes of light before the sound that remind them of thunder and lightning, though both are hallucinations. It’s also not uncommon to feel an electrical sensation moving from the torso or chest up to the head right before the noise.

Physical Signs and Symptoms

Exploding head syndrome can cause some secondary physical symptoms. Being woken up suddenly by a loud noise causes high amounts of anxiety, which leads to rapid breathing, elevated heart rate, sweating, and possibly heart palpitations. It can take time to calm down after an episode, and it is often difficult to fall back asleep.

Causes: Brain Stem

The cause of exploding head syndrome is not completely understood. One theory is a malfunction in the reticular formation of the brain stem. This can cause a miscommunication in the brain when it is supposed to be shutting down for sleep. The result is an auditory hallucination.

Causes: Seizures

Exploding head syndrome may be caused by minor seizures that attributed to a brief period of abnormal activity in the frontal lobe. This is not a major seizure that can lead to convulsions and loss of function and is not something to worry about unless accompanied by other serious symptoms. EHS may also be caused by abnormalities in communication between the inner ear and brain.

Causes: High Stress

While no direct relationship has been found, there seems to be a correlation between exploding head syndrome and high levels of anxiety and stress. Poor sleep, which can also add to stress and anxiety, is another possible cause of EHS. Specifically, a lack of delta sleep, a deep and restorative stage of the sleep cycle, appears to affect people with the condition.

Ceasing Antidepressants

People who stop taking antidepressants are at higher risk for developing exploding head syndrome. Antidepressants cause more serotonin to be available in the brain. One of serotonin’s jobs is to help regulate sleep. When someone goes off an antidepressant, serotonin levels may dip, having a significant effect on sleep patterns.

When to See a Doctor

Anyone who experiences exploding head syndrome should mention it to their doctor, especially if other significant changes to lifestyle or sleep quality develop around the same time. The doctor will likely want to rule out other causes and may ask the patient to keep a sleep journal to track the timing and severity of each episode.

Treatment

A tricyclic antidepressant medication may help people with exploding head syndrome, but some non-pharmacological treatments can help, too. Getting a good night’s sleep contributes to a stable sleep cycle. Avoiding spicy food before bed, cutting out alcohol and caffeine, and eliminating fatty foods can also help. For people coping with significant anxiety, try yoga, stretching, or a hot cup of herbal tea before bed to help the body and mind de-stress.

More Interventions

Although exploding head syndrome hallucinations can be very frightening, people with the condition need to keep reminding themselves that it is just a hallucination. Some find the condition goes away on its own once they get reassurance that what is happening is harmless, or incorporate other medicinal or holistic treatments. Having a good bedtime routine and getting a full night of sleep can also reduce or eliminate episodes.