Is exploding head syndrome the reason you can't sleep?
- People with EHS hear loud noises when going to sleep or on waking
- It can lead to sleeping problems and worse: temporary tachycardia
- Any problems tend to be because of the way people react to episodes
- Professor of psychology Dr Sharpless: 'EHS is generally harmless'
Exploding head syndrome may sound like a made-up condition - in fact, it's a real and frightening medical disorder, and one that a study suggests is surprisingly common.
People with exploding head syndrome (EHS) hear loud noises when going to sleep or on waking up.
The type of noise can vary from explosions and fireworks to slammed doors, the sound of a gun firing, an enormous roar, shouting, thunder or a crack of lightning. The noises start suddenly and last for a few seconds.
Before hearing the loud noise, one in ten also has visual disturbances, such as seeing lightning or flashes. These are similar to the auras some people have before a migraine headache.
People with exploding head syndrome (EHS) hear loud noises when going to sleep or on waking up
'In contrast to migraine, visual symptoms are brief - typically a single flash,' says Dr Nicholas Silver, a consultant neurologist at the Walton Centre NHS Foundation, Liverpool.
Exploding head syndrome may also cause a mild headache and sensations of heat; other symptoms include a jerk or 'jumping' limbs at the same time.
While some have only one attack in their life, others experience up to seven a night. They may come and go over weeks or months, though for some they occur almost daily for years.
It can lead to sleeping problems and worse: an attack may cause temporary tachycardia - a faster heart rate than normal - and palpitations.
In the longer term it can also lead to panic disorder, depression and catastrophising, where patients misinterpret symptoms as signs of more serious conditions, such as a stroke.
'I have assessed patients reporting apprehension who avoid sleep during chronic bouts of EHS,' says Dr Brian Sharpless, an assistant professor of psychology at Washington State University. 'It can be very frightening and scary for those who do not know what is happening.'
It can lead to sleeping problems and worse: an attack may cause temporary tachycardia
And a study published in the journal Sleep Medicine Reviews suggests that the disorder may affect as many as one in ten people at some time during their life.
'It has been claimed that EHS is rare, but preliminary data does not appear to imply rarity,' says Dr Sharpless, who led the study.
The disorder is known to be twice as common in women and typically affects the over-50s, though it has also been reported in children as young as ten.
Quite why it occurs is not clear. One theory is that it is caused by ear problems, especially those affecting the eustachian tube, which links the middle ear with the back of the nose and throat.
Problems here can affect air pressure in the middle ear, which can cause the perception of sounds when there are none.
Exploding head syndrome is also linked to rapid withdrawal from certain drugs such as benzodiazepines, given for anxiety or sleeping problems, or anti-depressants called selective serotonin re-uptake inhibitors.
However, Dr Sharpless says the most likely explanation is that there is some kind of temporary blip in the nerve cells of the brain during the switch from being awake to sleeping.
When we go to sleep, the brain orchestrates a switching off of various regions responsible for movement, vision, sound and so on. It's thought that EHS occurs because of a delay in this shut-down, resulting in a burst of activity - this is perceived as loud noises and flashes of light.
Yet even though it was identified 150 years ago, researchers say EHS remains little known.
'It is an entirely benign and non-threatening condition,' says Dr Silver. However, lack of awareness means it's often misdiagnosed, as 'night-time' epilepsy, thunder-clap headaches - sudden, severe pain that peaks within 60 seconds - or nightmare disorder, where people often wake with detailed recall of frightening dreams.
It is also misdiagnosed as migraine, cluster headaches - severe pain on one side, often behind the eye - and post-traumatic stress disorder flashbacks.
'Because a diagnosis of EHS does not occur to a lot of doctors, it is not uncommon to see patients having investigations to rule out disorders such as subarachnoid haemorrhage (sudden bleeding around the brain) or epilepsy,' says Dr Silver.
'Any problems tend to be because of the way people react to episodes, such as misinterpreting them as indicative of a more serious condition, or avoiding sleep'
Patients may be given scans or even a lumbar puncture - where a needle is used to remove spinal fluid to check for subarachnoid hemorrhage.
'My main concern is the lack of recognition of this disorder among the public, but also possibly among the medical profession as it does not feature highly in standard textbooks on medicine or neurology,' says Dr Silver.
He stresses the importance of educating doctors who have not come across EHS - 'so patients with this syndrome are not put through probable unnecessary scans or lumbar punctures'.
'As with most neurological conditions, diagnosis relies on taking a good history from the patient and excluding more worrisome possibilities.'
For without a diagnosis, people with EHS will also miss out on receiving proper treatment.
The good news, says Dr Sharpless, is that while EHS can be scary, it is generally harmless.
'Any problems tend to be because of the way people react to episodes, such as misinterpreting them as indicative of a more serious condition, or avoiding sleep.'
Most patients simply require reassurance. 'I find lifestyle advice, for instance avoiding caffeine before bed, is all they need,' says Dr Silver.
There are drug treatments that may be effective, including the antidepressant clomipramine, calcium channel-blockers and anticonvulsants - typically used for epilepsy - though it's not clear how these work.
'Drug treatment is reserved for those with frequent symptoms,' says Dr Silver.
Read more: http://www.dailymail.co.uk/health/article-2620837/Is-exploding-head-syndrome-reason-sleep.html#ixzz31qLBN0zl
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