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    Mayo Clinic Q and A: Understanding ‘exploding head syndrome’

a young woman in bed in a dark room, lying awake with her eyes open and her hand on her forehead, not sleeping and suffering from insomnia or stressDEAR MAYO CLINIC: A couple of times over the past few months, my wife has awoken in a panic saying she heard a loud noise like a crash. There was no noise, and she assumes it was a dream. Is this something to be concerned about?

ANSWER: It’s hard to say without a medical evaluation, but it sounds like you may be describing a poorly understood phenomenon called “exploding head syndrome.” Those who experience it report being startled awake by what’s often described as a loud, sharp noise, such as the crack of a whip, an explosion, a gunshot, a lightning crack, a metallic crashing noise, or an electrical noise. Some people also may experience flashes of light, mild pain, sweating or a racing heart rate.

It’s not known what causes this sensation, but it’s believed to occur as your brain is transitioning from wakefulness to sleep. It’s thought to be similar to the common phenomenon of jerking awake as you fall asleep.

Some people who experience exploding head syndrome have one event in a lifetime. Others have several a night. Episodes may occur consistently or come and go. It’s estimated to occur at least once in about 10 percent of the population and appears to be more common in women and older adults.

Exploding head syndrome doesn’t appear to cause direct physical harm. The main complication is fright and distress in those who have it, either because they fear a serious disease or because sleep is disrupted.

Diagnosis involves ruling out other possibilities, including a stroke. These possibilities usually can be distinguished easily from exploding head syndrome. For example, strokes usually have one-sided symptoms. Headaches are usually more painful, and the pain lasts longer than an episode of exploding head syndrome. Night seizures usually aren’t remembered, and panic attacks usually aren’t accompanied by a loud noise as is exploding head syndrome.

Reassurance and education on the phenomenon are often the only treatment needed. Additional treatment steps aren’t well-studied but may include management of stress or anxiety, or any known sleep disorders. In some cases, the use of one of several drugs may help, including tricyclic antidepressants, heart drugs in the calcium channel blocker class, or anti-seizure drugs.

If your wife continues to have episodes as you have described, encourage her to see her health care provider to rule out possible causes other than exploding head syndrome. If no cause is found, an appointment with a sleep medicine specialist may be recommended to determine if your wife’s symptoms are the result of a different sleep disorder. (adapted from Mayo Clinic Health Letter) — Dr. Eric J. Olson, Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minnesota


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