Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 12;48(5):zsaf007.
doi: 10.1093/sleep/zsaf007.

Prevalence and impact of exploding head syndrome in a Japanese working population

Uyanga Tsovoosed  1   2 , Yukiyoshi Sumi  1 , Yuji Ozeki  1 , Akiko Harada  3 , Hiroshi Kadotani  1
Affiliations

Prevalence and impact of exploding head syndrome in a Japanese working population

Uyanga Tsovoosed et al. Sleep. .

Abstract

Study objectives: Exploding head syndrome (EHS) is a parasomnia characterized by the perception of loud noises, or explosions inside the head during the sleep-to-wake transition. The prevalence of EHS remains unclear. This survey aimed to elucidate the prevalence of and factors associated with EHS in this cohort.

Methods: As part of the Night in Japan Home Sleep Monitoring Study (NinjaSleep study), a cross-sectional survey was conducted among government employees in Koka City, Shiga Prefecture, Japan, in 2022. Participants were queried regarding their experiences with EHS as defined in the International Classification of Sleep Disorders, 3rd Edition, including sudden loud noises or sensations of explosions, subsequent abrupt awakenings and feelings of fright. Various standardized instruments were employed to evaluate depression, anxiety, insomnia, quality of life, and fatigue.

Results: Of the 2081 employees invited to participate, 1878 completed the survey. After excluding respondents with epilepsy and incomplete responses, 1843 participants were deemed eligible for analysis. Among them, 46 (2.49%) reported experiencing sudden noises or sensations of explosions, with 23 (1.25%) meeting the diagnostic criteria for EHS. The EHS was significantly related to the scores on the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Athens insomnia scale, and Chalder fatigue scale, even after adjusting for age, sex, body mass index, and categorized mean sleep duration.

Conclusion: This study elucidates the prevalence of EHS among the Japanese population and underscores its potential association with insomnia symptoms and various psychological factors.

Keywords: anxiety; depression; exploding head syndrome; insomnia; parasomnias; quality of life assessment.

PubMed Disclaimer

Conflict of interest statement

HK received grants from Merck Sharp and Dohme Corp/MSD K.K. (Investigator-Initiated Studies Program), Eisai Co., Ltd., and the SECOM Science and Technology Foundation. The authors declare that this research was conducted without any commercial or financial relationships that could be construed as potential conflicts of interest. The funder played no role in the study design, collection, analysis, and interpretation of data, the writing of the manuscript, or the decision to publish the results.

Figures

Graphical Abstract
Graphical Abstract
Figure 1.
Figure 1.
Flow diagram of the participant selection process. EHS: exploding head syndrome.
Figure 2.
Figure 2.
Histogram shows the frequency of sudden noise or sense of explosion. EHS: exploding head syndrome.
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

References

    1. American Academy of Sleep Medicine. The international classification of sleep disorders. 3rd ed. Darien, IL: American Academy of Sleep Medicine; 2014.
    1. Pearce JM. Clinical features of the exploding head syndrome. J Neurol Neurosurg Psychiatry. 1989;52(7):907–910. doi: https://doi.org/10.1136/jnnp.52.7.907 - DOI - PMC - PubMed
    1. Fotis Sakellariou D, Nesbitt AD, Higgins S, et al. . Co-activation of rhythms during alpha band oscillations as an interictal biomarker of exploding head syndrome. Cephalalgia. 2020;40(9):949–958. doi: https://doi.org/10.1177/0333102420902705 - DOI - PMC - PubMed
    1. Sumi Y, Miyamoto T, Sudo S, Kadotani H, Ozeki Y, Imai M.. Explosive sound without external stimuli following electroencephalography kappa rhythm fluctuation: a case report. Cephalalgia. 2021;41(13):1396–1401. doi: https://doi.org/10.1177/03331024211021773 - DOI - PubMed
    1. Fortune DG, Richards HL.. Exploding head syndrome: a systematic scoping review. Sleep Med. Clin. 2024;19(1):121–142. doi: https://doi.org/10.1016/j.jsmc.2023.10.007 - DOI - PubMed

Supplementary concepts

Grants and funding