The Effectiveness of Medications for EHS (Exploding Head Syndrome) - Gwinnett Sleep

The Effectiveness of Medications for EHS (Exploding Head Syndrome)

Exploding Head Syndrome (EHS) is a perplexing sleep behavior disorder characterized by the perception of
hearing loud noises in the head while awake or falling asleep. These auditory hallucinations can be distressing,
causing significant disruption to an individual’s sleep and overall well-being. While the exact cause of EHS
remains unclear, medical professionals have explored various medications to alleviate symptoms and improve the
quality of life for those affected. This article aims to provide an in-depth analysis of the effectiveness of medications in managing EHS,
highlighting potential treatment approaches and their benefits.

Tricyclic Antidepressants (TCAs) for EHS

Based on preliminary evidence, TCAs have shown promising results in reducing the frequency and severity of EHS
episodes. These medications specifically target neurotransmitters in the brain, leading to improved sleep and
decreased sensory disturbances. Among the TCAs frequently recommended for EHS are amitriptyline and
nortriptyline.

Amitriptyline

Amitriptyline, a TCA, has been associated with improving the severity and frequency of EHS episodes. By
increasing serotonin and norepinephrine levels, amitriptyline enhances sleep quality and minimizes auditory
disruptions during sleep transitions. It promotes neural activity stabilization, resulting in better sleep
quality and alleviating EHS symptoms.

Nortriptyline

Another tricyclic antidepressant (TCA), nortriptyline, is useful in lowering the severity and frequency of
auditory hallucinations that occur while a person sleeps. Modulating the levels of neurotransmitters, in
particular serotonin and norepinephrine, improves the quality of sleep and provides relief from the symptoms of
EHS. The mechanism of action of nortriptyline includes altering the brain’s electrical
activity, which reduces the number of sensory disruptions experienced during the transitions between stages of
sleep.

Selective Serotonin Reuptake Inhibitors (SSRIs) for EHS

There is some evidence that selective serotonin reuptake inhibitors (SSRIs) help alleviate symptoms in certain
individuals. SSRIs are effective because they raise serotonin levels in the brain,  regulating sleep patterns
and minimizing interruptions to sensory processing that manifest while your body shifts between various sleep
states.

Fluoxetine

Off-label uses of the SSRI fluoxetine, which is often prescribed for patients suffering from depression and
anxiety, have been made in order to treat Exploding Head
Syndrome. Fluoxetine works to improve sleep quality and overall well-being by elevating
levels of the neurotransmitter serotonin. This is accomplished by lowering the frequency and severity of
auditory disruptions. It helps modulate the neurotransmitter systems in the brain, promoting a more balanced
sleep-wake cycle and reducing the intensity of EHS episodes.

Sertraline

Another commonly prescribed SSRI, sertraline, has been investigated as a possible therapeutic option for EHS.
Sertraline works to improve sleep quality by elevating serotonin levels in the brain, to lower the frequency of
auditory hallucinations that arise in the intervals between sleep phases. It relieves the symptoms of Exploding
Head Syndrome and promotes peaceful sleep, helping regulate neurotransmitter abnormalities.

Benzodiazepines and EHS

Benzodiazepines are a drug class known as depressants of the central nervous system. They are widely used for
conditions such as anxiety and sleep disturbances. Some patients have reported reduced frequency and intensity
of Exploding Head Syndrome episodes when using benzodiazepines, even though there is limited evidence to support
their efficacy in treating it.

Clonazepam

Clonazepam is a benzodiazepine that has anxiolytic characteristics. It has been used in people with Exploding
Head Syndrome to promote better sleep quality and decrease auditory hallucinations. Clonazepam assists in
reducing the activity of the brain by improving the effects of gamma-aminobutyric acid (GABA), a
neurotransmitter that reduces the excitability of neurons. This, in turn, leads to a reduction in EHS symptoms
and an improvement in sleep quality.

Diazepam

Diazepam, which is also a type of benzodiazepine, is one of the potential treatments that researchers have
investigated for Exploding Head
Syndrome. It’s possible that doing so will assist in cutting down on the number of times
auditory disruptions occur during the transitions between stages of sleep. Through its action on GABA receptors,
diazepam produces a sedative and relaxing effect, improving sleep quality and lessening the severity of EHS
episodes.

Melatonin as an Alternative Treatment

Melatonin is a hormone naturally created by the pineal gland in the human body, and it is responsible for
playing an important part in controlling sleep and waking cycles. Melatonin taken orally in supplement form has
been utilized as an alternate treatment for a variety of sleep disorders, including Exploding Head Syndrome. It
may improve the overall quality of your sleep and reduce the number of times you have auditory
hallucinations.

Melatonin has been shown to aid in regulating circadian rhythms and the beginning and maintenance of sleep.
Individuals diagnosed with EHS who take exogenous melatonin may notice an improvement in the quality of their
sleep, a reduction in the number of nighttime awakenings, and a less severe level of auditory disruptions
experienced during sleep transitions. Supplementation with melatonin is generally regarded as safe and
well-tolerated, making it an attractive choice for Exploding Head Syndrome management.

Antiepileptic Medications and EHS

A number of antiepileptic medicines have been investigated for their possible use in the treatment of EHS.
These drugs modify the brain’s electrical activity, which has the potential to reduce the number of times that
sensory disruptions occur while the patient is sleeping.

Carbamazepine

In treating EHS symptoms, the antiepileptic drug carbamazepine has demonstrated some encouraging results.
Carbamazepine works to stabilize neuronal activity to reduce the intensity and frequency of auditory
hallucinations that happen during the shifts between sleep stages. It helps control aberrant electrical
discharges in the brain, which in turn promotes more peaceful sleep and reduces the disruptive character of
Exploding Head Syndrome episodes.

Lamotrigine

Lamotrigine, a different antiepileptic medicine, has also been considered a potential treatment for EHS. It can
potentially be beneficial in lowering auditory problems that occur while sleeping. Lamotrigine’s mechanism of
action involves inhibiting the release of excitatory neurotransmitters; as a result, neuronal hyperactivity is
decreased, and more regular sleep patterns are facilitated. It aids in lowering the occurrence of EHS episodes
as well as the severity of such episodes, which contributes to enhanced sleep quality and overall
well-being.

Other Medications for EHS

In addition to the medications mentioned above, other drugs have been investigated for Exploding Head Syndrome
treatment, providing alternative approaches to manage symptoms.

Low-Dose Clomipramine

In some people, taking a low dose of the tricyclic antidepressant clomipramine has been demonstrated to be
effective in lowering the severity of EHS episodes as well as the frequency of those events. Clomipramine
improves the overall quality of sleep and lessens the severity of auditory disruptions that take place when
transitioning between different sleep phases.

Conclusion

Exploding Head Syndrome (EHS) is a challenging condition that can significantly disrupt both sleep and overall
quality of life. Various medications, such as tricyclic antidepressants, selective serotonin reuptake
inhibitors, benzodiazepines, melatonin, antiepileptic medications, and others, have shown promise in reducing
the frequency and severity of EHS episodes.

In addition to pharmacological treatments, it is crucial to consider non-pharmacological approaches, including
lifestyle modifications, relaxation techniques, and practicing good sleep hygiene. These complementary
strategies should be explored in conjunction with medication options, as they can enhance treatment outcomes.
Each individual’s treatment plan should be personalized, taking into account their unique requirements and
circumstances.

Further research is important to determine the most effective treatment protocols, potential combinations of
therapies, and long-term effects of EHS. With the support and guidance of healthcare professionals who prescribe
appropriate medications (and go over potential side effects or risks associated with
each medication discussed), provide individualized care, and offer comprehensive support,
individuals experiencing EHS can find relief from their symptoms, regain control over their sleep patterns, and
ultimately improve their overall well-being and quality of life.

FAQs

Exploding Head Syndrome While Awake

Whether you’ve been dealing with sleep disturbances for years or recently began experiencing troubling symptoms, the sleep disorder called exploding head syndrome (EHS) can be extremely frightening and disruptive. While the cause is still largely unknown, and little medical research has been conducted on it, current theories offer some insight into what may trigger EHS episodes – find out more here.

What is exploding head syndrome?

Exploding head syndrome was initially described in 1876; however, it was not officially classified as a sleep disorder until 2005. EHS is considered parasomnia, a disruptive type of sleep disorder in the same category as sleepwalking and sleep terrors. 

While it may sound like the title of a sci-fi movie, exploding head syndrome is an actual medical condition that causes loud noises in your head when falling asleep or waking up. These noises range from scary imaginary explosions to claps, bangs, roars, screeches, gunfire sounds, and more. Even if this phenomenon isn’t as widely discussed as other sleep conditions, such as narcolepsy or insomnia, many people suffer from it but don’t know its name. 

Experts say, “These events occur during the wake-sleep/sleep-wake transition period and generally last less than a second. Events are often accompanied by flashes of light and patient distress, but there is no significant associated pain.”

While it sounds painful, it’s good to understand that other than disturbing sleep and perhaps causing emotional distress, the jarring noises aren’t real and do not cause physical harm to the person experiencing them or anyone nearby. 

Thankfully, the prevalence of EHS is relatively low. About 10 percent of people may experience this at least once in their lifetime. However, some encounter the symptoms sporadically.

Symptoms of exploding head syndrome

While there aren’t many symptoms, the ones that occur can be frightening and confusing, especially when experiencing them for the first time. 

To become diagnosed with exploding head syndrome, someone must meet all of the following criteria, according to the International Classification of Sleep Disorders. 

  1. Complaints of loud noises or sensations that mimic the effects of an explosion in the head during transition periods between sleep and wakefulness.
  1. Feelings of intense arousal, and possibly fright, following these episodes.
  1. No significant physical pain during or following the episodes.

Others may encounter flashes of light and twitching muscles. Overall, the experience only lasts about one second, although people might feel like it was longer. Although there are hypothesized causes, there is no single known cause for this sleep disorder. 

Can exploding head syndrome occur while awake?

Simply put, no, exploding head syndrome does not occur while awake. Because these episodes happen during the transition between sleeping and waking, to many, it seems as if they experience EHS while awake. The symptoms of the sleep disorder are what rouse people to wake up, often startled and confused. 

Conclusion

If you’ve ever woken up to a loud noise that seems to be coming from inside your head, you may have experienced exploding head syndrome. Although it can be frightening, especially if you’ve never experienced it before, exploding head syndrome is not harmful. If you’re experiencing sleep problems or disorders, contact the caring team at Gwinnett Sleep to help. They will work with you to find a solution so you can get the restful night’s sleep you deserve.

How to Stop Exploding Head Syndrome ?

Do you experience loud explosions in your head just as you are fading off to sleep? Are these episodes accompanied by flashes of light and intense fear? If yes, then you may have exploding head syndrome (EHS). While researchers hypothesize why this strange sleep disorder occurs, there is no simple explanation as to why about 10% of the population experience it at one point in their lives. This unexplained phenomenon can be highly distressing for those affected. But the good news is that there are steps you can take to help stop EHS from occurring and get some much-needed restful sleep. 

How to know if you have exploding head syndrome

Exploding head syndrome is a type of sleep disorder that occurs suddenly, either when you are beginning to fall asleep or when you wake up in the middle of the night. This sleep disorder is characterized by hearing a loud noise or crashing sound in your head, which is not authentic or heard by anyone else. Along with the sound, EHS can also cause the patient to see flashes of light and experience muscle spasms. Unlike the name suggests, these episodes are not painful.

According to the International Classification of Sleep Disorders, the following criteria are symptoms someone must experience to be diagnosed with exploding head syndrome. 

  1. Complaints of loud noises or sensations that mimic the effects of an explosion in the head during transition periods between sleep and wakefulness.
  2. Feelings of intense arousal, and possibly fright, following these episodes.
  3. No significant physical pain during or following the episodes.

Fortunately, the entire episode only lasts one to two seconds, even though it can seem long to those who encounter them. 

If you think you may have exploding head syndrome, please seek a diagnosis with a licensed sleep specialist; do not simply assume this is what you are experiencing. Other medical conditions have these same symptoms. 

Available treatments for exploding head syndrome

As stated previously, a direct cause has not yet been connected to exploding head syndrome; however, there are a few theories researchers believe may be true, such as: 

  • A temporary increase in the activity of your brain’s sensory neurons
  • Damage or dysfunction in your inner ear structures
  • Abnormal attention processing in your brain during the sleep-wake transition
  • An aura that occurs before a migraine
  • Side effects from suddenly stopping selective serotonin reuptake inhibitors 

While the FDA has officially approved nothing, some sleep specialists prescribe a few different medications known to treat the symptoms of EHS. These are topiramate, nifedipine, amitriptyline, and clomipramine, which are all used to treat other conditions. 

ConclusionAs an alternative or in addition to medication, people with EHS can do some things at home to help stop the disorder. Practice de-stressing techniques such as yoga, meditation, baths, or reading before bed. Keeping good sleep habits may also help reduce or stop the symptoms.

Ultimately, speaking to a sleep specialist before attempting any at-home remedy is wise. Be 100% sure EHS is what is going on and not something else more dire.  

Conclusion

Exploding head syndrome may not have one specific cause, but that doesn’t mean there aren’t any possible treatments to try to stop it from happening. If you regularly experience EHS or have only had it a few times and are worried, the best option is to consult a sleep specialist who can help you create a treatment plan. At Gwinnett Sleep, our specialists are dedicated to helping our patients get the rest they need and deserve. Contact us today to learn more about how we can help you treat your sleep disorder.