When we think about our own mortality, dying in old age often seems to be the least frightening and probably painless route for many of us.
But dying in your sleep can happen at any age, often representing a huge shock to friends and family and leaving many questions unanswered.
So why exactly do people die in their sleep? Are such deaths preventable?
Research suggests that too much or too little sleep is associated with a higher overall mortality risk, but there is no clear evidence that the amount of sleep contributes to sleep death.
Most people who die in their sleep do so due to general health problems, experts say, and in some cases it is possible to reduce the risk of dying during the night.
“Dying in sleep is usually related to the heart, lungs or brain,” said Dr. Milind Sovani, respiratory medicine consultant (pulmonologist) at Nottingham University Hospitals NHS Trust in the UK news week. “Occasionally, people with diabetes can die from low glucose levels while they sleep.”
Sometimes more complicated conditions are a factor, says Sovani, adding that a young male patient in his thirties recently died in his sleep from Pompe disease, a glucose storage disorder that causes muscle weakness and difficulty breathing.
More commonly, however, conditions that lead to nocturnal deaths can be treated to reduce the risk.
Risk factors and health maintenance
The supine position – lying on the back – that many people assume when they sleep can affect lung volume, Sovani says, adding that nighttime breathing is also affected by conditions like diaphragm paralysis – the muscle that controls breathing can.
Neurological diseases such as epilepsy can also pose risks.
People with refractory epilepsy are more prone to a syndrome called Sudden Unexpected Death in Epilepsy (SUDEP), which is thought to be caused by seizures that affect the respiratory, heart, and electro-brain functions of the body.
Research results published in 2018 in Borders in Neurology found that SUDEP was more likely to occur at night or early in the morning.
Likewise, uncontrolled high blood pressure can increase the risk of stroke, which can be fatal and occur during sleep.
Other conditions that tend to worsen during the night include heart failure and sleep apnea, which cause breathing to start and stop during sleep.
According to a 2017 study from the Cleveland Clinic, people with obstructive sleep apnea, a form of the condition, are more than 2.5 times more likely to experience sudden cardiac death between midnight and 6 a.m.
The study also found that people over the age of 60 were at a higher risk of sudden cardiac death.
Although mild forms of the condition don’t always need treatment, more severe cases can be treated with a device known as a CPAP machine, which pumps air into a mask the sleeper wears over the mouth or nose at night.
Other heart conditions, such as arrhythmias or abnormal heart rhythms, can also be dangerous if left untreated, Sovani says. People with these disorders are often equipped with implantable pacemakers or defibrillators; The former uses pulses to make the heart beat at a normal rate, while the latter monitors the heart rhythm and delivers a shock if it detects dangerous ones.
Chronic conditions such as high blood pressure, diabetes, and obesity can contribute to poor overall health and increase the likelihood of complications. Managing these conditions and maintaining a healthy lifestyle can help reduce the risks.