Sleep: A Silent Killer?

Dying in your sleep is usually caused by underlying health issues, such as sleep apnea, cardiac arrest, and stroke. It can also be caused by external factors such as carbon monoxide poisoning. According to the Sudden Cardiac Arrest Foundation, about 30% of cardiac arrest deaths occur at night. Similarly, 25% of strokes occur during sleep. Obstructive sleep apnea can increase the risk of dying in your sleep by 30%, according to Dr. Chad Denman. While dying in your sleep is rare, taking preventative measures to address underlying health conditions can further reduce this risk.

Sleep apnea

The link between sleep apnea and mortality is particularly concerning due to the condition's high prevalence. Approximately one in five adults suffer from sleep apnea to some degree, with the condition being more common in men than in women. Left untreated, sleep apnea can lead to or exacerbate several life-threatening conditions, including cardiac arrest, heart attacks, strokes, and type 2 diabetes.

The adverse health effects of sleep apnea are primarily caused by hypoxia, or low oxygen levels in the body. This triggers a stress response, leading to an increased heart rate and narrowing of arteries. Consequently, sleep apnea increases the risk of cardiovascular problems and has been identified as an independent risk factor for all-cause mortality.

The good news is that sleep apnea is a treatable condition. Continuous positive airway pressure (CPAP) therapy is the most common treatment, where a mask is worn during sleep to provide a steady stream of air and keep the airway open. Other treatments include the use of bilevel positive airway pressure (BIPAP) devices, surgery, and lifestyle changes such as quitting smoking and avoiding sleeping pills and sedatives.

In conclusion, sleep apnea is a significant risk factor for mortality, particularly when left untreated. The condition affects a large portion of the population and can lead to serious health complications. However, effective treatments are available, and seeking medical help can improve quality of life and potentially save lives.

Cardiac arrest

Sudden cardiac arrest (SCA) is a common cause of nocturnal death, accounting for roughly 22% of all deaths during sleep, according to a 2021 study. The risk of death from SCA is higher at night because emergency medical responses often arrive too late.

SCA occurs when the heart suddenly stops beating, leading to death within minutes without immediate medical treatment. It is distinct from a heart attack, which is caused by an obstruction in a blood vessel supplying the heart muscle.

Causes of SCA

• Inherited heart conditions: Genetic conditions like Long QT syndrome, Brugada syndrome, and hypertrophic cardiomyopathy can increase the risk of SCA.
• Structural heart abnormalities: Congenital heart defects or other structural issues can disrupt the heart's electrical system.
• Arrhythmias: Irregular heart rhythms, if not properly managed, can lead to SCA.
• Underlying health conditions: Obesity, diabetes, and certain autoimmune disorders can contribute to heart problems and increase the risk of SCA.

Preventing SCA

To prevent SCA, consider the following measures:

• Regular medical check-ups: Routine visits to a healthcare professional can help identify and manage underlying health conditions.
• Healthy lifestyle: Maintaining a balanced diet, staying physically active, managing stress, and avoiding smoking and excessive alcohol consumption can contribute to overall heart health.
• Awareness of symptoms: Knowing the warning signs, such as chest pain, palpitations, dizziness, and fainting, can help prompt timely medical attention.
• Screening and genetic testing: Cardiac screenings and genetic tests can help detect potential issues early, especially if there is a family history of heart conditions.
• Education: Educating young females about heart health and early detection can be crucial, as they are susceptible to SCA.

Strokes

It is impossible to pinpoint the exact number of people who die in their sleep every day, but according to the CDC, in 2021, about 41 out of 100,000 people died from a stroke. In the US, someone dies of a stroke every 3 minutes and 14 seconds.

• Ischemic strokes, the most common type, are caused by a blockage in an artery supplying blood to the brain. They include thrombotic strokes, which occur when a blood clot forms within the blood vessels inside the brain, and embolic strokes, which occur when a blood clot forms in a blood vessel outside the brain and travels to a blood vessel inside the brain, causing a blockage.
• Hemorrhagic strokes involve a blood vessel in the brain rupturing or leaking. They include intracerebral strokes, caused by a ruptured artery in the brain, and subarachnoid strokes, which involve a rupture or leak that causes bleeding in the space between the brain and the tissue that covers it.
• Transient ischemic attacks (TIAs), also known as ministrokes, are temporary interruptions of blood flow to the brain that occur when the blockage breaks up before damage to the brain occurs. They carry a minimal risk of death and complications but increase the risk of a future stroke.

The risk of fatality from a stroke depends on several factors, including the region of the brain affected, the duration of the blood flow interruption, and how soon the person receives medical treatment. Strokes affecting a large area of the brain, such as the brainstem, are more likely to be fatal. Massive strokes that affect multiple areas of the brain also have a higher chance of fatality.

Early medical care, ideally within 3 hours of the first symptom, is crucial for increasing the chances of survival and preventing complications such as hemiparesis (weakness on one side of the body) and changes in behavior and personality. Treatment typically focuses on restoring blood flow to the brain and may include medication to dissolve clots and surgery to remove clots or repair damaged blood vessels.

People who have strokes while asleep may have an increased risk of complications and death due to delayed treatment. It is estimated that 20% of ischemic strokes happen during sleep. Recognizing the signs of a stroke, such as facial drooping, weakness in the arm, and slurred speech, is crucial, and emergency services should be called immediately if symptoms are noticed.

Carbon monoxide poisoning

Carbon monoxide is a silent killer, an invisible, odourless, and tasteless gas that can seep into spaces and claim lives without warning. It is produced by the incomplete combustion of carbon-rich fuels, from wood to gasoline, and finds its opportunity in various scenarios, from forest fires to boat engines. While carbon monoxide does not directly poison tissues, it kills primarily through a form of chemical suffocation. The gas binds with the proteins in our blood that transport oxygen, such as hemoglobin, and its bond is approximately 200 times stronger than that of oxygen. As a result, carbon monoxide displaces oxygen from the bloodstream, leading to fatal heart failure and respiratory arrest.

The insidious nature of carbon monoxide is exacerbated by the fact that initial exposure may manifest as common ailments like headaches, dizziness, and nausea, which can be easily mistaken for other conditions. However, as carbon monoxide levels rise, individuals may experience more severe symptoms, including an irregular heartbeat. When individuals are asleep or intoxicated, they are particularly vulnerable, as they may not exhibit any symptoms at all before succumbing to carbon monoxide poisoning.

The dangers of carbon monoxide are evident in numerous tragic incidents. For example, an elderly couple from Washington state perished from carbon monoxide poisoning while staying at a hotel in Boone, North Carolina. Just two months later, an 11-year-old boy, Jeffrey Williams, and his mother suffered the same fate in the same hotel room due to a leaky pool heater. Similarly, a Wisconsin man died in his sleep when a basement generator leaked carbon monoxide, and a young Indiana couple lost their lives after leaving a car running in their garage overnight. These incidents underscore the critical importance of carbon monoxide detectors, which can provide early warning and potentially save lives.

To prevent carbon monoxide poisoning, it is essential to be vigilant and proactive. Carbon monoxide detectors, which are relatively inexpensive, can be installed in homes and hotels to provide an early alert. Additionally, regular maintenance and proper installation of gas-burning appliances and engines are crucial to mitigate the risk of carbon monoxide leaks. By taking these precautions, we can reduce the number of preventable deaths caused by this silent and deadly gas.

Overdose

Drug overdose is a leading cause of death, with over 100,000 people in the US alone dying from drug-related overdoses each year. This figure has been increasing, with 107,941 drug overdose deaths reported in 2022, up from 101,000 in 2019.

The risk of overdose is particularly high for those taking sleeping pills, which are classified as "sedative hypnotics". These pills slow down the functions of the body and are highly addictive. Sleeping pills are widely used, with 50-70 million Americans suffering from sleeplessness and 4% using medication to aid sleep.

The likelihood of overdose increases when sleeping pills are taken with other substances, such as opioids or alcohol. Mixing sleeping pills with alcohol can cause the person to stop breathing, which may result in death. It is also possible to overdose on sleeping pills alone, with a dose of 60-90 times the recommended amount likely to cause an overdose.

The signs of a sleeping pill overdose include extreme lethargy, abdominal pain, breathing difficulties, and clumsiness. If you suspect someone has overdosed on sleeping pills, call emergency services immediately. While waiting for paramedics to arrive, place the person in the coma position and check their airway is clear and that they are breathing regularly. If there is no pulse, start CPR and inform the ambulance that the person is in cardiac arrest.

If the person is admitted to hospital, they will be closely monitored, usually in the intensive care unit. Treatment may include activated charcoal to absorb the excess drug, medication to move the drug through the urinary tract or bowel, IV fluids, a respirator, dialysis, and medication to stabilise heart function.

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