What Is Exploding Head Syndrome? Here's What to Know About This Bizarre Sleep Condition

You’re familiar with the exploding head emoji, and last night you tried a new brownie recipe that totally “blew your mind.” But have you ever heard of exploding head syndrome (EHS)? We reached out to  Dr. Pauline Jose, Medical Education Director of L.A.-based nonprofit Proactive Health Labs (pH) to get the skinny on this bizarre sleep condition.

What the heck is it? “The American Academy of Sleep Medicine classifies EHS as a sensory parasomnia and lists diagnostic criteria of an experience of sudden loud noise or sense of explosion occurring at the wake-sleep transition or during sleep, followed by immediate arousal often with a sense of fright, and without significant pain,” says Dr. Jose. In other words, exploding head syndrome is a condition where the person wakes from sleep with the sensation of a loud noise. According to Sleepeducation.org, this loud noise has been described as a painless loud bang, a clash of cymbals and even a bomb exploding.

What does it feel like? Although it sounds terrifying, exploding head syndrome is typically painless. Dr. Jose tells us that the most common symptoms are fast heart rate, brief muscle jerks or twitches and visual phenomena (often described as a flash of light). “About 5 percent of patients have a sensation of momentary respiratory arrest requiring a deliberate effort to breathe again. Several cases of EHS occurring with sleep paralysis have been reported, as well as a case of a woman with EHS and sleep-related orgasms.” Interesting, no?

What causes it? The causes of exploding head syndrome are unknown, although interestingly it does seem to affect women more so than men (a female to male ratio of 1.5:1 has been reported with median age of onset of 54, Jose tells us). There is some evidence to suggest that it can occur after withdrawal of benzodiazepines (like Valium and Xanax) and that stress could be a contributing factor. “Some postulate that the sound could be due to a disinhibition of the cochlea of the ear or a muscle twitch when a person is about to fall asleep,” says Dr. Jose. “Another theory is there is a decrease in firing of GABA (a neurotransmitter that causes calm) transmission when a person is about to fall asleep.” It’s also worth noting that many of the patients with EHS who had sleep studies had sleep problems to start with also.

How common is it? It’s hard to say for certain, but exploding head syndrome is pretty rare. In other words, it’s probably not something you need to worry about. “Prevalence is difficult to determine, as the disorder is likely both underreported and underrecognized. It is reported that only 11 percent who screen positive for EHS have actually discussed their symptoms with a healthcare provider, and some patients’ providers did not believe them when they reported their symptoms,” says Dr. Jose.

What’s the treatment? Per Dr. Jose, usually no treatment is necessary as EHS is benign and usually patients are fine after. “Often reassurance is all that is needed and sometimes if stress is associated then stress reduction is needed.” If patients are so distressed by the symptoms that they’re struggling to fall asleep, then there are medications available. If you suspect you suffer from exploding head syndrome, reach out to your primary care doctor.