Imagine lapsing into a peaceful sleep. The transition from wakefulness to slumber will be hardly noticeable but surely inevitable—after all, the night is so quiet, the bedsheets cozy and your bedroom just the right temperature. Consciousness has just about faded to dreamy sleep when suddenly…BOOOOOM!!! An explosion jerks you awake! You jump up in a panic, expecting to be in the midst of a catastrophe, but nothing has changed. Nothing at all. So there you are in bed in the dark and quiet of night wondering what in heck just happened.
Exploding head syndrome (EHS). It’s a sleep disorder that more people probably experience than experts have imagined, and it can happen once and never again…rarely…or monthly, weekly or even nightly.
Even though medical books say it’s rare, I’ve experienced it very many times since my youth, and I have friends who have experienced it, too. Now Brian Sharpless, PhD, director of the psychology clinic at Washington State University in Pullman, is doing research on EHS to finally nail down how common it is, what causes it and what should be done about it. So you bet I made a point to speak with him!
EHS generally happens not in the middle of sleep, but either as you’re drifting off to sleep or while in the early stages of naturally waking. The hallmark of EHS is hearing a sudden, very loud sound—literally as loud as an explosion—but it doesn’t always sound like an explosion. Besides explosions, people describe EHS sounds as slamming doors, gunshots, clashing cymbals, electrical zapping or a loud clunking or popping noise. About 10% of people who have EHS also perceive light flashes or some form of “visual static,” or they may feel an electrical sensation flow from their torsos to their heads just before the loud noise strikes.
Despite the disorder’s name and the fright it puts into people who experience it, it is not a sign of a physical disease. This is something I want to assure you of so you don’t add worry to an already odd and uncomfortable—and even downright freaky—event. But if you do have such an experience and have significant head pain when you wake up, this is a clear indication that you’re not experiencing EHS but a headache syndrome or possibly something more serious that should be checked out by a doctor.
Scientists aren’t exactly sure what causes EHS, but ordinary stress and emotional tension or just feeling out of sorts on a particular day might set if off. More severe psychological stressors that need to be addressed with a mental health-care professional might be behind EHS in people who experience it very frequently, such as several times a week—or night. Biologically, a glitch or something out of sync might be happening in the reticular formation, the part of the brain that monitors movement, balance, visual and auditory activity and is basically responsible for shutting you “off” so that you can go to sleep.
“A lot of things have to happen in your brain and body before you fall asleep. It’s kind of like shutting down a computer, and there is a lot of room for things to go wrong,” explained Dr. Sharpless. “Although the reticular formation is responsible for shutting everything down for sleep, our best guess about what happens in EHS—and there is some disagreement on this among researchers—is that instead of shutting down, the auditory neurons fire all at once. That’s why an explosive or otherwise startling noise is ‘heard’ even though no loud noise actually happened around you.”
You might be surprised to learn that EHS was first described in 1876—yet now, 138 years later, we still don’t know how common it is. From reviewing the few scientific reports that have been published, researchers have hypothesized that 10% to 50% of the population will have an EHS episode at least once. Meanwhile, medical books on sleep disorders have traditionally claimed that EHS is rare and that it generally targets people who are age 50 and older. Dr. Sharpless said that his own research shows that neither of these points is true and has documented EHS in adults of all ages, including college students.
Remember, there’s no indication that EHS will harm you, and it is not a sign of disease. At best, it might make an interesting topic for conversation at the next day’s breakfast. At worst, it can delay your sleep and lead to troubled sleep if it happens frequently…especially if you’re wracked with worry because you don’t understand what it is or why it’s happening.
There is no standard treatment for people who experience EHS on a regular basis (whether “regular” is a few times a year or a few times a month or week), but I can tell you that a low-dose magnesium supplement taken before bedtime seemed to work for me. And this makes sense, since magnesium is a natural calcium channel blocker, and Dr. Sharpless said that calcium channel blocker drugs (used to reduce blood pressure and also for migraine relief) have been shown to relieve EHS in case studies of people who had episodes of EHS several times per night.
Besides prescription calcium channel blockers such as flunarizine and nifedipine (Procardia), Dr. Sharpless said that the antidepressant clomipramine (Anafranil) also has been successfully used to stop EHS in people who have very frequent episodes. His advice for people who do experience EHS frequently is, again, to be reassured that they aren’t going crazy or experiencing anything life threatening. Because very frequent EHS episodes may be related to more serious stress-related psychological issues, Dr. Sharpless recommends that people who do have very frequent episodes consider seeing a behavioral sleep medicine specialist (usually a doctor trained in neurology and psychiatry who specializes in sleep disorders), a psychiatrist or a psychologist to deal with the stress and, thereby, alleviate EHS.
