Exploding head syndrome
Posted in Sleep disorders

Exploding head syndrome

Although the name exploding head syndrome appears scary, it is one of the parasomnias. People with (Exploding Head Syndrome) EHS hallucinate a sudden and alarmingly loud noise while they are falling asleep or when they are waking up.

What are Parasomnias?

Parasomnias are a category of sleep disorders that occur during the transitions between sleep and waking or between different stages of sleep.

What causes Exploding Head Syndrome?

While we do not exactly know what causes exploding head syndrome, some of the causes include ear problems, temporal lobe seizure, nerve dysfunction, or specific genetic changes.

What are the risk factors for exploding head syndrome?

Potential risk factors include psychological stress. It is classified as a sleep disorder or headache disorder. People often go undiagnosed.

What are the signs and symptoms of exploding head syndrome?

Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or waking up, 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.

Less common signs and symptoms may include the following:

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 the heightened arousal, people experience distress, confusion, myoclonic jerks, tachycardia, sweating, and the sensation that feels as if they have stopped breathing and have to make a deliberate effort to breathe again.

How common are the auditory hallucinations in exploding head syndrome?

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. 

What leads to EHS?
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 transition between waking and sleeping.

Other theories into causes of EHS include:

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

How do you treat EHS?

As of 2018, no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with clomipramine, flunarizine, nifedipine, topiramate, carbamazepine. Studies suggest that education and reassurance can reduce the frequency of EHS episodes. There is some evidence that individuals with EHS rarely report episodes to medical professionals.

Reassurance may be sufficient in some cases. Clomipramine and calcium channel blockers have been tried.

How common is EHS?

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. The condition was initially described at least as early as 1876. The current name came into use in 1988.

How can W8MD help?

Sleep Medicine Program uses state of the art technology including the convenient home sleep studies or in lab sleep diagnostic studies to diagnose and treat over 80 different sleep disorders including EHS. Contact the nearest W8MD center.

Prab R. Tumpati, MD. Dr. Tumpati is the founder and medical director of W8MD Weight Loss, Sleep and MedSpa Centers. Dr Tumpati is board certified physician practicing sleep medicine, obesity medicine, aesthetic medicine and internal medicine. Dr. Tumpati’s passion is to educate patients and get to the root of the problem rather than "band aid medicine". As a physician with fellowship training in Obesity Medicine, Dr. Tumpati has a unique approach to wellness, weight loss, and medical aesthetics with a focus on prevention rather than cure. Dr. Tumpati takes pride in helping patients come of many chronic life style medications such as blood pressure, cholesterol or diabetes medications by helping them lose weight and change their life style. Dr Tumpati believes in evidence based medicine rather than fad diets that do not work and works with each patient taking their unique situation in to consideration that causes them to gain weight so he can find a customized solution. Serving as the medical director of the W8MD's New York City, Cherry Hill NJ and greater Philadelphia offices, Dr Tumpati is the leading weight loss, sleep and aesthetic medicine physician in the tristate areas of Pennsylvania, New Jersey and New York.

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