Exploding Head Syndrome: Understanding the Unusual Phenomenon

It sounds like it’s come straight from a science fiction novel but for some individuals (as many as 10% of the population according to some reports), exploding head syndrome, or EHS, is a reality. Imagine you’re drifting off to sleep and suddenly you’re jolted awake by the noise of an explosion, but a sound that no one else hears. It is strange and perplexing, yet this is the reality for some people. 

Despite the somewhat alarming name, there is no actual explosion or physical harm. This condition is a unique sleep-related phenomenon that is characterised by the perception of a loud noise like an explosion or gunshot that is heard during the transition from wakefulness to sleep. It is unusual and, as such, has garnered a lot of attention from scientists. However, the condition itself remains largely a mystery. 

What is exploding head syndrome (EHS)?

This is a sleep-related problem whereby people perceive a loud and startling noise or sensation just as they’re drifting off to sleep or when they begin to wake up. Unlike its fear-mongering name, the head does not explode and there are no external stimuli. Instead, the sensation is completely confined to the perception of the individual and is all internal. 

This phenomenon happens suddenly as a sharp noise that sounds like a crash, gunshot, explosion or a loud burst of electricity. Effectively, it is an auditory hallucination. There is no physical pain, though some individuals claim to feel the sound inside their head as a sensation. Sometimes, people report flashes of light too.

Generally speaking, this is a completely benign condition. This means it is not associated with physical harm to health or as a result of a health problem. This doesn’t mean it isn’t distressing or startling to the person, though. However, individuals who experience exploding head syndrome don’t have serious medical consequences as a result. Despite the benign nature of the condition, its unexpected nature can disrupt sleep and, as a result, can contribute to heightened anxiety and stress for people who suffer from it.

Prevalence and occurrence

Though some sources, as mentioned above, believe that 1 in 10 people will experience this phenomenon in their lives, the majority of articles on the matter are individual case reports, which means there is no official prevalence rate to speak of.

EHS is thought to occur more frequently in females than in males, and initially it was thought that middle-aged women suffered the most. People now believe it is more common than was believed and around 16% of college students have reported an event of EHS in one particular study. 

It is believed that older adults report it more because they are more likely to feel anxious about intracranial pathology due to their age. Generally speaking, it is still considered to be rare and research is limited.

Those suffering from exploding head syndrome might only ever have one episode. Some, though, might have recurrent episodes or fluctuating frequencies over time. Individuals might also go through periods of remission when symptoms disappear or become less frequent. Yet, EHS is usually entirely unpredictable. It happens sporadically with no discernible pattern. This makes it challenging to know when an episode might occur. What’s more, the intensity of the episode noises can vary. Sometimes they’re reported as mild or faint noises while others might be startling and more pronounced.

Symptoms and experiences

Individuals with exploding head syndrome (EHS) often describe unique symptoms that help distinguish between this condition and other sleep-related symptoms. The hallmark characteristic is the perception of a loud and startling noise or sensation as the person is transitioning between wakefulness and sleep. 

Though you might consider the term ‘exploding head’ to evoke thoughts or pain of physical explosions, this is not the case. The sensations are confined to the person’s mind and are subjective. The noise isn’t perceived by anyone other than the affected individual.

Here are the main symptoms and experiences of EHS broken down:

Auditory hallucinations

The main symptom of EHS is an auditory hallucination whereby the individual reports the perception of a sudden and sharp noise. The noise can vary in nature, but it generally sounds like an explosion, gunshot, crash or another loud and unexpected noise.

Visual accompaniments

Sometimes the auditory hallucinations of EHS are accompanied by visual experiences that manifest as flashes of light or other disturbances. This adds an additional layer of complexity to the overall experience. 

No physical pain

Importantly, while the perceived noise might be intense and startling, EHS doesn’t actually involve any physical pain. The sensation is internal and doesn’t result from anything other than a hallucination. 

Variability in intensity

The intensity of EHS episodes can vary depending on the person. Some people may describe the sensations as mild or faint. Others, however, have more pronounced auditory and visual experiences. 

Unpredictability 

EHS episodes are unpredictable. They occur without warning and disrupt the natural progression of sleep. The lack of pattern in the occurrence of episodes makes it challenging for sufferers to predict when it might happen, which can cause anxiety.

Fluctuations in frequency

The frequency of episodes of exploding head syndrome varies between individuals as well as for the same individual. Some might only experience one isolated occurrence while others have recurrent episodes. Periods of increased frequency may be followed by reduced occurrence or remission too.

Causes and triggers

The exact causes and triggers of exploding head syndrome aren’t known. Many believe it to be an interplay of physiological, psychological and environmental factors contributing to its manifestation. Here are some ideas behind the causes and triggers:

• Stress and anxiety: High levels of stress and anxiety could be a potential trigger for EHS. Emotional distress and heightened anxiety can disrupt the normal sleep-wake cycle, contributing to the occurrence of unusual experiences during the transition to sleep.
• Fatigue and sleep deprivation: Inadequate sleep and fatigue have been linked to an increased likelihood of EHS episodes. Irregular sleep patterns and sleep deprivation may impact the brain’s ability to transition smoothly between wakefulness and sleep. This leads to the potential of having abnormal sensations.
• Sleep disruptions: Disruptions to the normal sleep cycle like frequent night awakenings and insomnia could play a role in the development of EHS. This can interfere with the processes of transitioning into sleep.
• Neurological factors: Some people believe that brain activity abnormalities during the transition phases of sleep contribute to EHS. When the brain shifts from wakefulness to different stages of sleep it undergoes changes. Disturbances could result in unusual sensory perceptions.
• Medication and substance use: Certain medicines can influence sleep patterns and, therefore, contribute to the development of EHS. Doctors should consider the potential influence of pharmaceuticals or substances on the sleep-wake transition.
• Genetic predisposition: Many people speculate that there is a genetic predisposition to the condition.

Impact on sleep and wellbeing

EHS can have a significant impact on an individual’s sleep and wellbeing. This is because the episodes often disrupt the natural sleep cycle and also elicit emotional responses. 

The loud and startling auditory hallucinations can jolt people awake, which prevents them from going into the sleep cycle normally. This can lead to fragmented sleep and inadequate rest, which contribute to fatigue and daytime sleepiness.

EHS episodes can also evoke strong emotions like anxiety and fear. The perceived noises can create a sense of unpredictability and vulnerability when one should be feeling restful and at ease. This might lead to anticipatory anxiety as the individual worries about experiencing it again, which further exacerbates sleep disturbances. 

Prolonged exposure to EHS can have implications for mental health problems. This is because sleep is closely linked to mental wellbeing. If sleep disturbances are frequent, they may bring on mood disorders, higher stress levels and a reduction in overall quality of life.

The impact of this condition also extends beyond the night. Sleep disruptions affect daytime functioning and can result in poor concentration and a decrease in the ability to perform usual tasks. Over a long period of time, this can have a cumulative effect on productivity and functioning. 

For students or those in work, disrupted sleep due to EHS can result in difficulties maintaining focus and alertness, which could impact performance.

Diagnosis and treatment

Diagnosing exploding head syndrome usually involves a comprehensive assessment to exclude other sleep disorders. You might go through the following process:

• • Visit to a GP: Usually the first port of call is with a GP who will take a detailed clinical history to explore the experiences and any associated factors like anxiety and stress.
  • Sleep study: Sometimes a doctor may request a polysomnography or sleep study, but it is usually diagnosed without this. If there are concerns about other sleep disorders as well, this study can help. It involves monitoring physiological activity during sleep. This includes brain activity, eye movements and heart rate.
  • Excluding other problems: EHS can have symptoms that overlap with other conditions. This could be sleep-related epilepsy, parasomnias, or sleep-related headaches.
  • Psychological evaluation: Since EHS can be associated with stress and anxiety, it is common for a psychological evaluation to take place. This will assess the person’s mental health and explore factors that could contribute to episodes.

Treatment for EHS

Usually, there is no treatment given for EHS as this is a benign condition that isn’t associated with health risks. However, it is important to manage stress and improve sleep hygiene as this may reduce the frequency and impact of episodes. Treatment could include:

• Stress management: Since stress is considered a potential trigger for EHS, stress management techniques like relaxation exercises, mindfulness and cognitive behavioural therapy might be recommended. These aim to address the emotional aspects associated with EHS.
• Improved sleep hygiene: Establishing good sleep habits and optimising sleep hygiene will provide better sleep. This involves maintaining a consistent sleep schedule and creating a comfortable sleep environment. It also means avoiding stimulants or electronic devices near bedtime.
• Medication: In rare instances, EHS can be distressing or disruptive, which necessitates medication. However, this isn’t the primary approach.

Coping strategies

There are several strategies that can help those suffering from EHS. These are generally to do with good sleep hygiene practices. 

Maintaining a regular sleep schedule

This is crucial for managing EHS symptoms. Individuals should aim to go to bed and wake up at the same time every day. This should extend to weekends too as it helps to regulate the body’s internal clock and promotes healthy sleep.

Creating a relaxing environment for sleep

Those who suffer from EHS are encouraged to make their sleep environment conducive to relaxation. This means making it dark, cool and quiet. For some, blackout curtains, earplugs and even a white noise machine are helpful to block out external disturbances that could trigger anxiety or EHS episodes.

Adopting good sleep hygiene

Avoiding stimulants like caffeine and nicotine close to bedtime can help improve sleep quality. Screentime should be avoided before sleep. The hour before bedtime should be filled with calming activities like reading. 

Having a good bedtime routine also teaches your body to recognise that sleep is on its way.

Reducing stress

Experts believe that stress can trigger EHS. As such, it is a good idea to incorporate techniques to reduce stress into your daily routine. Deep breathing, yoga, progressive muscle relaxation and mindfulness meditation can help. 

Exercising regularly

Physical exercise is important for sleep and stress levels. Thirty minutes of moderate exercise most days can help. Intense exercise close to bedtime should be avoided. 

Seek emotional support

Exploding head syndrome can feel isolating but sharing your experiences with a friend, family member or therapist can help. Talking about your concerns and feelings can help alleviate the anxiety that is associated with exploding head syndrome. 

Final thoughts on exploding head syndrome

Though its causes and prevalence are largely unknown, exploding head syndrome (EHS) is very real for those who experience it, and it can be distressing. Those who suffer from EHS should seek advice from a medical practitioner to rule out other problems. The good news is that it is a benign condition that is annoying but not harmful.