Exploding Head Syndrome: An In-Depth Look at the Sleep Disorder

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Exploding head syndrome (EHS) is a distressing yet relatively harmless sleep disorder. A person with EHS experiences the sound or sensation of an explosion in their head while they are falling asleep or waking up. EHS is painless, but it may cause a person to become so alert that they have trouble going back to sleep.

An episode of EHS can be frightening. But having an understanding of the causes and most common symptoms of this sleep disorder may provide some much-needed relief. 

Exploding head syndrome is a sleep disorder characterized by the sense or sound of a loud, sudden explosion inside of a person’s head, often prompting feelings of fear or panic. 

EHS is a type of sleep disorder known as a parasomnia. Parasomnias involve recurring events or behaviors that happen as a person sleeps, while they’re falling asleep, or while they’re waking up. These include unwanted movements, dreams, or feelings that cause nighttime awakenings.

In EHS, a person feels like something is exploding within their head or imagines a loud noise that startles them from sleep. People with EHS offer several descriptions of these sounds, including:

• A bomb exploding
• A crack of lightning or clap of thunder
• A clang of cymbals
• Fireworks
• A gunshot

Occasionally, the sound may be less dramatic, such as buzzing, beeping, or a door slamming. A muscle jerk or twitch and a flash of light may also accompany the sound or feeling.

Episodes of EHS usually occur just as a person is on the verge of falling asleep or waking up and only last a brief moment. The frequency of these episodes can vary. They often come in clusters, with multiple episodes in a single night followed by a gap of several weeks or even months.

EHS may be more widespread than previously known, as recent studies suggest. But there’s currently no test that can diagnose EHS. To diagnose other sleep disorders, doctors may use a sleep study, which is an overnight medical exam. However, people with EHS usually have normal results on a sleep study. 

Moreover, because many people are not familiar with EHS, those who have EHS episodes may be less likely to report them. EHS is likely underdiagnosed as well, as doctors may mistake the condition for a headache syndrome or another disorder.

Medical experts don’t fully understand the cause of exploding head syndrome, but researchers have come up with several theories that could explain EHS symptoms.

• Disorders of the ear: One possible explanation for why people with EHS imagine startling noises is that they may have diseases or abnormalities in the structures within the ears.
• Differences in brain activity: Another theory is that people with EHS have problems in the activity of their brain cells as they fall asleep. Normally, the parts of the brain that control sensations like touch and sound begin to shut off during the transition to sleep, but this process could be delayed in people with EHS.
• A genetic mutation: This theory suggests that there may be changes in brain cell activity in people with EHS, but the changes are due to a mutation in a gene that helps regulate neuron activity at the molecular level.
• Symptoms of drug withdrawal: Some researchers believe the symptoms of EHS could be the result of withdrawal from certain substances, including some anti-anxiety medications and antidepressants.

While these theories are intriguing, more evidence will be needed to fully understand the root causes of EHS. 

Researchers are also working to understand whether certain people are more prone to EHS than others. Some evidence suggests that EHS occurs more frequently in women and people assigned female at birth. People who have been diagnosed with sleep paralysis may also be more likely to have episodes of EHS.

Additionally, stress has a profound impact on many facets of sleep, and this relationship extends to EHS. People with EHS are more likely to have episodes during periods of stress and bouts of insomnia.

Medical experts do not believe that exploding head syndrome causes physical harm. However, EHS episodes can be frightening, especially when a person doesn’t understand that there is no danger in these episodes. After waking up from an EHS episode, it’s common to feel:

• Panic
• Shock
• Shortness of breath
• Sweating
• Heart palpitations

Before receiving a diagnosis, people with EHS may worry that it’s a sign of a more serious underlying medical issue. However, EHS is not dangerous, and simply learning more about the disorder may help improve a person’s symptoms. 

Although exploding head syndrome is not a major cause for concern, EHS may bring on or worsen certain issues like insomnia, anxiety, and migraine headaches. 

It’s worth emphasizing that EHS episodes should not cause substantial pain. If a person experiences pain or headaches, they should seek treatment from a medical professional. For example, waking up with a headache could be a sign of a number of medical issues, including sleep apnea.

There are distinct differences between EHS and headaches. Headaches experienced before bed or immediately upon waking typically do not feature the startling sensations of explosions or loud noises seen in EHS. Instead, the pain associated with sleep-related headaches is usually more dull, and may radiate from the back of the head or neck, forehead, or behind the eyes.

Treatment for exploding head syndrome involves education about the condition, identifying potential triggers, and addressing any underlying health issues like anxiety.

• Education: The main treatment for EHS is education about the disorder. Having a medical professional offer reassurance that your symptoms are largely harmless may help reduce the frequency of episodes.
• Identify triggers: Work with your doctor to identify your personal triggers. Stress is a well-documented trigger for EHS, so it can be a good idea to think about sources of tension in your life and take steps to relieve your stress. 
• Address underlying anxiety: In addition to stress, untreated anxiety may trigger EHS. Discuss ways to address anxiety with your doctor. This can include getting more exercise, avoiding caffeine, eating a well-balanced diet, practicing mindfulness meditation, or trying a combination of psychotherapy and medication.
• Treat other sleep disorders: A lack of sleep may trigger EHS, and frequent EHS episodes can make insomnia worse. While working to address your EHS symptoms, it’s also important to identify and treat other sleep disorders like insomnia or sleep apnea.
• Consider medication: If you’re having particularly distressing or severe EHS episodes, you may not respond to first-line interventions like education. Although further study is required, doctors have used several medications to help reduce symptoms like pain, anxiety, or sleep disruptions. Discuss your options with your health provider. 

If you have EHS, the good news is that the outlook is generally positive. While the symptoms can be scary, EHS does not cause any serious physical complications. And, with a little time and education, you may have a significant reduction or even a full recovery from your symptoms.

About The Author

Alison Deshong

Staff Writer, Product Testing Team

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Alison is a health writer with ample experience reading and interpreting academic, peer-reviewed research. Based in San Diego, she is published in the journal PLOS Genetics and the Journal of Biological Chemistry and has been a copywriter for SmartBug media. With a master’s degree in biochemistry from the University of California, Davis, she has nearly a decade of academic research experience in life sciences. She enjoys helping people cut through the noise to understand the bigger picture about sleep and health. Alison likes to stay active with rock climbing, hiking, and walking her dog.

• POSITION: Stomach Sleeper
• TEMPERATURE: Neutral Sleeper
• CHRONOTYPE: Bear

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