1394 Severe Insomnia Due to a Sledgehammer: A Case Report on Exploding Head Syndrome

Abstract Introduction Exploding head syndrome (EHS) is a non-life-threatening sleep disorder that can cause tremendous suffering for patients. The International Classification of Sleep Disorders (ICSD-3) classifies EHS as Other Parasomnias characterized by sudden loud noise or sense of explosion in the head at sleep onset. EHS is typically described as sounds like thunder, blasts, gunshots, or electrical sounds. We report a case of a 77 year-old female suffering from severe insomnia secondary to a sledgehammer pounding her head. Report of case(s) A 77-year-old female with a past medical history of headache, anxiety, chronic insomnia, and obesity, presented for severe insomnia for 15 years. Patient describes a painless sledgehammer banging in her brain every night at sleep onset. This sensation shocks her awake causing significant anxiety. Patient intentionally prevented sleep until exhaustion so the sledgehammer could no longer wake her. Once asleep, patient reported averaging 7 hours of continuous sleep. She reported mild snoring. She denied any headache, pain, numbness, or abnormal movements. Patient had multiple brain imaging in the last 15 years, which were negative for stroke or any acute process. She follows neurology for these painless head explosions. Patient was prescribed various headache medications over the years and only gabapentin improved the severity. Patient was diagnosed with EHS and reassurance was provided. Patient had polysomnography (PSG) to evaluate for obstructive sleep apnea and parasomnias. Patient doubted that she could fall asleep before her usual sleep onset time of 4am. Her PSG was diagnostic for mild obstructive sleep apnea, AHI 3% of 11.49/hour. Sleep latency was 74 minutes (sleep onset time was 23:10pm), significantly improved compared to her usual sleep latency of over 360 minutes. Patient reported better sleep compared to at home and did not experience EHS symptoms during the PSG. Conclusion Our case report demonstrates when delayed diagnosis of EHS can have significant disruption to a patient’s life. Despite multiple evaluations, the diagnosis of this parasomnia was missed. After counseling and reassurance of the prognosis of EHS, patient was able to sleep better during her PSG than she had in the last 15 years. Support (if any)