1343 Not Just in Your Head: Recognizing Exploding Head Syndrome as a Sleep Disorder
Sleep May 1, 2026 Hollyann Loui, Melisa Chang
A 63-year-old man with diabetes and hypertension experienced loud clapping noises while falling asleep for 25 years, occurring 5-6 times weekly. He was diagnosed with exploding head syndrome (EHS) after a polysomnogram showed moderate obstructive sleep apnea (apnea-hypopnea index of 22/hr), and a brain MRI and audiologic exam were normal. At a 6-month follow-up, episodes reduced to 1-2 times weekly without OSA treatment. EHS is an underrecognized parasomnia with lifetime prevalence of 10% to over 30%, considered benign and self-limited. No established association exists between EHS and OSA or hearing loss; EHS is most strongly associated with insomnia, sleep paralysis, and dissociative experiences.