Miya Pearson
Many people fear death, and it's natural to want to know what to expect. While dying in your sleep is often seen as peaceful, there are still specific causes, and it's important to understand the mechanics. There are many reasons why someone might die in their sleep, including sleep apnea, cardiac arrest, heart attack, stroke, and seizures. Some people may choke in their sleep due to vomiting after a seizure or from falling asleep with food in their mouth. Sleep disorders such as sleepwalking can also lead to dangerous and deadly situations. As death approaches, you may drift in and out of consciousness, with touch and hearing being the last senses to go. Your breathing patterns can signal how close you are, with unpredictable breathing being a sign of failing health or death.
| Characteristics | Values |
|---|---|
| Cause of death | Sleep apnea, cardiac arrest, heart attack, stroke, epilepsy, hypoglycemia, carbon monoxide poisoning, choking |
| Symptoms before death | Unpredictable breathing, extended periods without breathing, saliva build-up in the throat, sudden bursts of energy, restlessness, frustration with caregivers |
| Physical characteristics | Drop in body temperature, cold or clammy skin |
| Mental characteristics | Inability to sleep to recharge, dreaming |
| Risk factors | Sleepwalking, REM behavior disorder, status dissociatus, parasomnias, untreated obstructive sleep apnea, age (over 60), severe apnea, very low oxygen levels |
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What You'll Learn
Sleep apnea
OSA can be diagnosed through a sleep study, where a healthcare provider monitors brain signals, heart rate, and breathing. The test records if and when a person's breathing is restricted, and the results are used to calculate the apnea-hypopnea index (AHI), which measures the number of breathing disruptions per hour.
OSA can be treated with positive airway pressure (PAP) therapy, such as CPAP, which uses a special mask to direct pressurised air into the airway to keep it open during sleep. Oral appliances and upper airway surgery are also treatment options for OSA.
Untreated OSA has been linked to an increased risk of death. It can exacerbate other medical conditions, such as strokes, heart attacks, heart failure, and arrhythmias, which can result in sudden death. OSA can also interfere with the normal functions of the cardiovascular and nervous systems, leading to abnormalities in heart rhythms and other problems that can cause sudden cardiac death. Research suggests that the risk of mortality in people with OSA may be linked to the severity of their breathing disruptions.
Observational research has found that OSA increases a person's risk of sudden death, especially in older individuals, those with critical illnesses, and those with severe OSA. However, one study found no statistically significant differences in mortality between individuals with OSA and those without, and no OSA patients in the study died in their sleep.
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Choking
Another cause of choking in sleep is Gastroesophageal Reflux Disease (GERD), where stomach acid flows back into the oesophagus, causing irritation, swelling, and symptoms such as heartburn, regurgitation, and coughing or choking while sleeping. Choking due to GERD can indicate a serious medical condition and should be evaluated by a healthcare professional. It is recommended to seek medical advice and follow a GERD diet to manage the condition and reduce the risk of choking.
Certain lifestyle factors can also contribute to choking in sleep. For example, smoking can increase the risk of choking by causing swelling in the airways and affecting lung function. Losing weight, particularly around the neck, can also help reduce the risk of OSA and GERD, strengthening throat muscles and improving symptoms. Additionally, positional therapy or the use of positional sleep apnea devices can help encourage side sleeping, reducing the likelihood of choking episodes.
In some cases, choking in sleep can be caused by vomiting during a nighttime seizure or after excessive alcohol consumption. It can also occur if an individual falls asleep with food or a throat lozenge in their mouth, accidentally inhaling it. Seeking medical attention and making necessary lifestyle changes can help address these underlying causes and reduce the risk of choking during sleep.
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Strokes
A stroke, or a "wake-up stroke", can occur during sleep. A stroke happens when a blocked artery prevents blood from flowing to the brain, or a blood vessel in the brain leaks or ruptures. This is known as an ischemic stroke, caused by blocked blood flow in the brain, or a hemorrhagic stroke, caused by bleeding in the brain.
Wake-up strokes are not technically different from other strokes, but they can be more dangerous because treatment is delayed while the person is sleeping. Studies have shown that between 8% and 28% of strokes occur during sleep, with some studies suggesting that this figure may be even higher. Wake-up strokes may account for a quarter of all stroke cases, if not more. A 2019 study found that wake-up strokes accounted for roughly a third of all stroke cases, while a 2022 study found that 19% of strokes were wake-up strokes.
The time of onset of a wake-up stroke is unknown, which can delay emergency medical treatment and exclude survivors from typical stroke treatments. The symptoms of a wake-up stroke are the same as those of a stroke that occurs during the day, but they are not noticed until the person wakes up. These symptoms include weakness, vision loss, dizziness, incontinence, or confusion. If you or someone close to you is experiencing these symptoms, it is important to seek medical attention as soon as possible.
Certain health conditions can increase the risk of having a stroke, including high blood pressure, high cholesterol, diabetes, atrial fibrillation, and obstructive sleep apnea. Obstructive sleep apnea is a condition that causes breathing disruptions during sleep, and it is believed that the low oxygen levels associated with this condition may increase the risk of stroke.
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Sleep disorders
Sleep is essential for keeping us healthy. When we sleep, our brain works with our body to support itself, so we feel awake and energised when we wake up. However, sleep disorders can hinder this process and adversely affect health and longevity. There are around 90 distinct sleep disorders, most marked by symptoms such as excessive daytime sleepiness, difficulty falling asleep, or maintaining sleep.
One such sleep disorder is fatal insomnia, a rare neurodegenerative prion disease that results in insomnia as its primary symptom. The condition is fatal within a few months to a few years, and there is currently no known cure or treatment. The disease is characterised by a worsening of insomnia, leading to panic attacks, paranoia, and phobias. As the disease progresses, the person becomes stuck in a state of pre-sleep limbo, or hypnagogia, during which people commonly and repeatedly move their limbs as if they were dreaming. Other symptoms include profuse sweating, pinpoint pupils, sudden menopause or impotence, neck stiffness, and elevated heart rate and blood pressure. The cause of death for people diagnosed with fatal insomnia is brain and nervous system damage caused by prion proteins accumulating in the thalamus.
Obstructive sleep apnea (OSA) is another sleep disorder that can increase the risk of choking in your sleep and exacerbate other medical conditions that may ultimately be fatal, such as strokes, heart attacks, heart failure, and abnormal heart rhythms (arrhythmias). Untreated OSA can also lead to problems with concentration and decision-making, impair memory, and increase the risk of errors and accidents. Diagnosis and treatment of OSA often involve the use of nighttime breathing devices like continuous positive airway pressure (CPAP) machines to improve breathing and normalise oxygen levels.
Parasomnias are another group of sleep disorders that can lead to dangerous behaviours during sleep, such as sleepwalking, acting out dreams, or intense motor activity. While rare, these disorders can result in fatal outcomes if the sleeping person unknowingly engages in hazardous activities, such as walking into traffic or self-harm. Treatment options and safety measures, such as locking windows and removing sharp objects from the bedroom, can effectively prevent adverse outcomes.
Additionally, certain health conditions, such as type 1 diabetes, can lead to nocturnal death, especially in younger people under 50. Even with vigilant management of sugar levels during the day, individuals with type 1 diabetes can experience seizures or death during sleep due to hypoglycemia (low blood sugar).
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Heart attacks
Sudden cardiac death accounts for 15 to 20% of deaths worldwide, with almost a quarter of these events occurring at night. A heart attack, also known as myocardial infarction, occurs when a blood vessel supplying the heart muscle becomes obstructed and the tissue supplied is damaged or dies. A massive heart attack can reduce blood flow to the part of the brain that controls breathing, leading to respiratory arrest. The charge required to fire off heart muscle in a synchronized way can become disrupted, with contractions becoming irregular, too fast, or too slow, compromising the heart's pumping effectiveness.
It is important to recognize that the symptoms of a heart attack can vary between individuals, and in some cases, a person may experience a silent heart attack with mild or atypical symptoms. Warning signs that should not be ignored include chest pain or discomfort, palpitations, breathlessness during activity, and heightened fatigue. Seeking medical attention promptly is crucial, as quick treatment to restore blood flow is essential for minimizing damage to the heart muscle.
To lower the risk of experiencing a heart attack during sleep, it is advisable to follow a healthy routine, take prescribed medications, and make necessary lifestyle adjustments. Regular moderate to intense workouts, a balanced diet rich in protein and fiber, sufficient sleep, and stress-reducing practices like meditation can all contribute to a healthier cardiovascular system. Additionally, paying attention to how you feel and seeking medical evaluation for any concerning symptoms is vital for early detection and intervention.
In summary, heart attacks can occur during sleep and pose a serious risk to individuals with underlying cardiovascular conditions or unhealthy lifestyle habits. By recognizing risk factors and symptoms, seeking prompt medical attention, and adopting heart-healthy practices, the chances of experiencing a heart attack while asleep can be reduced.
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Frequently asked questions
There are many causes of dying in your sleep, including sleep apnea, cardiac arrest, heart attack, stroke, epilepsy, and carbon monoxide poisoning.
Some signs that someone is dying in their sleep include unpredictable breathing patterns, extended periods of rest, and a buildup of saliva in the back of the throat, causing a rattling sound when breathing.
Risk factors for dying in your sleep vary and include sleep apnea, type 1 diabetes, heart disease, and epilepsy.
Treatments for sleep apnea include lifestyle changes, such as weight loss and avoiding alcohol, as well as oral appliances and, in some cases, upper airway surgery.
It is generally believed that dying in your sleep is peaceful and without pain. However, the process of dying can involve heightened sensory perception and restlessness.
