Evie Summers
Many people have shared their experiences of waking up in the middle of the night, feeling like they are dying. This phenomenon can be attributed to various factors, including sleep disorders, sleep deprivation, and even the body's natural response to approaching death. Some individuals wake up suddenly, feeling disconnected from themselves, while others experience violent shaking, a sense of doom, or the urge to walk around or sit up. These episodes can be terrifying and may lead to individuals seeking comfort or reassurance. In some cases, individuals may experience sleep apnea, sleepwalking, or parasomnias, which can result in abnormal movements and behaviours during sleep. While the exact causes vary, it is important to recognise that these experiences are not uncommon and can be improved by finding ways to relax and seeking medical advice if necessary.
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What You'll Learn
Sleep disorders and parasomnias
There are three groups of parasomnias based on the stage of sleep they affect: non-rapid eye movement (non-REM) sleep, rapid eye movement (REM) sleep, and those that occur during any sleep stage or during the transition into or out of wakefulness. REM parasomnias usually appear alongside an underlying neurological or degenerative brain condition and affect people during adulthood. Non-REM parasomnias tend to be more common in children and can be associated with neurological or psychiatric health conditions such as epilepsy, ADHD, or developmental challenges.
Some examples of parasomnias include sleepwalking (somnambulism), night terrors, nightmares, sleep-related eating disorder, sexsomnia, REM sleep behaviour disorder (RSBD), sleep enuresis (bedwetting), sleep-related groaning (catathrenia), and exploding head syndrome. While parasomnias can cause abnormal movements and behaviours, it is rare for them to result in fatal physical injuries. However, in some cases, parasomnias can lead to dangerous situations, such as walking into traffic or engaging in self-injury.
In addition to parasomnias, there are other sleep disorders that can impact an individual's quality of sleep. For example, an individual may experience exhaustion due to a lack of sleep or napping during the day, as described in a personal account. Sleep quality and quantity are essential for overall health and well-being. Disturbed sleep can also be a symptom of various conditions, such as sleep apnea, restless leg syndrome, or chronic pain.
While dying in one's sleep is a common fear, it is important to understand the process of death and the factors that contribute to it. The timeline of death varies depending on an individual's health, treatments, and the cause of death. For example, sudden cardiac arrest or respiratory failure can lead to death within minutes, while chronic conditions may result in a longer dying process. During death, the body's vital functions, such as heart function, breathing, and brain activity, cease entirely.
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Nightmares and seizures
In a study of 20 patients with temporal lobe epilepsy (TLE) and parasomnia, 14 experienced recurrent nightmares that included content reminiscent of daytime seizures. These nightmares evoked intense negative emotions, an unexplained sense of dread, and fear. The nightmares were associated with epileptic discharges during sleep, and parasomnia remission was observed after therapy. This suggests a link between nightmares and seizures.
Additionally, some patients with epilepsy have reported subjective feelings associated with seizures as a component of their dreams. In one case, a patient with sleep-related hypermotor epilepsy described being awakened by a nightmare in which he violently struggled against attackers. This suggests that motor symptoms and cognitive experiences related to seizures can be incorporated into dreams.
Furthermore, a study by Bentes et al. (2011) found that 71% of drug-resistant TLE patients undergoing video-EEG recordings reported dreams, but their dream recall frequency was lower than that of healthy controls. This indicates a potential relationship between epilepsy and dreaming, with seizures possibly influencing dream content and frequency.
While the causes of parasomnias are often unknown, they can create unsafe conditions, such as sleepwalking, and may lead to dangerous behaviours. If a patient's sleep event poses a safety risk, they should consult a doctor and may be referred to a sleep specialist.
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Death by chronic illness
During the final stages of a chronic illness, the person's breathing patterns may become unpredictable, with longer periods without breathing. They may also experience a build-up of saliva in the back of their throat, which can cause a rattling sound when they breathe. Their sleep patterns may be disrupted, with sudden bursts of energy or restlessness following long periods of sleep. They may also experience changes in their sensory perception, such as differences in how they process sounds, sights, and smells.
As death draws near, the person may drift in and out of consciousness, similar to being in a coma or dream-like state. They may wake up briefly but will sleep more as their body becomes too weak to stay active. Touch and hearing are believed to be the last senses to go, so it is important for loved ones to continue speaking to and touching the person as they enter this final stage.
Chronic illnesses, such as heart disease, cancer, diabetes, and chronic lung disease, are often treatable, and these treatments can prolong the dying process, making it easier to recognize the signs that death is approaching. However, despite advancements in medicine, chronic illnesses remain the leading cause of death and disability worldwide, with high economic costs due to healthcare expenses and loss of workforce productivity.
While the idea of dying in one's sleep may evoke a sense of peace and tranquility, the reality of death by chronic illness involves a gradual decline and a series of physical and mental changes. Understanding these changes can help caregivers and loved ones provide comfort and support during this challenging time.
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Traumatic brain injuries
The effects of a TBI can be immediate or develop gradually over time. Some signs and symptoms of mild TBI include sensory problems, such as blurred vision, ringing in the ears, a bad taste in the mouth, or changes in the ability to smell. More serious TBIs can result in bruising, torn tissues, bleeding, and other physical damage to the brain, leading to long-term complications or death. In children, symptoms of TBI may include headaches, sensory problems, confusion, and behavioural changes.
Some TBIs are considered primary, meaning the damage is immediate and sudden. Others are secondary, meaning they occur gradually over time after the initial injury. Secondary brain injuries are caused by reactive processes that occur after the head trauma, such as the hemorrhagic progression of a contusion (HPC), which can lead to brain cell loss and swelling.
The most common causes of TBI include falls, vehicle-related collisions, violence, and sports injuries. Falls are the leading cause of TBI overall, particularly in older adults and young children. Vehicle accidents, including car, motorcycle, and bicycle collisions, are also a frequent cause, as are violent assaults and gunshots. Shaken baby syndrome, resulting from violent shaking, is a type of TBI seen in infants.
The impact of a TBI can be severe and may result in permanent disability or death. Post-traumatic dementia (PTD) and chronic traumatic encephalopathy (CTE) are progressive neurological disorders that can arise from severe TBIs and lead to problems with thinking, understanding, communicating, and movement. Epilepsy is also more likely to develop after a severe or penetrating brain injury, with seizures occurring immediately or within the first year after the injury.
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Sleepwalking and sleep talking
Sleep-walking and sleep-talking episodes can involve routine activities such as sitting up in bed or walking to the bathroom, or more extreme behaviours such as getting in a car and driving. Sleep-related eating and other complex activities may also occur, to the surprise of the individual the next morning. Sleepwalking can be triggered by various factors, including genetics, sleep deprivation, medications, stress, fatigue, illness, alcohol use, and physiological stimuli such as a full bladder. It is more common in children and tends to diminish as they grow older.
For habitual sleepwalkers, it is important to modify the sleeping environment to reduce the risk of injury. This includes ensuring that all doors and windows are locked, sharp objects are secured, and the risk of tripping and falling, especially down stairs, is minimised. While sleepwalking can be a source of humour, it is important to recognise that it can be a sign of an underlying sleep disorder or other health issue. If you or someone you know is experiencing frequent or intense episodes of sleepwalking or sleep talking, it is recommended to consult a healthcare professional for advice and potential treatment options.
In some cases, sleepwalking and sleep talking can be symptoms of a more serious condition known as REM sleep behaviour disorder (RBD). RBD occurs when the mechanism in the brain that paralyses muscle movements during REM sleep malfunctions, allowing individuals to act out their dreams. These dreams are often violent and intense, and individuals may engage in dangerous behaviours such as running, playing sports, or lecturing, which can result in injuries. RBD has been linked to rare forms of dementia and Parkinson's disease, and its symptoms can predate Parkinson's by several years.
While dying in one's sleep is often peaceful and painless, it can be preceded by signs and symptoms. For example, sudden bursts of energy or restlessness after long periods of sleep, changes in sensory perception, unpredictable breathing patterns, and severe brain trauma can all indicate that death is near. Additionally, certain conditions, such as heart disease, chronic lung disease, and cancer, can prolong the dying process, making it easier to recognise the signs that death is approaching. Understanding the signs of death and seeking medical attention when necessary can help ensure a person's comfort and peace during their final moments.
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Frequently asked questions
There are several reasons why people die in their sleep. Some of the most common causes of nocturnal death include sudden cardiac arrest, heart attack, heart arrhythmia, congestive heart failure, and stroke. Other causes include respiratory failure, seizures, and choking.
During death, the body's vital functions stop entirely. The heart stops beating, breathing stops, and brain function ceases. However, studies suggest that brain activity may continue for several minutes after death. Death can be a gradual process, with the body undergoing a series of changes as it transitions into unconsciousness and eventually, death.
There are several signs that may indicate someone is dying in their sleep. These include sudden bursts of energy or restlessness following long periods of sleep, changes in sensory perception, and unpredictable breathing patterns. Additionally, sleep disorders such as sleepwalking, nightmares, and parasomnias can also be indicators.
