Exploding head syndrome

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Exploding head syndrome
Other namesEpisodic cranial sensory shock, [1] snapping of the brain, [2] auditory sleep start [3]
Specialty Sleep medicine
SymptomsHearing loud noises when falling asleep or waking up [2]
DurationShort [2]
CausesUnknown [3]
Differential diagnosis Nocturnal epilepsy, hypnic headaches, nightmare disorder, PTSD [2]
TreatmentReassurance, clomipramine, calcium channel blockers [2]
PrognosisGood [2]
Frequency~10% of people [2]

Exploding head syndrome (EHS) is a condition in which a person experiences unreal noises that are loud and of short duration when falling asleep or waking up. [2] [4] The noise may be frightening, typically occurs only occasionally, and is not a serious health concern. [2] People may also experience a flash of light. [5] Pain is typically absent. [2]

Hallucination Perception in the absence of external stimulation that has the qualities of real perception

A hallucination is a perception in the absence of external stimulus that has qualities of real perception. Hallucinations are vivid, substantial, and are perceived to be located in external objective space. They are distinguishable from several related phenomena, such as dreaming, which does not involve wakefulness; pseudohallucination, which does not mimic real perception, and is accurately perceived as unreal; illusion, which involves distorted or misinterpreted real perception; and imagery, which does not mimic real perception and is under voluntary control. Hallucinations also differ from "delusional perceptions", in which a correctly sensed and interpreted stimulus is given some additional significance.

Contents

The cause is unknown. [3] Potential explanations include ear problems, temporal lobe seizure, nerve dysfunction, or specific genetic changes. [2] Potential risk factors include psychological stress. [2] It is classified as a sleep disorder or headache disorder. [2] [5] People often go undiagnosed. [5]

Mutation A permanent change of the nucleotide sequence of the genome of an organism

In biology, a mutation is the alteration of the nucleotide sequence of the genome of an organism, virus, or extrachromosomal DNA.

Psychological stress feeling of strain and pressure

In psychology, stress is a feeling of strain and pressure. Stress is a type of psychological pain. Small amounts of stress may be desired, beneficial, and even healthy. Positive stress helps improve athletic performance. It also plays a factor in motivation, adaptation, and reaction to the environment. Excessive amounts of stress, however, may lead to bodily harm. Stress can increase the risk of strokes, heart attacks, ulcers, and mental illnesses such as depression.

Sleep disorder disease of mental health that involves disruption of sleep patterns

A sleep disorder, or somnipathy, is a medical disorder of the sleep patterns of a person or animal. Some sleep disorders are serious enough to interfere with normal physical, mental, social and emotional functioning. Polysomnography and actigraphy are tests commonly ordered for some sleep disorders.

There is no high quality evidence to support treatment. [2] Reassurance may be sufficient. [2] Clomipramine and calcium channel blockers have been tried. [2] While the frequency of the condition is not well studied, some have estimated that it occurs in about 10% of people. [2] Females are reportedly more commonly affected. [5] The condition was initially described at least as early as 1876. [2] The current name came into use in 1988. [5]

Clomipramine chemical compound

Clomipramine, sold under the brand name Anafranil among others, is a tricyclic antidepressant (TCA). It is used for the treatment of obsessive–compulsive disorder, panic disorder, major depressive disorder, and chronic pain. It may decrease the risk of suicide in those over the age of 65. It is taken by mouth.

Signs and symptoms

Individuals with exploding head syndrome hear or experience loud imagined noises as they are falling asleep or waking up, have a strong, often frightened emotional reaction to the sound, and do not report significant pain; around 10% of people also experience visual disturbances like perceiving visual static, lightning, or flashes of light. Some people may also experience heat, strange feelings in their torso, or a feeling of electrical tinglings that ascends to the head before the auditory hallucinations occur. [2] With the heightened arousal, people experience distress, confusion, myoclonic jerks, tachycardia, sweating, and the sensation that feels as if they have stopped breathing and have to make a deliberate effort to breathe again. [4] [6] [7] [8]

Tachycardia Heart rate that exceeds the normal resting rate

Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal or abnormal.

The pattern of the auditory hallucinations is variable. Some people report having a total of two or four attacks followed by a prolonged or total remission, having attacks over the course of a few weeks or months before the attacks spontaneously disappear, or the attacks may even recur irregularly every few days, weeks, or months for much of a lifetime. [2]

Some individuals mistakenly believe that EHS episodes are not natural events, but are the effects of directed energy weapons which create an auditory effect. [9] Thus, EHS has been worked into conspiracy theories, but there is no scientific evidence that EHS has non-natural origins.

Causes

The cause of EHS is unknown. [3] A number of hypotheses have been put forth with the most common being dysfunction of the reticular formation in the brainstem responsible for transition between waking and sleeping. [2]

Other theories into causes of EHS include:

Diagnosis

Classification

Exploding head syndrome is classified under other parasomnias by the 2014 International Classification of Sleep Disorders (ICSD, 3rd.Ed.) and is an unusual type of auditory hallucination in that it occurs in people who are not fully awake. [10] [11]

According to ICD-10 and DSM-5 EHS is classified as either another specified sleep-wake disorder (codes:780.59 or G47.8) or unspecified sleep-wake disorder (codes: 780.59 or G47.9). [12] [13]

Treatment

As of 2018, no clinical trials had been conducted to determine what treatments are safe and effective; a few case reports had been published describing treatment of small numbers of people (two to twelve per report) with clomipramine, flunarizine, nifedipine, topiramate, carbamazepine. [2] Studies suggest that education and reassurance can reduce the frequency of EHS episodes. [4] There is some evidence that individuals with EHS rarely report episodes to medical professionals. [8]

Epidemiology

There have not been sufficient studies to make conclusive statements about how common or who is most often affected. [2] One study found that 14% of a sample of undergrads reported at least one episode over the course of their lives, with higher rates in those who also have sleep paralysis. [14]

History

Case reports of EHS have been published since at least 1876, which Silas Weir Mitchell described as "sensory discharges" in a patient. [14] However, it has been suggested that the earliest written account of EHS was described in the biography of the French philosopher René Descartes in 1691. [15] The phrase "snapping of the brain" was coined in 1920 by the British physician and psychiatrist Robert Armstrong-Jones. [14] A detailed description of the syndrome and the name "exploding head syndrome" was given by British neurologist John M. S. Pearce in 1989. [16] More recently, Peter Goadsby and Brian Sharpless have proposed renaming EHS "episodic cranial sensory shock" [1] as it describes the symptoms more accurately (including the non-auditory elements) and better attributes to Mitchell.

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Dementia with Lewy bodies Type of dementia associated with abnormal clumps of alpha-synuclein protein in neurons

Dementia with Lewy bodies (DLB) is a type of dementia accompanied by changes in behavior, cognition, and movement. A progressive condition, it is diagnosed when cognitive decline interferes with normal daily functioning. Memory loss is not always an early symptom. A core feature is REM sleep behavior disorder (RBD), in which individuals lose normal muscle paralysis during REM sleep, and act out their dreams. RBD may appear years or decades before other symptoms. Other frequent symptoms include visual hallucinations; marked fluctuations in attention or alertness; and slowness of movement, trouble walking, or rigidity. The autonomic nervous system is usually affected, resulting in changes in blood pressure, heart and gastrointestinal function, with constipation as a common symptom. Mood changes such as depression and apathy are common.

Sleep paralysis phenomenon

Sleep paralysis is when, during waking up or falling asleep, a person is aware but unable to move or speak. During an episode, one may hallucinate, which often results in fear. Episodes generally last less than a couple of minutes. It may occur as a single episode or be recurrent.

Sleepwalking phenomenon of combined sleep and wakefulness

Sleepwalking, also known as somnambulism or noctambulism, is a phenomenon of combined sleep and wakefulness. It is classified as a sleep disorder belonging to the parasomnia family. It occurs during slow wave sleep stage, in a state of low consciousness, with performance of activities that are usually performed during a state of full consciousness. These activities can be as benign as talking, sitting up in bed, walking to a bathroom, and cleaning, or as hazardous as cooking, driving, violent gestures, grabbing at hallucinated objects, or even homicide.

Rapid eye movement sleep behavior disorder sleep disorder that involves abnormal behavior including the acting out of violent or dramatic dreams during the sleep phase with rapid eye movement

Rapid eye movement sleep behavior disorder (RBD) is a sleep disorder in which people act out their dreams. It involves abnormal behavior during the sleep phase with rapid eye movement (REM) sleep. The major feature of RBD is loss of muscle atonia during otherwise intact REM sleep. REM sleep is the stage of sleep in which most vivid dreaming occurs. The loss of motor inhibition leads to a wide spectrum of behavioral release during sleep. This extends from simple limb twitches to more complex integrated movement. These behaviors can be violent in nature and in some cases will result in injury to either the individual or their bed partner.

Cluster headache

Cluster headache (CH) is a neurological disorder characterized by recurrent severe headaches on one side of the head, typically around the eye. There is often accompanying eye watering, nasal congestion, or swelling around the eye on the affected side. These symptoms typically last 15 minutes to 3 hours. Attacks often occur in clusters which typically last for weeks or months and occasionally more than a year.

Night terror, also known as sleep terror, is a sleep disorder causing feelings of terror or dread typically occuring during the first hours of stage 3–4 non-rapid eye movement (NREM) sleep and lasting for 1 to 10 minutes. They can last longer, especially in children. Sleep terrors are then classified in the category of parasomnias in NREM-related parasomnias in the International Classification of Sleep Disorders. There are two other categories : REM-related parasomnias and other parasomnias. Parasomnias are qualified as undesirable physical events or experience that occur during entry into sleep, within sleep, or during arousals from sleep.

Visual snow visual impairment

Visual snow, also known as visual static, is a proposed condition in which people see white or black dots in parts or the whole of their visual fields. The problem is typically always present and can last years.

Hypersomnia, is a neurological disorder of excessive time spent sleeping or excessive sleepiness. It can have many possible causes and can cause distress and problems with functioning. In the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), hypersomnolence, of which there are several subtypes, appears under sleep-wake disorders.

Parasomnias are a category of sleep disorders that involve abnormal movements, behaviors, emotions, perceptions, and dreams that occur while falling asleep, sleeping, between sleep stages, or during arousal from sleep. Parasomnias are dissociated sleep states which are partial arousals during the transitions between wakefulness, NREM sleep, and REM sleep, and their combinations.

The International Classification of Sleep Disorders (ICSD) is "a primary diagnostic, epidemiological and coding resource for clinicians and researchers in the field of sleep and sleep medicine". The ICSD was produced by the American Academy of Sleep Medicine (AASM) in association with the European Sleep Research Society, the Japanese Society of Sleep Research, and the Latin American Sleep Society. The classification was developed as a revision and update of the Diagnostic Classification of Sleep and Arousal Disorders (DCSAD) that was produced by both the Association of Sleep Disorders Centers (ASDC) and the Association for the Psychophysiological Study of Sleep and was published in the journal Sleep in 1979. A second edition, called ICSD-2, was published in 2005. The third edition, ICSD-3, was released in 2014.

A paracusia, or auditory hallucination, is a form of hallucination that involves perceiving sounds without auditory stimulus.

Narcolepsy sleep disorder that involves an excessive urge to sleep at inappropriate times, such as while at work

Narcolepsy is a long-term neurological disorder that involves a decreased ability to regulate sleep-wake cycles. Symptoms include periods of excessive daytime sleepiness that usually last from seconds to minutes and may occur at any time. About 70% of those affected also experience episodes of sudden loss of muscle strength, known as cataplexy. These experiences can be brought on by strong emotions. Less commonly, there may be inability to move or vivid hallucinations while falling asleep or waking up. People with narcolepsy tend to sleep about the same number of hours per day as people without, but the quality of sleep tends to be worse.

Vestibular migraine (VM) is vertigo associated with a migraine, either as a symptom of migraine or as a related but neurological disorder; when referred to as a disease unto itself.

Musical hallucinations fall under the category of auditory hallucinations and describe a disorder in which a sound is perceived as instrumental music, sounds, or songs. It is a very rare disorder, reporting only 0.16% in a cohort study of 3,678 individuals.

Synucleinopathy neurodegenerative disease that is characterized by the abnormal accumulation of aggregates of alpha-synuclein protein in neurons, nerve fibres or glial cells

Synucleinopathies are neurodegenerative diseases characterised by the abnormal accumulation of aggregates of alpha-synuclein protein in neurons, nerve fibres or glial cells. There are three main types of synucleinopathy: Parkinson's disease (PD), dementia with Lewy bodies (DLB), and multiple system atrophy (MSA). Other rare disorders, such as various neuroaxonal dystrophies, also have α-synuclein pathologies.

Classification of sleep disorders, as developed in the 19th century, used primarily three categories: Insomnia, Hypersomnia and Nightmare. In the 20th century, increasingly in the last half of it, technological discoveries led to rapid advances in the understanding of sleep and recognition of sleep disorders. Major sleep disorders were defined following the development of Electroencephalography (EEG) in 1924 by Hans Berger.

References

  1. 1 2 Goadsby, Peter J.; Sharpless, Brian A. (2016-11-01). "Exploding head syndrome, snapping of the brain or episodic cranial sensory shock?". J Neurol Neurosurg Psychiatry. 87 (11): 1259–1260. doi:10.1136/jnnp-2015-312617. ISSN   0022-3050. PMID   26833175.
  2. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Sharpless, Brian A. (December 2014). "Exploding head syndrome". Sleep Medicine Reviews. 18 (6): 489–493. doi:10.1016/j.smrv.2014.03.001. PMID   24703829.
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  5. 1 2 3 4 5 Ceriani, CEJ; Nahas, SJ (30 July 2018). "Exploding Head Syndrome: a Review". Current Pain and Headache Reports. 22 (10): 63. doi:10.1007/s11916-018-0717-1. PMID   30062616.
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  8. 1 2 Sharpless, Brian A (2017-04-06). "Characteristic symptoms and associated features of exploding head syndrome in undergraduates". Cephalalgia. 38 (3): 595–599. doi:10.1177/0333102417702128. PMID   28385085.
  9. A., Sharpless, Brian (2016-11-15). Unusual and rare psychological disorders : a handbook for clinical practice and research. ISBN   9780190245863. OCLC   952152912.
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  14. 1 2 3 Sharpless BA (2015). "Exploding head syndrome is common in college students". J Sleep Res. 24 (4): 447–9. doi:10.1111/jsr.12292. PMID   25773787.
  15. Otaiku AI (2018). "Did René Descartes have Exploding Head Syndrome?". J Clin Sleep Med. 14 (4): 675–8. doi:10.5664/jcsm.7068. PMC   5886445 . PMID   29609724.
  16. Thorpy MJ, Plazzi G (2010). The Parasomnias and Other Sleep-Related Movement Disorders. Cambridge University Press. p. 231. ISBN   978-0-521-11157-7 . Retrieved 2011-03-18.
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